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: augmentin / gluten attending: chief complaint: back pain/groin pain major surgical or invasive procedure: picc line placement ct-guided left paraspinal muscle biopsy right knee arthrocentesis history of present illness: 70 year old female with celiac disease, osteoporosis, b12 deficiency, l4 compression fracture initially presented with to pcp with right groin/hip pain x 2 weeks; u/s was without dvt. she was seen in clinic and underwent an pelvic mri, later read as a right sacral insufficiency fracture. she presented to the ed complaining of continued right groin pain, associated with difficulty starting her urine stream and constipation. in the ed, she had a temp to 101.6, and was noted to be hypotensive sbp 80s (baseline 90s-100s)in the setting of a hct 24 (baseline 34-36). she received fluid and 1 unit of prbc and was admitted to the icu for further evaluation. in the icu, she received 1 unit of prbc. given she remained hemodynamically stable, she was kept off antibiotics and transferred to the general medical floor p.m. currently, she notes mild low back pain. no groin pain at rest, but pain occurs, "gnawing" in character, when she moves her right leg. she notes that the back pain is in a band across her back, worse on the left, occasional shooting pain around her back, but not down her leg. she also notes bilateral leg weakness r>l, although it is difficult for her to determine whether this is due to true weakness or pain. she notes fever and chills x 1 week. she has noted difficulty initiating urinary stream x 6 mos, denies urinary/bowel incontinence ros: she denies shortness of breath or cough. no sore throat, no dysuria, no diarrhea. she is constipated, no black stool or rectal bleeding past medical history: celiac sprue: chronic diarrhea, improved recently on a gluten-free diet. osteoporosis- l4 compression fx (~) vitamin b12 deficiency hyperhomocysteinemia lactose intolerance actinic keratosis blepharitis sciatica multiple miscarriages social history: she does do some part-time work writing. no tobacco, quite , 1 glass of wine daily. does yoga family history: mother with osteoporosis and diabetes. physical exam: physical exam on transfer to general medical floor tc 100.1, bpc 112/55, resp 18, 99% ra gen: elderly female, a&ox3, nad heent: anicteric, pale conjunctiva, ommm, op clear, neck supple cardiac: rrr, no m/r/g appreciated pulm: (+) crackles at bases bilaterally l>r, no wheezes abd: nabs, mildly distended, soft, nt/nd ext: no cyanosis, clubbing. (+) mild edema right lower extremity. (+) right groin tenderness over hamstring tendon. neuro: cn ii-xii grossly intact and symmetric bilaterally. 4+/5 strength left plantar/dorsiflexors, 2+/5 strength hip flexors and extensors, 5/5 strength left lower extremity, 5/5 strength upper extremities bilaterally. 2+ dtr throughout except right lower extremity which is 1+. toes equivocal on left, downgoing on right. sensation intact to light touch proximally and distally in upper and lower extremities bilaterally psychiatric: appropriate, pleasant gu: normal external genitalia heme/lymph: no cervical or supraclavicular lymphadenopathy back: (+) point tenderness l4, l5, s1. (+) paraspinal muscle spasm at l5. (+) pain at hip flexion to 60 degrees, but pain is in groin, not back/leg. pertinent results: laboratory studies on admission: wbc-14.5 hgb-8.2 hct-24.8 mcv-87 rdw-12.6 plt count-823 neuts-83.1* lymphs-10.6* monos-5.9 eos-0.2 basos-0.2 iron-8 caltibc-213 vit b12- > folate-19.1 haptoglob-369 ferritin-219 ld(ldh)-124 tot bili-0.2 fibrinoge-671 glucose-95 urea n-7 creat-0.4 sodium-128* potassium-4.0 chloride-90* total co2-30 lactate-0.8 u/a: urine blood-neg nitrite-neg protein-neg glucose-neg ketone-15 bilirubin-neg urobilngn-neg ph-8.0 leuk-neg laboratory studies on discharge: wbc 5.9 rbc hgb 9.1* hct 28 plt 318 glucose 89 urean 11 creat 0.5 na 137 k 3.8 cl 101 hco3 28 ekg: sinus tachycardia. left atrial abnormality. rsr' pattern in leads vi-v2 represents a normal variant. no previous tracing available for comparison. radiology torso ct: no pulmonary nodules, parenchymal consolidations, or pleural effusions are noted within the lungs. there is a calcific focus/surgical clip in the calcification in the left lung apex which is associated with fibrotic change most likely secondary to the patient's prior granulomatous disease. shotty mediastinal and hilar lymph nodes are not pathologically enlarged by ct criteria. the liver has decreased attenuation consistent with fatty change. no pathologically enlarged retroperitoneal mesenteric lymph nodes are seen. right ischial bursitis. fluid collections are noted within both hip joints most likely secondary to an underlying arthritis. there are areas of sclerosis within the sacral bones which are consistent with the patient's history of sacral insufficiency fracture. the previously mentioned hypodensity in the left paraspinal area at the level of l4 and t11 are unchanged. mri l-spine: no significant interval change in the enhancement of the left paraspinal muscle tissues compared to . differential diagnosis would include both infection versus inflammation. right upper extremity ultrasound: thrombosis of the right cephalic vein. no evidence of extension to other veins of the upper arm. tte: the left atrium is normal in size. