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: levoxyl attending: chief complaint: low blood pressure major surgical or invasive procedure: hemodialysis history of present illness: 44 y/o male with pmh of esrd, gastric bypass, hx of bilateral dvts and orthostatic hypotension presented to osh with chronically low albumin after his gastric bypass found on routine labs at dialysis. at , patient was found to have systolic blood pressure of 75. patient was transferred to for further evaluation. . in the ed, vs: t98.6 hr 88 bp 79/50 rr 16 97%on nc ?l. received 500cc ns bolus x 3, zofran for nausea, midodrine 10mg x 1. patient was mentating well despite hypotension. he denied any symptoms with the exception of occasional nausea. a right femoral line was placed and patient was started on dopamine. prior to transfer, he developed hypoxia, o2sat 70's per report though no note in chart, and dropped his bp to sys 50s despite pressors. ecg was notable for sinus tachycardia without other changes. patient said he could feel his heart "pounding" since starting the dopamine. he was sent for cta that was negative for pe but did note large bilateral effusions. patient was sent to the floor for further bp monitoring and pressors as needed. . of note patient has been hypotensive at dialysis limiting his fluid removal. per report, his weight is up 5kg. he does endorse history of syncope secondary to low bp. patient was recently evaluated on by neurology and was diagnosis with orthostatic hypotension. he was started on midodrine and directed to minimize period of time that he is supine along with taking salt tabs. patient does not believe he started salt tabs. has been eating only bowls of wonton soup daily. patient spends most of his time lying in bed. has had surgical complications since gastric bypass in . at one point, comatose for 3 weeks. since then, minimal activity. . ros: denies fevers, chills, weakness, chest pain, shortness of breath, abdominal pain past medical history: iddm ?????? diagnosed at 27 years age; complicated by end-organ failure s/p gastric bypass bilateral dvts dx in chronic renal insufficiency on hd s/p parathyroidectomy diabetic retinopathy; legally blind bilateral ankle arthrosis (??????charcot joints??????): sequential fractures to ankles requiring orif. social history: separated from wife; father effective hcp; has high school diploma and is unemployed. nonsmoker, no etoh, remote marijuana use, otherwise no illicit drugs family history: no known neurological disorder. parents alive at 77, mother has lung ca. three healthy children, ages 14, 17, and 18. physical exam: vs: afebrile bp 72.47 hr 117 96%ra gen: obese male lying in bed awake, alert in nad heent: eomi, perrl, anicteric, op clear neck: supple chest: cta anteriorly, no wheezes, rales, rhonchi cv: tachycardic, s1s2, no m/r/g abd: soft, nt, nd; laparatomy scar c/d/i ext: nonpitting edema bilaterally; 2x3cm stage 4 ulcer on left heel, necrotic with granulation tissue; l av fistula skin: hyperpigmentation of b/l les neuro: aaox3; cn ii-xii intact; strength 5/5 in ues, bilateral lower extremities; toes downgoing; decreased sensation in b/l lower extremities pertinent results: 07:01pm blood wbc-5.3 rbc-4.61 hgb-12.5* hct-42.5 mcv-92 mch-27.1 mchc-29.5* rdw-18.6* plt ct-299 05:25am blood wbc-10.0# rbc-3.81* hgb-10.9* hct-35.1* mcv-92 mch-28.7 mchc-31.2 rdw-19.0* plt ct-404 02:55pm blood hct-33.9* 12:20am blood pt-26.4* ptt-32.1 inr(pt)-2.6* 07:01pm blood glucose-121* urean-14 creat-4.4* na-142 k-3.9 cl-99 hco3-37* angap-10 05:25am blood glucose-89 urean-15 creat-4.1* na-142 k-3.0* cl-101 hco3-31 angap-13 07:01pm blood alt-36 ast-48* ck(cpk)-17* alkphos-271* totbili-1.4 05:25am blood alt-29 ast-43* ld(ldh)-226 ck(cpk)-11* alkphos-232* totbili-1.6* 07:01pm blood ck-mb-notdone ctropnt-0.13* 05:25am blood ck-mb-3 ctropnt-0.14* 05:25am blood albumin-2.2* calcium-7.2* phos-2.5* mg-1.5* 07:01pm blood albumin-1.8* 07:01pm blood tsh-2.0 07:01pm blood t4-6.3 07:03pm blood lactate-1.6 . blood culture (): pending. c. diff toxin assay (): pending. . ct chest/abd/pelvis with contrast (): 1. no evidence of pulmonary embolism with ______through the proximal segmental pulmonary arteries. distal segmental pulmonary arteries and subsegmental arteries are not optimally evaluated on this study. 2. pulmonary edema and bilateral large pleural effusions without definite cardiomegaly. extensive coronary artery disease. 3. moderate right proximal subclavian artery stenosis and calcified plaque. 4. diffuse fatty infiltration of the liver. 5. cholelithiasis, without evidence of cholecystitis. 6. extensive renal calcification from diabetes and chronic renal insufficiency. 