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: ace inhibitors / sulfa (sulfonamide antibiotics) / fish product derivatives attending: chief complaint: angioedema major surgical or invasive procedure: intubation, mechanical ventilation history of present illness: 87 yo female with pmh atrial fibrillation on coumadin, htn on lisinopril , hl, eczema, recent drermatologic rashes, and recent facial/lip swelling presenting with new tongue swelling this am. pt called daughter around 10:45 am and speech sounded garbled and pt complained of new swollen tongue. she took 1 tab of benedryl this am and called her pcp who referred her to the ed. of note per her family pt had episodes of ichy skin this summer and was seen by dr. in dermatology. family also reports facial and periorbital swelling on and off since of unknown etiology. some family members report voice sounding funny on and off. also 2 wks ago had significant swelling of the lips that was thought to be associated with eating pineapple. she took benadryl for several days with improvement and had appointment with allergist for later this month. . pt took benedryl 25mg po at home and received 50mg iv in the ambulance. in the emergency department on arrival vitals were t98.2 hr73 bp139/65 rr16 98% ra. the patient had significant tongue swelling and was difficult to understand. the decision was made to intubate the patient due to difficulty speaking. ekg was done and reported to have mild depressions in inferior leads. in the ed he received solumedrol 125mg iv x1, pepcid 20mg iv x1, versed 2mg iv prn sedation. vss stable on transfer. . unable to obtain ros given pt intubated. family reported pt recently feeling well except for hpi. past medical history: atrial fibrillation hypertension hyperlipidemia osteoporosis osteoarthritis s/p right hip replacement eczema hayfever as a child social history: lives at an independent living facility. walks with walker and is very active and does exercise program. never smoker. 1 glass wine per week. no illicits. family history: -1st cousin with peanut allergy developed in his 80s. -no fh of asthma or eczema physical exam: physical exam on admission: t 97/8 bp 147/61 hr 78 rr 20 o2 100% ra general: sedated, arousable, able to open eyes on command but no squeeze hands heent: markedly swollen tongue unable to visualize back of throat. no facial or periorbital swelling. normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla. mmm. cardiac: irregular rhythm. no murmurs, rubs or . no jvd. lungs: ctab, good air movement bilaterally anteriorly. abdomen: +bs. soft, nt, nd. no hsm extremities: no edema, 2+ dorsalis pedis and radial pulses. skin: + macular papular rash with excoriations on right back and hip. neuro: sedated, arousable, able to open eyes on command but no squeeze hands pertinent results: labs on admission: . 12:30pm blood wbc-11.6* rbc-4.10* hgb-12.4 hct-37.1 mcv-91 mch-30.2 mchc-33.4 rdw-12.9 plt ct-266 12:30pm blood neuts-69.0 lymphs-24.5 monos-4.6 eos-1.6 baso-0.4 12:30pm blood plt ct-266 05:45pm blood pt-27.3* ptt-30.3 inr(pt)-2.7* 12:30pm blood glucose-118* urean-28* creat-1.0 na-143 k-5.4* cl-109* hco3-21* angap-18 12:30pm blood calcium-9.2 phos-3.1 mg-2.1 . labs during admission 04:55am blood pt-38.8* ptt-30.9 inr(pt)-4.0* 04:55am blood esr-28* 04:55am blood alt-32 ast-48* 04:55am blood tsh-0.096* 04:55am blood t3-pnd free t4-1.4 04:55am blood anti-tg-pnd antitpo-pnd 05:45pm blood c4-43* . cardiac enzymes: 12:30pm blood ck(cpk)-92 05:45pm blood ck(cpk)-57 04:00am blood ck(cpk)-43 12:30pm blood ck-mb-3 ctropnt-<0.01 05:45pm blood ck-mb-3 ctropnt-<0.01 04:00am blood ck-mb-2 ctropnt-<0.01 . ekg (): atrial fibrillation, average ventricular rate 81. right bundle-branch block. diffuse non-diagnostic repolarization abnormalities. no previous tracing available for comparison. . cxr (): endotracheal tube as above. for optimal placement, consider retraction by approximately 1 cm. a tortuous aorta with cardiomegaly and no signs of failure. . 07:20am blood wbc-11.8* rbc-4.42 hgb-13.6 hct-39.5 mcv-89 mch-30.7 mchc-34.4 rdw-12.2 plt ct-258 07:20am blood pt-25.8* inr(pt)-2.5* 07:20am blood glucose-125* urean-23* creat-0.9 na-138 k-3.5 cl-98 hco3-27 angap-17 04:55am blood alt-32 ast-48* 04:55am blood tsh-0.096* 04:55am blood t3-pnd free t4-1.4 04:55am blood anti-tg-pnd antitpo-pnd 05:45pm blood c4-43* 04:55am blood cu index (anti-fcer1 antibody)-pnd 05:45pm blood c1 inhibitor-pnd brief hospital course: 87 yo female with pmh atrial fibrillation on coumadin, htn on lisinopril , hl, eczema, recent drermatologic rashes, and recent facial/lip swelling, who presented with new tongue swelling and s/p intubation in the ed. each of the problems addressed during this hospitalization are described in detail below: . angioedema: the patient was intubated in the ed as was having trouble talking secondary to tongue swelling and was tranferred to icu for further care. although pt with recent facial and lip swelling on and off since end of , this was first episode of tongue swelling. the patient also noted to have had hay fever as child. allergies to fish and sulfa but no exposure recently. of note, the patient was also recently followed by dermatologist for rash. because of the high degree of suspicion that this was caused by lisinopril, this medication was dicontinued and added to the list of allergies. the patient was continued on benadryl 50mg iv q6hrs, iv methylprednisolone 80mg q8hrs, pepcid 20mg iv bid, fexofenadine. the morning after