Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: chief complaint: hypotension and melena major surgical or invasive procedure: splenic artery embolization history of present illness: 38 y/o m referred from osh for evaluation of melena and unknown gastric lesion. his symptoms started 3 days prior to admission, when he noted feeling lightheaded with doing regular daily activities. he also noted elevated glucose in 400's. he thinks he began noticing black stools later that evening, which he describes as "coffee-ground" stools. the following day he layed in bed all day, noting increasing orthostasis and continued black bm's. he also noted associated doe and sob with even minimal activity. he denies any abdominal pain, but notes mild feelings of nausea with no vomiting. on further ros he notes some subjective fevers/chills and mild nonproductive , but his wife did not note a fever at home. he notes decreased po intake and decreased urine output as well. . he presented to his pcp with these who noted at hct of 35 but pale appears with a bun/cr of 92/2.6 and sbp 80's-90's with hr ~100. he was referred to the ed where he was felt to be severely volume depleted and given several liters of ns and 3u prbc's overnight. am hct was 27.4, and follow-up bun/cr improved to 63/1.4. in addition his sbp improved to 110-120 range. am egd done by dr was notable for a gastric lesion of unclear etiology c/w bleeding leoimyoma vs varix. by report pt had an abdominal u/s notable for a normal portal circulation with a slightly enlarged spleen. he was placed on ppi and somatostatin. after d/w dr he was referred to for further evaluation. . on arrival pt states that he feels much improved compared to arrival to osh. he denies current lh but notes mild thirst. on further history he states that he normally takes tylenol pm to sleep, but ran out tylenol pm about 1 week prior to his symptoms. he started taking 2 of motrin at night in an attempt to help him sleep, which he does not usually take. past medical history: 1. diabetes mellitus (previously type 2 diagnosed several weeks before developing severe pancreatitis, insulin depended but no h/o dka) 2. h/o pancreatitis in , requiring a 4 week hospitalization and s/p cholecystectomy social history: pt works in a senior position for a plastics company; he notes a long h/o exposure to chemicals. he has smoked ~1ppd x 3-4 years, was able to quit for 3-4 weeks but then restarted. he notes occasional etoh use, notes 2 beers a night the past few nights which is unusual for him. denies h/o ivda. lives with his wife and 3 daughters. family history: father: dm mother: htn sister: died of cervical cancer another sister: thyroid cancer physical exam: vs: t=99.3, bp=113/54, hr=81, rr=14, o2=97% on ra gen: pt resting comfortably in nad heent: nonicteric, mucosa moist, no lad chest: cta bilaterally cv: rrr, no murmers abd: soft, obese, nt, nd, prior ccy scar; rectal exam w/o hemorrhoid, with guiac positive black stools ext: no le edema neuro: aao x 3, cn's intact, grossly nonfocal pertinent results: 09:56pm wbc-4.3 rbc-3.39* hgb-11.0* hct-29.1* mcv-86 mch-32.4* mchc-37.7* rdw-14.8 09:56pm plt smr-very low plt count-64* 08:25pm glucose-83 urea n-45* creat-1.3* sodium-143 potassium-4.5 chloride-110* total co2-26 anion gap-12 08:25pm alt(sgpt)-30 ast(sgot)-68* ld(ldh)-201 alk phos-44 amylase-25 tot bili-1.1 08:25pm lipase-13 08:25pm albumin-3.3* calcium-8.0* phosphate-3.4 magnesium-1.2* 08:25pm pt-14.2* ptt-20.5* inr(pt)-1.3* ecg: sinus bradycardia with borderline 1st degree a-v block lateral t wave changes are nonspecific intervals axes rate pr qrs qt/qtc p qrs t 42 214 82 448/386.86 39 48 24 cxr: right costophrenic angle is not included within the film view. the heart size is normal. no mediastinal or hilar enlargement is present. lungs are clear. no pneumothorax or pleural effusion is seen. impression: normal chest x-ray. ct abdomen: 1. occlusion of the splenic vein and a focal area of the superior mesenteric vein leading to venous shunting and significant formation of splenic and gastric varices. the main portal vein and hepatic veins appear patent. no esophageal varices are identified. 2. splenomegaly. 3. 6.8-cm cystic structure with peripheral calcification in the region of the pancreas which may represent a pseudocyst, although a focal mass cannot be entirely excluded. 4. hypoattenuating lesions within the apex of the left kidney which are too small to characterize likely reflecting simple cysts. nonobstructing punctate calculus is also identified within the left kidney. 5. fused left si joint. leni: normal compressibility, augmentation, respiratory variation, where appropriate within the deep veins of the left upper extremity. particularly, the left internal jugular vein, subclavian vein, axillary vein are patent. there is no evidence of subclavian vein thrombosis. venogram: 1) portal venogram demonstrating high-grade stenosis of the superior/proximal superior mesenteric vein (smv), with a pressure gradient of 17 mm hg across the stenosis. 2) multiple large varices; one bypassing the tight stenosis from the inferior portion of the smv to the main portal vein, the remainder draining the extensive gastric variceal system in the left upper quadrant. 3) nonvisualization of the splenic vein and inferior mesenteric vein. 4) after discussion with dr. , a decision was made again stenting or other intervention at this time, and the 23 cm-long, 5-french -tip sheath was left in place with its distal tip in the main portal vein and attached externally to heparinized saline pressure bag. ir guided stent placement: successful placement of 14 x 40 mm smart stent dilated to 12 mm, spanning from the inferior portion of the main portal vein to the superior portion of the smv. post-stent venogram demonstrated good flow throughout the stent and no residual venous pressure gradient. abdominal ultrasound: the portal vein is patent with hepatopetal flow. the smv stent cannot be directly visualized secondary to significant bowel gas. however, the smv is visualized proximal to the stent and flow is patent. since flow is demonstrated proximal and distal to the site of the stent, we infer the stent itself to be patent. impression: inferred patency of smv stent though not directly visualized. brief hospital course: a/p: 38 y/o m referred from osh with recent h/o orthostatis, resoloving arf, and unclear gastric lesion c/w varix or tumor. . 