7. large cystic lesion superior to the bladder and inseparable from the sigmoid colon likely represents an enteric duplication cyst; however, this is uncertain without intravenous contrast. a pelvic mri is recommended to characterize further if this has not been characterized on outside studies. 8. extensive arteriosclerosis from diabetes and chronic insufficiency. . cxr (): limited study with small right pleural effusion and increased retrocardiac opacity, which may reflect atelectasis versus early pneumonia. dedicated pa and lateral views may be obtained to further assess. . echo cardiogram the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. overall normal biventricular cavity sizes and systolic function. no pericardial effusion. . . mri pelvis: preliminary findings and impression: mr images were obtained without intravenous contrast because of end-stage renal disease. non-contrast images demonstrate a large cystic lesion with a mildly thickened and irregular wall immediately superior to the bladder, including a small amount of debris. the lesion closely approaches the sigmoid colon, but does not definitely communicate with it. differential considerations include a giant sigmoid diverticulum, duplication cyst but an unusual appearance of a cystic gastrointestinal stromal tumor or paraganglioma is not entirely excluded. in order to assess further for the possibility of solid vascular components, ultrasound examination is recommended, as there is apparently a good window from the anterior abdominal wall. depending on the results, ct with contrast could be considered. brief hospital course: icu course: mr. is a 44 yo m with a history of dm with complications of esrd who underwent recent gastric bypass with significant weight loss and complications of very low albumin and severe, asymptomatic hypotension. the patient reported that his outpatient nephrologist thought he needed albumin with dialysis. due to profound hypotension to the range of sbp 60-70, the patient underwent cta to evaluate for pe and abd/pelvis ct. both studies was unrevealing unrevealing for source of hypotension. the patient was completely asymptomatic with apparently normal mentation. renal was consulted for dialysis. the renal fellow did find a case report of severe, incapacitating autonomic dysfunction in a diabetic after large sum weight loss, as occurred in this patient. the patient's outpatient pcp/nephrologist was contact and she reported that the patient had a history of poor compliance. she was concerned about possible depression and was considering psychiatry consult as well as feeding tube for supplementation due to poor oral feeding. the patient's prior pcp noted that she recommended that the patient not undergo gastric bypass surgery though he went ahead anyway (with significant complications) and reported to the icu team that he underwent the surgery to improve his chances of renal transplant. . wards course: 44 yo m with pmh of dm, esrd on hd, hx of bilateral dvt, s/p gastric bypass with dx of orthostatic hypotension here with low bp and hypoalbuminemia . hypoxia: underwent cta in ed for acute hypoxia with o2sats in 70s per report. per patient, no sob or chest pain. cta negative for pe. satting 96% on 2l on arrival to floor and rapidly weaned to ra. improved with hemodialysis. hypoxia may have been due to pleural effusion from hypoalbuminemia. . hypotension: recent evaluation by neurology (autonomics). notable for abnormal tilt test and impaired parasympathetic and sympathetic function. likely secondary to autonomic and peripheral neuropathy from longstanding diabetes. unclear whether there was a dehydration component from c difficile, though his bp improved with better hydration status and treating his c diff infection. he was able to tolerated hd. initially albumin was used during hd but per renal reports, he probably does not need it anymore given his bp's. he should continue taking midodrine and fludrocortisone. he should continue to follow with the autonomic service in our hospital. appointment already scheduled. he remained orthostatic while seen by pt but asymptomatic. further eval will be done as outpatient by the autonomic seervice. . hypoalbuminemia: likely secondary to poor po intake following gastric bypass surgery. he should be strongly encouraged to keep a good po intake. . bilateral pleural effusions: likely secondary to third spacing from hypoalbuminemia as well as weight gain as dialysis was initially was limited by low bp's. echo normal r/o cardiac etiology. sating well on ra on discharge . c diff infection: patient + for c diff. initially on flagyl but given poor response switched to vancomycin po . he should complete a 14 day course. . diabetes: patient placed on insulin sliding scale. minimal insulin requirment. he should be monitor closely. no lantus was administered while in house. . esrd: likely secondary to diabetic