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: no known allergies / adverse drug reactions attending: chief complaint: abdominal pain, hypotension major surgical or invasive procedure: none history of present illness: history of present illness: 57 yo female with esrd on hd (mwf), htn, hcv cirrhosis, hypothyroidism, anxiety, chronic back pain on methadone, called in to complaining of lower right abdominal pain, and referred to the ed. of note, she was recently admitted to the hospitalist service for hypotension. during that admission she was thought to be over medicated, taking nitroglycerin daily instead of prn, over beta-blocked. the patient was found to also be very hypothyroid, with tsh > assay. adrenal insufficiency was ruled out. she was determined to have a dry weight of 74kg. today, she reported to the nurse that her pain started on sunday and radiates to the right side of the umbilicus. she feels this pain was similar to ovarian and renal cysts she had in the past. the pain limits ambulation and po intake. she reports nausea and vomiting x1 today. denies diarrhea, melena, hematochezia, urinary symptoms. last hd yesterday, and per her report her bp dropped to 70/p, hd had to be stopped early. . in the ed, initial vs were: 97.8 87 74/55 18 98% ra. triggered for hypotension on arrival, denies taking any antihypertensives, took methadone at 7am. on exam, she was found to be somnolent, right sided cva tenderness. her labs were significant for lipase of 118, ap 199, alt 47, ast 52, tbili wnl, no leukocytosis, mild thrombocytopenia, inr 1.4, ag of 16, lactate of 2.5 initially and corrected to 1.5 with fluids. cxr showed mild bibasilar atelectasis. ct of the abd showed no acute abd pathology, fibroid uterus, 4-cm r adnexal complex cyst (old), atrophic right kidney, right hemicolectomy, new splenomegaly. received a total of 1.2l ns with only mild improvement in bp to 89 systolic. she then had a r ij placed, with improvement in bp to 104/69 without pressors. she also received vanc/zosyn for ? infection, although unclear source. on transfer to the floor, 77 104/69 12 98% on 2l. . on the floor, the patient continues to complain of right lower abdominal pain that radiates to her right flank and right leg. she reports mental slowing and "not feeling well." past medical history: -htn -esrd on hemodialysis -hcv cirrhosis -spinal stenosis with back pain -seizure disorder -depression -hypothyroidism -substance abuse -lumbar laminectomy -status post failed renal transplant -cholecystectomy -thyroidectomy social history: retired special education teacher. widowed, lives at home with sister, who is primary caregiver. one son, who is healthy. # tobacco: 3 packs per week since teenager # alcohol: denies # drugs: past ivdu, but not in several years family history: father: esrd and hypertension mother: lung cancer physical exam: general: alert, with mildly slow to answer questions, oriented, no acute distress heent: sclera anicteric, mm mildly dry, oropharynx clear neck: rij in place, supple, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: murmur radiates to the graft on the left, no rubs, gallops abdomen: mild ttp of rlq, ruq, distended, soft, +bs gu: no foley ext: rle first two missing large portion of the toenail, granulation tissue present, no purulence. pertinent results: 07:31pm lactate-1.5 06:48pm lactate-1.7 03:33pm lactate-2.5* 03:33pm hgb-11.7* calchct-35 03:20pm glucose-151* urea n-37* creat-6.5* sodium-140 potassium-5.1 chloride-97 total co2-27 anion gap-21* 03:20pm estgfr-using this 03:20pm alt(sgpt)-47* ast(sgot)-52* alk phos-199* tot bili-0.3 03:20pm lipase-118* 03:20pm albumin-4.3 calcium-7.9* phosphate-5.3* magnesium-1.8 03:20pm wbc-5.9# rbc-3.76* hgb-11.4* hct-34.2* mcv-91 mch-30.3 mchc-33.3 rdw-18.1* 03:20pm neuts-61.2 lymphs-29.2 monos-6.0 eos-2.8 basos-0.7 03:20pm plt count-119* 03:20pm pt-16.3* ptt-27.1 inr(pt)-1.4* , imaging: ct abdomen: indication: 57-year-old female with right abdominal and flank pain x few days. comparison: ct from and mr from . technique: helical mdct images were acquired from the lung bases through the greater trochanters without and with intravenous contrast, per the ct urogram protocol. the patient is scheduled for dialysis within the next 24 hours, per discussion with the referring physician, . . 