admission, the patient was successfully extubated as the swelling had significantly improved. the patient had no further episodes of facial or tongue swelling, difficulty breathing while in the icu. the patient was seen by allergy service, who will follow up the patient as outpatient. as part of workup for allergy, c4 levels were normal, c1 inhibitor levels, tsh, thyroglobulin antibody, cu index (anti-fcer1 antibody), anti-tpo antibody, sed rate, rast, and rast for pineapple, flounder, cod, haddock, salmon. the tsh was 0.096 and free t4 was 1.4. the t3 was pending. the patient was switched to po prednisone, h2 blocker, and antihistamine. she will continue prednisone 40mg daily, as well as her h2 blocker and antihistamine until follow up with allergy to decide a taper. . low tsh: tsh was 0.096 with free t4 of 1.4. t3, antitpo, antitg pending at discharge. by review of systems and exam, there was no evidence of thyroid dysfunction. the case was discussed with endocrinology, who felt her low tsh was a result of her recent high dose steroids, vs sick euthyroid syndrome, unlikely contributing to her angioedema in the setting of her lisinopril. her tfts should be rechecked in weeks, and her pending results followed up. . ekg changes: on admission, the patient was noted to have st depression in inferior leads from ekg in ed. no ekg was available for comparison. no aspirin as given on admission given angioedema. the patient had 3 sets of negative cardiac enzymes. she had no symptoms concerning for acs. we continued home metoprolol and zocor. . hypertension: lisinopril was discontinued due to angioedema. we continued home amlodipine and metoprolol. she was started on hydralazine for a third hypertension . her bp stabilized and she was discharged on higher dose metoprolol (50mg ) as well as her amlodipine. . eczema: we continued outpatient triamcinolone topical 0.1% 1 app qid . hyperlipidemia: we continued zocor. . atrial fibrillation: inr was theraputic an arrival. coumadin was re-started on the morning of extubation. inr then became supertherapeutic to 4 and coumadin was held. on the day of discharge her inr was 2.5. her home warfarin was resumed and her inr should be rechecked on and adjusted accordingly. . osteoporosis: home calcium and vitamin d were re-started in the morning after extubation. patient receives fosamax q wednesday. . medications on admission: coumadin 2.5 mg 1 tab mwf;1/2tab all other days metoprolol 50 mg tab am; 1 tab pm claritin 10 mg 1 tab(s) once a day triamcinolone topical 0.1% 1 app qid norvasc 10 mg 1 tab(s) once a day calcium and vitamin d combination 600 mg-200 units 1 tab(s) tid fosamax 70 mg 1 tab(s) 1x/w lisinopril 10 mg 1 tab(s) once a day zocor 20 mg 1 tab(s) once a day (at bedtime) discharge medications: 1. simvastatin 10 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 2. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 3. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 4. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 5. prednisone 20 mg tablet sig: two (2) tablet po daily (daily): to continue until your allergist appointment. do not stop this medication abruptly. disp:*60 tablet(s)* refills:*0* 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 8. triamcinolone acetonide 0.1 % ointment sig: one (1) appl topical qid (4 times a day) as needed for itchiness: apply to affected area. 9. alendronate 70 mg tablet sig: one (1) tablet po qwed (every wednesday). 10. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 11. warfarin 2.5 mg tablet sig: one (1) tablet po daily (daily): please resume your normal coumadin dosing and check your inr on . discharge disposition: home discharge diagnosis: angioedema secondary to ace inhibitor atrial fibrillation hypertension, benign sublcinical hyperthyroidism eczema discharge condition: good discharge instructions: you were admitted with swelling of the tongue (angioedema), and were briefly intubated to protect your airway. with steroids and anti-inflammatory medication, you condition improved. this was most likely caused by your lisinopril. please do not take this medication or similar medications (ace inhibitors) in the future. you ill be prescribed anti-inflammatory medications to treat your condition. . it is very important that you follow up with the allergist on , to decide a taper of your prednisone and to identify a cause. . your thyroid test was abnormal, which may be a false value. you will need your thyroid tests checked in weeks to further assess this value. . resume all medications as prescribed. your metoprolol has been increased to 50mg twice daily. please resume your coumadin and recheck your inr on . return to the hospital with recurrent lip/tongue swelling, shortness of breath, or any other concerning symptoms. followup instructions: allergist appointment provider: , phone: date/time: 2:00 . please follow up with pcp: , i. , in weeks procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: atrial fibrillation other and unspecified hyperlipidemia osteoporosis, unspecified long-term (current) use of anticoagulants osteoarthrosis, unspecified whether generalized or localized, site unspecified angioneurotic edema, not elsewhere classified benign essential hypertension contact dermatitis and other eczema, unspecified cause other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use thyrotoxicosis of other specified origin without mention of thyrotoxic crisis or storm 

Answer: The patient is high likely exposed to