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion right shoulder x-ray: no fracture is seen. the glenohumeral and ac joints appear normal. the visualized portions of the lungs are clear. no prior shoulder studies available c/t/l spine mri with contrast: cervical spine: no disc, vertebral or paraspinal pathology is seen. there is no spinal stenosis or suluxation of the component vertebrae. the visualized spinal cord, foramen magnum and its contents are unremarkable. thoracic spine: no significant interval changes are seen in the thoracic spine images when compared to a prior study. folowing gadolinium adiminstration, no abnormal enhancement is seen. lumbar spine: sagital and axial images of the lumbar spine after gadolinium administration demonstrate enhancement of the left paraspinal muscles from l2 to l5 extending into the subcutaneous soft tissues. no other areas of abnormal enhancement are noted. the intervertebral disks as well ad the vertebral bodies show normal signal intensity. impression: l2 to l5 left paraspinal muscle enhancement extending into the subcutaneous tissues. in view of negative history of recent trauma, these findings most likely represent infection. mri t spine without contrast: there is mild compression of the superior endplate of t11 identified without increased signal on inversion recovery images indicating chronic compression. mild degenerative changes are seen in the thoracic region. no evidence of acute compression fracture identified. there is no evidence of cord compression. there is no evidence of intraspinal fluid collection. mri l spine without contrast: insufficiency fracture involving the right ala of sacrum. fluid within the left facet joint of l4-5 with soft tissue increased signal in the adjacent areas could be secondary to degenerative change and soft tissue edema but early septic arthritis of the facet joint could not be excluded. gadolinium-enhanced images with fat suppression of the lumbar spine are recommended. ct abd/pelvis w/o contrast: no retroperitoneal bleed or intra-abdominal collections. tiny perihepatic air bubbles of unknown significance. bowel loops are unremarkable. mri hip: bilateral sacral insufficiency fractures r>l, bilateral hip effusions, extensive sc edema, small amt of intraperitoneal free fluid lumbar spine plain films: unchanged l4 compression fracture, mild degnerative arthritis, narrowing of l4-5 disc space leni: tubular hypoechogenic strcuture in right groin area adjacent to tendinous structures that could represent hematoma pathology left paraspinal muscle biopsy: nodular fibroblastic proliferation with associated dense fibrosis and focal chronic inflammation; adjacent skeleton muscle with atrophic and reactive changes; no active inflammation present. left temporal artery biopsy: no arteritis seen. focal calcifications of internal elastic band. brief hospital course: 70 year old female with celiac disease, osteoporosis, and spinal compression fractures admitted with groin/back pain in the setting of recently diagnosed sacral insufficiency fractures, found to be anemic with fever and elevated inflammatory markers. 1) fevers/myositis/elevated systemic inflammation markers: given fever, back pain, and lower extremity weakness, there was an initial concern for epidural/spinal infection. the patient underwent c/t/l spine mris with and without contrast (see results section), which were significant for fluid within the left facet joint of l4-5 with soft tissue increased signal in the adjacent areas that could be secondary to degenerative change and soft tissue edema but early septic arthritis of the facet joint could not be excluded. the infectious disease service was consulted, and the patient was treated empirically with vancomycin for suspected facet infection/myositis. a repeat mri of the l-spine was obtained on which showed no significant interval change in the enhancement of the left paraspinal muscle tissues compared to . the mris were reviewed with the radiologists, id team, and primary team who decided that the probability of facet infection/infectious myositis was unlikely; antibiotics were therefore discontinued (received 7 days of vancomycin). she underwent a ct-guided biopsy of the left paraspinal muscle on , the cultures of which were negative. the biopsy showed nodular fibroblastic proliferation with associated dense fibrosis and focal chronic inflammation; adjacent skeleton muscle with atrophic and reactive changes; no active inflammation was present. in terms of other infectious work-up, blood cultures had no growth to date, tte was without evidence of endocarditis, and urine culture was negative. lyme antibody was pending at time of discharge. given elevated esr (max 103) and crp (max >300) a rheumatology consult was obtained. was negative and rf was not elevated; spep and upep were without monoclonal bands. the patient underwent an arthrocentesis of her