5-mm axial, coronal, and sagittal multiplanar reformats were generated. findings: mild atelectasis is noted at the lung bases. there are no pleural effusions. the heart is normal in size, without pericardial effusion. note is made of a moderate sliding hiatal hernia. abdomen: the liver is mildly heterogeneous with a slightly irregular contour, consistent with known cirrhosis. note is made of a recanalized umbilical vein and mild gastrohepatic varices. the gallbladder is surgically absent. the pancreas is normal. there is no intra- or extra-hepatic biliary ductal dilatation. the spleen is enlarged at 19 cm, previously 15 cm. accessory splenule is noted posterior to the main splenic body. the adrenals are normal. the kidneys are atrophic, but enhance symmetrically. multiple bilateral renal cysts are present. there are no renal stones, masses, or hydronephrosis. stomach is distended with retained oral contents. note is made of a diverticulum arising from the second portion of the duodenum. the small bowel demonstrates a slightly unusual configuration, likely post-surgical. pelvis: slightly atrophic transplant kidney measuring 6 cm in length is noted in the right iliac fossa, without significant contrast enhancement. changes of right hemicolectomy are present, with intact anastomotic suture line in the right abdomen. there is a moderate amount of retained fecal material throughout the transverse and sigmoid colon. multiple calcified fibroids are again noted in the uterus. there is a 4 x 4 cm right adnexal cystic lesion with single internal septation, which previously measured 4.3 x 3.5 cm. the bladder is partially collapsed. small bilateral fat-containing inguinal hernias are present, left greater than right. scattered calcifications are noted in the abdominal aorta and iliac arteries, with patent branch vessel origins. scattered retroperitoneal and mesenteric lymph nodes measure up to 6 mm in short axis. there is no free intraperitoneal fluid or air. mild degenerative changes are noted in the thoracolumbar spine, with grade 1 anterolisthesis at l4-l5. moderate diffuse disc bulges are noted at l3-l4 through l5-s1, with impingement of the thecal sac outline; please note that ct cannot visualize intrathecal detail. moderate facet hypertrophy and ligamentum flavum thickening are also present. impression: 1. fibroid uterus, with 4-cm right adnexal hypodense structure that should be evaluated by non-emergent pelvic ultrasound. 2. acutely increased splenomegaly, may reflect infection or lymphoproliferative process. please correlate clinically. 3. cirrhosis 4. atrophic native and transplant kidneys 5. moderate hiatal hernia. the study and the report were reviewed by the staff radiologist. . us: the transabdominal ultrasound did not allow visualization of the uterus or the ovaries; therefore, we proceeded to a transvaginal examination. the uterus is enlarged and contains multiple fibroids. overall, the uterus measures approximately 7.6 x 5.5 x 6 cm. multiple, partially calcified fibroids distort the endometrial cavity. the largest fibroid lies posteriorly in the uterine body and measures approximately 4.5 x 4.3 x 3.9 cm. the endometrium is distorted by the multiple fibroids and difficult to visualize throughout its length, this measures approximately 3 mm in thickness. there is a large predominantly cystic mass in the right ovary. this measures 4 x 5 x 3 cm and contains multiple internal septations, several of which demonstrate internal blood flow. the left ovary measures 2.6 x 2 x 2 cm and contains multiple small cysts as well as a small calcified lesion measuring 0.7 x 0.6 x 0.6 cm. no free fluid seen in the pelvis. . impression: 1. bulky fibroid uterus as described. 2. the large cystic mass in the right ovary has some complex features, with multiple internal septations, some of which demonstrate vascularity and concerning for neoplasm. recommend referral to ob/gyn for further assessment. 