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: history of present illness: this patient is a 79-year-old male with a history of evans' syndrome and cryptogenic cirrhosis who was transferred to us from hospital for further work up of fever and right upper quadrant pain. his past medical history begins in in when he experienced flu-like symptoms with fever, shaking chills and persistent nausea and vomiting. while hospitalized there, he was found to be thrombocytopenic with a hemolytic anemia and was diagnosed with evans' syndrome. the patient had followed up with dr. later that year. he was found to have negative direct and indirect coombs test with a low haptoglobin and negative cold agglutinins. spep showed polyclonal igg and iga increases, no monoclonal spikes. there was no evidence for lymphoproliferative diseases at that time based on bone marrow results. in , mr. had a long admission here at again where he came from . he had been admitted for loss of consciousness, fatigue and weakness. he developed a large amount of ascites, had a questionable dupuytren's contracture on the right hand and some mild palmar erythema. he was not status post splenectomy from the year prior. he was encephalopathic that admission. ultrasound showed large amounts of ascites with a left pleural effusion. mri showed normal liver, no mass in the pancreas or ductal dilatation. taps of his ascites revealed an saag of 2.4 indicating portal hypertension with 400 white blood cells, 5444 red blood cells, 43% polys, 12% lymphocytes and 31% monocytes. spep and upep at that time were negative. mra of the abdomen was negative. echocardiogram revealed normal rv function. hepatitis serologies were done indicating a previous hepatitis b infection, but not chronic. endoscopy at that time showed a grade 1 varix, at which time the patient was started on propanolol. given all of the negative serologies, including , ama and human immunodeficiency virus, the patient was given a diagnosis of cryptogenic cirrhosis. transjugular biopsy of the liver was done at that time which was a very small specimen leading to a non diagnostic study although some periportal fibrosis was seen. on , this patient presented to hospital with weakness, hypotension and dehydration. he had eaten a three pound lobster the night before and felt nauseous, diaphoretic and weak. he had some dry heaves, but did not actually vomit, did not have any diarrhea and had a temperature to 102?????? at home. he was seen by his primary care physician as an outpatient and was hypotensive to 100/60, non tachycardic. his chest x-ray was clear at the time. his primary care physician thought that he was dehydrated and instructed him to drink plenty of fluids and increased his prednisone from 15 to 30. shortly thereafter, he became even more hypotensive to 70/60 while standing and was admitted to hospital. bone marrow biopsy was repeated, as was a liver biopsy. all other studies there, including right upper quadrant ultrasound and ercp were normal. on admission there, the patient's total bilirubin was 3, rising to 8 before transfer. his transaminases were in the 100s going up to the 200s at the time of his transfer. amylase and lipase were normal. tsh was normal as well. the bone marrow biopsy from the outside hospital showed that it was normocellular with all lines present, had ill formed granulomas and mild lymphocytosis. he had mild myeloid hyperplasia with unremarkable maturation. there was a mild increase in megakaryocytes which were not dysplastic. he had mild eosinophilia, plasmacytosis, approximately 3% mostly mature. there was 1+ to 2+/4 on the iron stain with no increase in ringed sideroblasts. acid fast and pas stains were nasogastric for afb and fungus. echocardiogram done on admission also showed normal rv function. i was consulted on , felt that the patient had a picture of obstructive liver disease and was started empirically on unasyn for cholangitis. on , mr. was transferred to for continuing work up. his unasyn was discontinued on admission. his solu-medrol was changed to prednisone. at time of presentation, he was very lethargic, was not complaining of any pain and was afebrile. he denied any recent nausea, vomiting or diarrhea. he had no abdominal pain. past medical history: 1. evans' syndrome which is an itp with warm autoimmune hemolytic anemia. 2. hepatitis b 3. cryptogenic cirrhosis with a history of massive ascites 4. esophageal varices 5. benign prostatic hypertrophy 6. prostatitis 7. back surgery x3 8. left inguinal hernia repair 9. he is status post cholecystectomy. 10. he has a history of atrial fibrillation. 11. he has a history of pulmonary embolism status post ivc filter and he is status post splenectomy in . allergies: no known drug allergies. admission medications: 1. solu-medrol 20 mg intravenous q 8 2. digoxin 0.125 mg po qd 3. unasyn 3 gm intravenous q 8 which was to be completed on . 4. zovirax topical ointment to face 5. glucotrol xl 5 mg qd 6. prednisone 30 mg qd 7. inderal 20 mg 8. aldactone 25 mg qd 9. lactulose 30 cc 10. prevacid 30 mg qd 11. benadryl 25 mg q hs 12. ambien 5 mg po q hs prn 13. tylenol 650 mg po prn physical exam: vital signs: at admission, 98.6??????, blood pressure 130/70, heart rate 83, respiratory rate 20, 97% on room air. fingerstick showed a glucose of 164. pertinent physical findings: the patient was drowsy, but arousable and oriented x3. he was very jaundiced. head, ears, eyes, nose and throat: sublingual icterus as well as scleral icterus bilaterally. he had a dry oral mucosa. heart: normal s1 and s2 beating in a regular rhythm with a 3/6 systolic murmur. lungs: clear bilaterally. extremities: atrophic skin with multiple ecchymoses, no cyanosis or clubbing with 1+ lower extremity edema bilaterally. he had good dorsalis pedis pulses bilaterally. hospital course: 1. gastrointestinal: the patient's unasyn was discontinued and solu-medrol was changed to prednisone 60 mg. an attempt was made to retrieve the biopsy specimens, including liver and bone marrow from hospital to be reviewed by staff pathologists at . on , the patient felt nauseous, had some dry heaves, became hypotensive and passed a large bowel movement consisting of melena and burgundy clots. he was started on octreotide, given a dose of ciprofloxacin, transfused and taken to the medical