nephropathy on hd. initially with problems due to low . however, his bp improved and over last 72 hours in house, he had no problems with hd. . hx of bilateral dvts: patient was continued on warfarin. last inr 2.7. received 3 mg. prior days 2 mg/day. goal inr . . hypothyroidism: tsh normal in house. synthroid continued. . l ankle ulcer: evaluated by wound care consult team. recommendations attached with this d/c summary. patient has a follow up with his vascular surgeon in . . abnormal ct findings: noncontrast ct abdomen on admission showed large cystic lesion superior to the bladder and inseparable from the sigmoid colon that likely represents an enteric duplication cyst; however, this is uncertain without intravenous contrast. a pelvic mri was recommended and done on . mri final read is stilll pending. preliminary suggested ddx a giant sigmoid diverticulum, duplication cyst but an unusual appearance of a cystic gastrointestinal stromal tumor or paraganglioma was not entirely excluded. in order to assess further for the possibility of solid vascular components ultrasound examination was recommended, as there was an apparently good window from the anterior abdominal wall. depending on the results, ct with contrast could be considered. this finding should be further assessed during his next pcp appointment on at . . medications on admission: vit. d 50,000 units weekly. heparin 2,000 units iv tue, thurs, sat prior to hemodialysis. asa 325 mg daily. protonix 40 mg daily. coumadin 4 mg daily. synthroid 300 mcg daily. calcitriol 0.25 mcg tues, thurs, sat. ocuflox 0.3% ophthalmic one drop 4 times a day. pred forte 1% ophthalmic one drop left eye 4 times a day. midodrine 10 mg twice daily. diflucan 200 mg daily. nephrocaps one daily. zocor 10 mg at bedtime. phoslo 667 mg one cap three times a day with meals. neurontin 300 mg prn pain, max 900 mg per day. zaroxolyn 2.5 mg one tab on sun, mon, wed, and fri. lasix 80 mg one tab on mon, wed, and fri. dilaudid 2 mg prn every 8 hours for pain. discharge medications: 1. vitamin d 50,000 unit capsule sig: one (1) capsule po once a week. 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. warfarin 1 mg tablet sig: three (3) tablet po once daily at 4 pm: last inr 2.7 . 5. levothyroxine 100 mcg tablet sig: three (3) tablet po daily (daily). 6. nephrocaps 1 mg capsule sig: one (1) capsule po once a day. 7. fludrocortisone 0.1 mg tablet sig: one (1) tablet po daily (daily). 8. midodrine 5 mg tablet sig: two (2) tablet po tid (3 times a day). 9. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 10. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 11. gabapentin 300 mg capsule sig: one (1) capsule po q8h (every 8 hours) as needed. 12. vancomycin 250 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 12 days. 13. calcium carbonate 500 mg tablet, chewable sig: three (3) tablet, chewable po qid (4 times a day) as needed. 14. hydromorphone 2 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 15. miconazole nitrate 2 % powder sig: one (1) appl topical hs (at bedtime) as needed. 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 17. insulin insulin sliding scale. attached to paperwork discharge disposition: extended care facility: highgate manor discharge diagnosis: orthostatic hypotension clostridium difficille diarrhea abdominal cyst secondary: end stage renal disease discharge condition: good discharge instructions: you were admitted with hypotension. not a clear source of infection was located initially, but we did find that you had a c. diff gi infection. you should be on antibiotics for the next 12 days. you should continue taking your midodrine, fludrocortisone as prescribed. please follow all physical therapy recomendations to improve your blood pressures the final of your abdomen mri is still pending. please keep your appointment wtih your new pcp so this issue can be readressed. followup instructions: please follow up with a new pcp at : provider: , md phone: date/time: 2:30 provider: laboratory phone: date/time: 8:30 provider: . & phone: date/time: 1:30 md procedure: venous catheterization, not elsewhere classified hemodialysis infusion of vasopressor agent diagnoses: end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere unspecified pleural effusion unspecified acquired hypothyroidism diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled intestinal infection due to clostridium difficile long-term (current) use of anticoagulants personal history of venous thrombosis and embolism other disorders of plasma protein metabolism diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy other anomalies of intestine bariatric surgery status ulcer of ankle peripheral autonomic neuropathy in disorders classified elsewhere 

Answer: The patient is high likely exposed to