3. multiple small cysts seen in the left ovary are also atypical in a postmenopausal woman and this should also be evaluated by ob/gyn. dr. was informed of the findings by telephone at 2pm . . mri findings: arising from the right ovary is a multiseptated lobular well-circumscribed t2 hyperintense lesion measuring 4.2 x 3.7 x 5.0 cm. multiple internal septations are seen some with slight thickening. no nodular components are present. no surrounding inflammatory changes. the left ovary measures 2.8 x 1.5 cm and contains many physiologic follicles the uterus is anteverted with multiple t1 and t2 hypoattenuating masses demonstrating significant enhancement. the largest is in the posterior myometrium and measures 4.0 x 4.4 x 4.4 cm. it demonstrates progressive enhancement. an avidly enhancing exophytic anterior fibroid is also present measuring 2.2 x 2.4 cm. additional smaller myometrial and subserosal fibroids are seen. there is trace fluid in the endometrial canal. adjacent to the right external iliac vessels, a 1.0 x 0.8 cm ovoid soft tissue density is seen, perhaps a lymph node. no significant free fluid is present within the pelvis. no significant pelvic sidewall or inguinal adenopathy. subcentimeter inguinal lymph nodes are present. fat-containing left inguinal hernia without bowel content. the rectosigmoid contains a large amount of stool. no pericolonic stranding. presacral fat is preserved. within the right iliac fossa is an atrophic, abnormally appearing right renal transplant measuring 5.6 x 2.6 cm with diffuse irregular enhancement. no surrounding inflammatory changes. visualized bone marrow signal is preserved. multilevel lower lumbar degenerative disease. post-surgical changes in the anterior hypogastrium are seen. no abnormal fluid collections. impression: 1. well-circumscribed multiseptated right adnexal lesion is present containing fluid content. septations appear smooth throughout though some of the septations are mildly thickened. though enhancement cannot be assessed without contrast, no definite nodular components or adjacent inflammatory changes are present. it appears stable in size since but is new since the examination of . this lesion has features suggesting mucinous cystadenoma of the ovary. if no surgical intervention is planned, consider follow up imaging with mr or us to assess for continued stability. 2. multiple uterine fibroids as previously described. most demonstrate avid enhancement. 3. left ovary with multiple physiologic follicles. no free fluid. 4. atrophic, deformed right iliac fossa renal transplant. discharge labs 05:34am blood wbc-4.0 rbc-3.52* hgb-10.7* hct-31.9* mcv-91 mch-30.4 mchc-33.6 rdw-17.4* plt ct-106* 05:34am blood glucose-95 urean-42* creat-6.1*# na-138 k-5.0 cl-91* hco3-35* angap-17 03:03am blood alt-43* ast-44* ck(cpk)-79 alkphos-175* totbili-0.3 05:34am blood calcium-7.9* phos-4.9*# mg-2.0 03:20pm blood tsh-5.6* 11:42am blood cortsol-32.1* brief hospital course: ms. is a 57 year old female with hcv cirrhosis, esrd s/p failed renal transplant, htn, cad, hypothyroidism, and chronic back pain requiring methadone who presented to the ed with right lower quadrant pain in the context of a right adnexal complex mass. she became hypotensive in the ed and required fluid rescusitation in micu overnight with an unclear cause of her hypotension. # hypotension: the differential diganosis for her hypotension was broad, but it was felt that she had been taking her anti-hypertensives incorrectly and her hypotension corrected with volume. additional causes of hypotension including adrenal insufficieny, hypothyroidism, and sepsis were all entertained. upon arrival to the floor she was continued on hd for her esrd, and her anti-hypertension medications were held. she will need to have her anti-hypertensive medications restarted as an outpatient. . # r ovarian mass: she presented with focal rlq abdominal pain that was concerning for malignancy, but after consultation with gyn/onc, it was felt that the mass was not cancer and should be followed with serial imaging. # chronic pain: she has been on methadone for chronic pain. she was started on dilaudid prn for addtional right lower quadrant pain. . # esrd: due to her hypocalcemia when she presented, there was concern that it may have caused her hypotension. cinacalcet was discontinued, and she was started on vitamin d and calcium. . #cirrhosis and splenomegaly: secondary to hcv. her lt's were mildly elevated during this admission, but otherwise stable. she has tender splenomegaly and portal or mesenteric vein thrombosis could be considered. . # cad: her last cath showed that she did not have significant coronary artery disease. nevertheless, due to her hypotension, she was ruled out during this admission. she was continued on asa 81 mg and simvastatin 20 mg po daily. . # hypothyroidism: she was continued on her home levothyroxine 188mcg. . # coagulopathy: she had a mildly elevated inr