intensive care unit for endoscopy. endoscopy showed a grade 1 varix in the esophagus which was not bleeding at the time and the patient was transferred out of the medical intensive care unit, was re-scoped on the 12th again showing the same findings with the addition of a polypoid mass in the stomach which again was not bleeding. the patient was then transferred back to the floor. he now had rectal bag in place making it easier to follow his stool output. it continued to drain a black liquid. he was transfused again with 1 unit and his blood pressure was monitored very carefully. his aldactone and beta blockers were held for blood pressure support. endoscopy again on the 16th was performed due to increased encephalopathy. again, no bleeding was seen although blood was seen in the stomach and the polypoid lesion in the stomach was biopsied and sent for pathology. pathology report from that showed that it was an adenoma. both the bone marrow and liver biopsies were consistent with granulomatous disease. other causes of granulomatous diseases were ruled out with the following serologies: was negative. ama was negative. anti-smooth muscle antibody was negative. cmv was negative. hsv was negative. ebv/igm was negative. igg was positive. hepatitis serologies were repeated. hepatitis b surface antibody was positive. hepatitis b surface antigen was negative. hepatitis e antibody was nonreactive and hepatitis e antigen was nonreactive. hepatitis c antibody was negative. haptoglobin was 30. labs throughout hospital course: the patient's total bilirubin on the day of admission was 36.1 which peaked at a of 41.9; it was 33.7 prior to discharge. alt and ast were in the 230s at admission which peaked in the 400s and 500s respectively and were now down to the 200s at the time of discharge. alkaline phosphatase was 310 on admission, peaked at 416 and is now down to the 300s again. white blood cell count was 9.7 on admission and rose to 16.7 with no obvious source of infection. it was thought that the rise in white blood cell count was due to the chronic steroid treatment. the patient's hematocrit was 42 on admission and with the recurrent bleeds, fell as low as 31. he was transfused and remained stable around 33 at the time of discharge. platelets were 97 on admission and remained in the 80s throughout the hospital course. no platelet transfusions were ever necessary. given the granulomatous disease seen in these multiple organs without obvious pulmonary involvement and other things ruled out, sarcoidosis was entertained as a diagnosis. a serum ace level was checked which was returned at 327 with the normal range being 9 to 67. with this information, a working diagnosis of systemic sarcoidosis was entertained. the most recent biopsy of the liver revealed ill formed granulomas which are noted to be adjacent to the portal areas. it was 2+ to 3+ periportal and intralobular inflammation noted consisting of lymphocytes and rare plasma cells, polymorphs and rare eosinophils. there was interface hepatitis. mild steatosis was noted. rare necrotic liver cells were present. there was a focus of bile duct proliferation present, but no acute cholangitis was noted. there was stage 1 to 2 periportal and sinusoidal fibrosis. there was minimal stainable iron present in the hepatocytes. there were no hyaline or biostasis noted. acid fast stain was negative for afb. there was mild sinusoidal dilatation. the patient's pt and inr remained normal throughout the admission. chest x-ray was negative. towards the end of the hospital course, infectious diseases and rheumatology were consulted to provide their input into the treatment of sarcoidosis by rheumatology, as well as for infectious diseases to recommend other infectious causes of granulomatous hepatitis. rheumatology informed us that there was no good evidence that cytoxan is beneficial on extrapulmonary sarcoidosis and recommended continuing with the prednisone therapy. infectious diseases recommended checking a number of other serologies, including brucellosis, coxiella, rpr, human immunodeficiency virus and these are checked the day prior to admission. results are still pending. we will follow up. 2. nutrition: the patient was npo for a number of days while he was bleeding and undergoing multiple endoscopies. a central line had been placed for his transfusion which was also used for tpn. at the end of the admission, the central line actually was pulled out and the patient began to take po's very well without complication. 3. endocrine: the patient does not have a history of diabetes, but given the high dose steroids he is on, his glycemic control was difficult to manage. he was on glucotrol 5 mg q day and covered with an insulin sliding scale. 4. cardiovascular: the patient's blood pressure remained stable after being transfused with the aldactone and beta blockers being held. this was discussed with gastrointestinal and given the patient does not have varices that are concerning, there is no need to continue with beta blocker therapy. the patient has no ascites this entire admission, therefore the aldactone was discontinued as well. discharge condition: stable discharge medication: 1. prednisone 60 mg po qd 2. ursodiol 300 mg po tid 3. lactulose 30 cc po tid 4. protonix 40 mg po qd 5. calcium carbonate 500 mg po tid 6. vitamin d 800 international units po q day 7. regular insulin sliding scale 8. neutra-phos 2 packets po tid 9. digoxin 0.125 mg po qd 10. glucotrol xl 5 mg po qd 11. ambien 5 mg po q hs prn insomnia 12. tylenol 650 mg po q 4 to 6 hours prn discharge diagnoses: 1. likely systemic sarcoidosis 2. evans' syndrome 3. itp 4. autoimmune hemolytic anemia, status post splenectomy disposition: the patient is discharged to the acute care facility. he will be instructed to follow up with his primary care physician, . , at (. dr., 12-869 dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances esophagogastroduodenoscopy [egd] with closed biopsy esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: cirrhosis of liver without mention of alcohol unspecified protein-calorie malnutrition atrial fibrillation sarcoidosis hematemesis hepatic encephalopathy esophageal varices in diseases classified elsewhere, without mention of bleeding autoimmune hemolytic anemias 

Answer: The patient is high likely exposed to