right knee on with 5250 wbc and only a few intra/extracellular monosodium urate crystals, not felt be significant. she has a torso ct which showed left apical lung calcific focus, shotty, non-pathologically enlarged mediastinal/hilar lad, fatty liver, right ischial bursitis, and bilateral hip effusions, but no evidence of malignancy. orthopedics were consulted for possible hip arthrocentesis, but given good range of movement of hips without significant pain, these were not felt to be infected (rheumatology and infectious disease services agreed). the patient underwent a temporal artery biopsy to evaluate for giant cell arteritis on , which was without evidence of arteritis. she remained afebrile and, at time of discharge, her esr and crp were trending down (85 and 119.7, respectively). her platelets were also trending down, 318 on discharge from a maximum of 1069. she will follow-up with rheumatology as an outpatient. she should also follow-up with her gastroenterologist for egd/colonoscopy (given risk of lymphoma with celiac sprue) and have age-appropriate outpatient cancer screening (mammogram - last birads 1, pap smear). 2) bilateral sacral insufficiency fractures: the orthopedic service (dr. was consulted, who recommended weight bearing as tolerated and follow-up with orthopedics as an outpatient. 3) anemia of chronic disease: the patient's hct was 24 on admit from 36 on 11/. she has a history of celiac sprue, but her symptoms have improved on low-gluten diet. iron studies were consistent with anemia of chronic disease (due to celiac sprue vs above inflammatory process), vitamin b12 was elevated, folate wnl, and upep/spep without monoclonal bands (has had abnormal tests in the past). fibrinogen was elevated, not consistent with dic, and haptoglobin was elevated, not consistent with hemolysis. her hematocrit remained stable at 28 following 2 units of prbc. the gastroenterology service was consulted, and recommended outpatient follow-up with dr. . 6) hyponatremia: the patient was gently hydrated following admission, given she appeared intravascularly dry, but her sodium continued to trend down to 128. the nephrology team was consulted, who felt this was secondary to siadh (possibly related to pain, chest ct/head ct without abnormalities) and recommended fluid restriction (2l/day) and salt tabs. her sodium improved to 137 on discharge. 8) osteoporosis/spinal compression fx: the patient was continued on calcium, vitamin d, and fosamax 9) right arm cephalic vein thrombosis: following a right picc line placement, the placement developed right arm swelling. an ultrasound revealed a catheter-associated right cephalic vein clot. the catheter was removed and the patient's arm swelling resolved. full code medications on admission: calcium carbonate 1000mg daily ferrous sulfate 325mg daily fosamax 70mg po q weekly metamucil percocet for pain ibuprofen 400-1600mg daily since last vitamin b12 1,000mg im q monthly vitamin d 50,000 units monthly budesonide - took from discharge medications: 1. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po q 12h (every 12 hours). 2. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po q 12h (every 12 hours). 3. alendronate 70 mg tablet sig: one (1) tablet po qfri (every friday). 4. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 5. vitamin b-12 1,000 mcg/ml solution sig: 1000 (1000) mcg injection once a month. 6. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 7. oxycodone 5 mg tablet sig: 0.5-1 tablet po q4-6h (every 4 to 6 hours) as needed. 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). discharge disposition: extended care facility: for the aged - discharge diagnosis: primary: l2-l4 paraspinal myositis secondary: bilateral sacral insufficiency fractures, vertebral compression fractures, anemia of chronic disease, hyponatremia discharge condition: stable discharge instructions: 1) please take all medications as prescribed 2) please follow-up as indicated below. 3) please see your primary care physician or come to the emergency room if you develop worsening back pain, weakness, fevers, chills, or other symptoms that concern you. followup instructions: 1. you have an appointment scheduled with dr. in the rheumatology clinic ( medical building) on tuesday, at 9:30 a.m. . this is to follow-up the results of your biopsy. 2. you have an appointment scheduled with dr. in the orthopedic clinic (, , building, ) on at 9:30. 3. you have an appointment scheduled with a physician who works in dr. office: , md phone: date/time: 4:00 p.m. 4. you have an appointment scheduled with dr. (gi) on at 11:40. md procedure: venous catheterization, not elsewhere classified arthrocentesis open biopsy of soft tissue biopsy of blood vessel diagnoses: anemia, unspecified hyposmolality and/or hyponatremia other b-complex deficiencies hypotension, unspecified osteoporosis, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to other vascular device, implant, and graft myalgia and myositis, unspecified pathologic fracture of vertebrae arterial embolism and thrombosis of upper extremity 

Answer: The patient is high likely exposed to