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: penicillins / zantac / morphine / tylenol / naprosyn / ketorolac attending: chief complaint: right-sided abdominal pain, nausea, vomiting, low blood pressure major surgical or invasive procedure: femoral central venous line () history of present illness: 44 yo f with esrd on hd, iddm, and cad s/p mi who presents from dialysis with abdominal pain and hypotension. patient was at dialysis today for one hour, and ate some lunch. approximately half an hour later, she suddenly started complaining of rlq abdominal pain and became hypotensive to 60s (per emt report). she was also reported to have some nausea and vomiting right after eating. she was in her usoh at her rehab prior to dialysis today, other than an episode of diarrhea on sunday (brown, non-bloody). denied any fevers. has had a cough productive of sputum for a few days now. denies any chest pain, shortness of breath, joint pains, new rashes, blood in her stools, lh, or syncope. no recent changes in her medications per patient, although her rehab list of medications is not completely congruent with her last discharge medications, as they do not contain any anti-hypertensives. she was brought by the emts to the ed for further evaluation for her hypotension. in the emergency department, vs were 97.7 61 87/41 20 99% ra. pt received 1 l ivfs, vancomycin iv, cefepime iv, dilaudid 1 mg iv x1. r femoral line was placed and pt was started on levophed gtt due to blood pressure dropping to 70s in the ed. it is unclear if this occurred in the setting of receiving her dilaudid. labs sig for wbc of 5.0, hct of 40.7, cre of 9.0. per ed resident, pain was thought to be out of proportion to physical exam, concerning for mesenteric ischemia. lactate was 1.4. of note, also having difficulty getting good pulse oximetry on the patient. ct abdomen pre-lim read showed no acute intra-abdominal process. no cxr was performed. pt transferred to the micu for further work-up. in the micu, pt admitted to not feeling 'good' about her symptoms, and asked the team 'not to leave her alone'. complaining of some mild rlq pain that improved with iv medication. of note, patient states she was hospitalized for several months recently at and recently. review of systems: (+)ve: (-)ve: fever, chills, night sweats, loss of appetite, fatigue, chest pain, palpitations, rhinorrhea, nasal congestion, cough, sputum production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, nausea, vomiting, diarrhea, constipation, hematochezia, melena, dysuria, urinary frequency, urinary urgency, focal numbness, focal weakness, myalgias, arthralgias past medical history: esrd on hd tues/thurs/sat with lle av fistula cad s/p inferior mi (cath with non-obstructive cad, ef 65%, inf hypokinesis) iddm ii h/o lle dvt (on coumadin), most recently had popliteal dvt on u/s s/p ivc filter placement htn hyperlipidema gerd reported history of mrsa social history: born in . moved from to mass. recently. lives at manor. divorced; has 21 and 16 y/o daughters who live with their father. denies /etoh/illicits. family history: non-contributory, daughters (x2) without insulin-dependent diabetes physical exam: gen: anxious, nad heent: perrla. mmm. neck: neck supple pulm: ctab no crackles + expiratory wheezes card: rrr soft sm heard best at llsb, no g/r abd: nttp, +bs, no g/rt, no hsm. ext: cold distal extremities, dps, pts 1+ skin: multiple excoriations neuro: aox3e, very anxious pertinent results: admission labs 04:10pm blood wbc-5.0 rbc-4.59 hgb-13.3 hct-40.7 mcv-89 mch-29.0 mchc-32.8 rdw-16.3* plt ct-154# 04:10pm blood neuts-70.3* lymphs-16.8* monos-7.1 eos-4.5* baso-1.3 04:10pm blood glucose-132* urean-47* creat-9.0*# na-136 k-4.0 cl-93* hco3-27 angap-20 04:10pm blood alt-14 ast-16 ck(cpk)-76 alkphos-223* totbili-0.2 04:10pm blood lipase-28 10:50pm blood cortsol-5.6 04:21pm blood lactate-1.4 pertinent labs 04:10pm blood ctropnt-0.08* 10:50pm blood ck-mb-5 ctropnt-0.27* 05:12am blood ck-mb-6 ctropnt-0.35* 09:14am blood ck-mb-5 ctropnt-0.29* 02:12pm blood ck-mb-5 ctropnt-0.26* 10:50pm blood cortsol-5.6 05:12am blood cortsol-6.8 10:51pm blood lactate-1.2 05:33am blood lactate-1.1 labs on discharge: 09:50am blood wbc-4.2 rbc-4.08* hgb-12.0 hct-37.6 mcv-92 mch-29.5 mchc-32.0 rdw-16.6* plt ct-177 09:50am blood glucose-220* urean-28* creat-7.1*# na-135 k-5.5* cl-94* hco3-30 angap-17 09:50am blood calcium-9.3 phos-4.1 mg-2.4 pertinent reports ct abdomen/pelvis with contrast () 1. no acute pathology identified to account for the patient's symptoms. the appendix is normal. 2. heterogeneous-appearing endometrium with possible polyp. clinical correlation is recommended and a pelvic ultrasound can be obtained for further evaluation on a nonemergent basis. 3. atrophic native kidneys. 