which was thought to be secondary to underlying poor synthetic liver function . # thrombocytopenia: her thrombocytopenia was thought to be secondary to her cirrhosis and was stable during this admission. . # anemia of ckd: she receives erythropoietin as an outpatient. her anemia was stable during this admission. . # seizure disorder: she was continued on her levetiracetam . # depression/anxiety: she was continued on her clonazepam and fluoxetine. . discharge: home with services transition of care: the patient will need help with her medication regiment, she will also need to have her medications, including her hypertensive medication regiment adjusted. medications on admission: levetiracetam 250 mg po bid fluticasone-salmeterol 250-50 mcg/dose disk levothyroxine 100 mcg + 88mcg once a day gabapentin 300 mg po qhd clonazepam 0.5 mg po bid methadone 10 mg/ml concentrate 44 mg po daily fluoxetine 60 mg po daily calcium acetate 667 mg po tid with meals aspirin 81 mg po once a day. simvastatin 20 mg po once a day. sensipar 30 mg po once a day. omeprazole 20 mg po once a day. folic acid 1 mg po once a day. trazodone 50 mg po at bedtime. discharge medications: 1. levetiracetam 250 mg tablet sig: one (1) tablet po bid (2 times a day). 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. gabapentin 300 mg capsule sig: one (1) capsule po qhd (each hemodialysis). 4. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for anxiety. 5. methadone 10 mg/ml concentrate sig: forty four (44) mg po daily (daily). 6. fluoxetine 20 mg capsule sig: three (3) capsule po daily (daily). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 10. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 11. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 12. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 13. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 14. levothyroxine 100 mcg capsule sig: one (1) capsule po daily (daily). 15. levothyroxine 88 mcg capsule sig: one (1) capsule po once a day. 16. calcium 500 500 mg calcium (1,250 mg) tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 17. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*2* 18. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: hypotension right ovarian mass discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you at . you were admitted to the hospital for treatment of low blood pressure and a right ovarian mass. you were in the medical intensive care unit for one night, where you were given intravenous fluids. your blood pressure improved. on the regular medical floor, the gynecologists evaluated your right ovarian mass. after doing an ultrasound and mri, we determined that the right ovarian mass is unlikely to be cancer. we will follow it with an ultrasound in . please make the following changes to your home medications: - take dilaudid 2-4 mg up to four times per day as needed for pain for the next few days - stop sensipar - start calcium carbonate 500 mg twice daily - start vitamin d 1000 units daily followup instructions: department: when: thursday at 3:20 pm with: , md building: sc clinical ctr campus: east best parking: garage department: gastroenterology when: thursday at 4:40 pm with: , md building: lm campus: west best parking: garage department: radiology when: thursday at 10:00 am building: campus: east best parking: garage department: gyn specialty when: thursday at 12:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified hemodialysis diagnoses: acidosis other iatrogenic hypotension thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery cirrhosis of liver without mention of alcohol acquired coagulation factor deficiency unspecified acquired hypothyroidism unspecified viral hepatitis c without hepatic coma opioid type dependence, continuous hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease dysthymic disorder epilepsy, unspecified, without mention of intractable epilepsy abdominal pain, left lower quadrant kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypovolemia surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation spinal stenosis, unspecified region migraine, unspecified, without mention of intractable migraine without mention of status migrainosus complications of transplanted kidney hypotension of hemodialysis neoplasm of unspecified nature of other genitourinary organs 

Answer: The patient is high likely exposed to