1. gastric lesion/melena - endoscopy revealed multiple isolated gastric varices. as it is unusual to develop isolated gastric varices, splenic vein throbosis must be more closely evaluated in a patient with a known h/o cirrhosis or portal hypertension. after speaking with dr from gi, an abdominal ct was performed on the evening of admission to evaluate for splenic vein throbosis as this would be a superior study to abd u/s. the abdominal ct was read as positive for splenic vein thrombosis with gastric varices as well as splenomegaly. in addition, the abd ct also found from avm in the chest as well concerning for a subclavian stenosis/thrombosis. 3 peripheral ivs (18, 20, 20 gauges) were placed in the pt. the pt was started on supportive management with ivf's, serial hct's, ppi, and somatostatin therapy. as he continued to have brbpr, prbcs and ffp were transfused. gi recommended surgical evaluation for possible splenectomy as there is no gi intervention that would resolve the underlying issue. a swan ganz catheter was floated from the femoral vein to measure the pressures in the portal system to determine if the patient had portal hypertension as well. it showed a gradient of 6 from the hepatic vein to the wedge, which is not consistent with hypertension. surgery was reluctant to intervene as the operative mortality is high (up to 10%) for splenectomy in a patient with multiple collaterals in the mesentary and omentum. instead, a venography was performed which showed a high grade stenosis in the smv. at this point, it was thought that relieving this obstruction could be the definitive therapy for the gastric varices. ir placed a stent in the smv. the patient was not initially anticoagulated as he continued to have blood in his bms. . 2. dm - with the patient's history it is difficult to tell if he is a type ii or if became type i after the onset of severe pancreatitis. glucose management became difficult given his npo status and somatostatin use. he was placed on a sliding scale with lantus 30units qam (55units qam and actos (pioglitazone) at home). this was too high as the patient became hypoglycemic with fs in the 50's since he was npo. he was instead given d50 and the lantus was stopped. 3. arf - given his h/o hypotension at the osh and poor po intake and decreased urine output, his arf appears to be pre-renal in nature. his cr appears to have significantly improved with ivf's and prbc's. his elevated bun is likely related to his ugib. given his dm and recent arf, he was prehydrated him with bicarb and mucomyst prior to iv contrast for his abd ct and for his ir procedures. . 4. hypotension - now resolved, appears to be related to ugib and vokume depletion. given his c/o subjective fevers/chills and nonproductive , check cxr, ua, and bc's to look for evidence of infection as well. above is the brief hospital internal medical note. below is the surgical brief hospital note. upon consult, the patient hct was observed for a few days. a decision was made to embolize the splenic artery, allow the spleen to be infarcted, and have the patient come back to for surgery a few weeks later to remove the spleen as well as an exploratory laparotomy to further evaluate the region around the splenic vein thrombosis. at time of discharged, the patient had been stable for several days without having to require a transfusion. he was discharged in stable condition with specific instructions for post-hospital care, as well as, follow-up. medications on admission: allergies: nkda . medications at admission: 1. ibuprofen prn, 2 tabs at night 2. lantus 55u qam 3. humalog iss 4. actos 15mg qd 5. zetroretic (? antihypertensive) discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed: please do not take while taking percocet. disp:*40 tablet(s)* refills:*0* 2. nicotine 21 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 4. multivitamin capsule sig: one (1) cap po daily (daily). 5. pioglitazone 15 mg tablet sig: three (3) tablet po daily (daily). disp:*14 tablet(s)* refills:*0* 6. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*40 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: bleeding gastric varices superior mesenteric vein thrombosis diabetes mellitus gout discharge condition: good discharge instructions: please call or return if you have fever >101, feel lightheaded, persitent nausea or vomiting, bloody vomiting, have bloody diarrhea or stools, abdominal pain, fatigue, chest pain, shortness of breath, bleeding or drainage around wounds, severe pain, or anything else that causes you concern. please ice and rest your left knee, if it get inflammed or pain worsens please call rheumatology for an appointment - ( please return next week for scheduled surgery. please restart your preadmission medications except for your blood pressure medications followup instructions: please follow up for your vision with the outpatient ophthalmology clinic at . please come in next thursday () for your surgery - dr. office will call you with the time ( procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine angioplasty of other non-coronary vessel(s) pulmonary artery wedge monitoring arthrocentesis insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) other endovascular procedures on other vessels arteriography of other specified sites transfusion of packed cells transfusion of other serum phlebography of the portal venous system using contrast material cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: tobacco use disorder acute posthemorrhagic anemia acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hypotension, unspecified diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled blood in stool compression of vein varices of other sites acute vascular insufficiency of intestine other specified visual disturbances cyst and pseudocyst of pancreas other diseases of spleen chronic congestive splenomegaly papilledema associated with decreased ocular pressure 

Answer: The patient is high likely exposed to