4. sebaceous cyst within the right inferior anterior chest wall. tte (): normal global and regional biventricular systolic function. no pulmonary hypertension or clinically-significant valvular disease seen. cxr (): unchanged moderate cardiomegaly with minimal retrocardiac atelectasis. small overall lung volumes. no pulmonary edema. no pleural effusion. no pneumonia. the hilar and mediastinal contours are unremarkable. transvaginal ultrasound: 1. endometrial lesion measuring up to 17 mm with internal vascularity. most likely represents endometrial polyp but differential diagnosis consideration includes submucosal fibroid and hyperplasia. neoplastic process deemed less likely given patient's age, but cannot be completely excluded. recommend short-term followup with son and/or biopsy for further assessment. 2. 1.9 cm left ovarian cyst. the study and the report were reviewed by the staff radiologist. pending data at discharge: aldosterone, renin levels brief hospital course: 44 year old female with esrd on hd, iddm, cad who presented with hypotension and abdominal pain at hd session. #. hypotension: initial differential included septic , hypovolemic , cardiogenic , neurogenic and adrenal insufficiency. she was initially started on norepineprhine to keep her map > 65 but able to wean off norepinephrine after her blood pressure responded to intravenous fluid boluses. she did not have a source of infection on imaging (ct abdomen/pelvis and cxr), fever or inappropriate mixed venous oxygen. unlikely to be septic , antibiotics were discontinued on . unlikely to be neurogenic with no history of stroke, trauma and appropriate mental status. unlikely to be cardiogenic with no change in tte, normal stress test within past year seen on records obtained from hospital. once transferred to the floor, she was administered a trial of dexamethasone. she was evaluated by endocrine service for question of adrenal insufficiency. she had cosyntropin stim test performed which showed adequate adrenal response. her random and am cortisol is low, however, this was drawn after she was given empiric dexamethasone. random levels are appropriate. endocrine believed may be component of autonomic neuropathy socondary to long standing dm. she was started on fluorinef and continued at discharge. her blood pressures remained stable in 85-110 range systolic. renin and aldosterose are pending at the time of discharge. # abdominal pain: unclear etiology. ct abdomen/pelvis with contast showed no underlying etiology. her pain responded with bowel rest and dilaudid. she was able to tolerate advanced diet on . # troponin leak: 0.08 on admision. peaked at 0.35. trended downward. cks flat. likely due to demand ischemia with hypotension in underlying esrd. checked lipid panel for risk stratification and started on atorvastatin 80 mg po qdaily. tte showed no focal wall motion abnormality with normal structure and function. #. esrd on hd tues/thurs/sat with lle av fistula: underwent dialysis as an inpatient. continued renal meds. converted to aranesp to epo while in house #. cad: s/p inferior mi (cath with non-obstructive cad, ef 65%, inf hypokinesis). continued asa and started on atorvastatin 80 mg po qdaily due to elevated troponins. not on bb on admission and not started due to low blood pressures. #. iddm ii: continue riss with levemir 6 u qhs (glargine while in- house). sugars fluctuated dramatically in setting of dexamethasone trial, and resolved as the dexamethasone wore off gradually. # endometrial polyp: patient experienced vaginal bleeding as inpatient, but hct remained stable. underwent trans-vaginal pelvic ultrasound which showed endometrial lesion measuring up to 17 mm with internal vascularity. most likely represents endometrial polyp but differential diagnosis consideration includes submucosal fibroid and hyperplasia. neoplastic process deemed less likely given patient's age, but cannot be completely excluded. recommend short-term followup with son and/or biopsy for further assessment. medications on admission: aranesp 04 mcg/0.4 ml 4 pm sq weekly artificial tears bisacoldyl 10 mg po qdaily fluticasone nasal spray 2 sprays inh daily hiss + levemir 6 u qhs lidoderm 5% patch tp q12h on q12h off miralax nephrocaps 1 cap po daily neurontin 200 mg po daily prilosec 20 mg po daiy renal getl 800 mg po tid with meals senna xalatan eye drops diazepam 5 mg po daily:prn anxiety dilaudid 1 mg po q6h:prn pain haldol 5 mg po q6h:prn behavior/anxiety immodium prn: diarrhea tyelenol 325 mg po q4h:prn discharge medications: 1. aranesp (polysorbate) 40 mcg/0.4 ml syringe sig: one (1) injection injection once a week. 2. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic (2 times a day). 3. bisacodyl 5 mg tablet sig: two (2) tablet po once a day. 4. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal (2 times a day). 5. levemir 100 unit/ml solution sig: six (6) units subcutaneous at bedtime. 6. insulin sliding scale as previous 7. lidoderm 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) patch topical 12 hours on, 12 hours off. 8. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 9. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 10. gabapentin 100 mg capsule sig: two (2) capsule po daily (daily). 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 13. diazepam 5 mg tablet sig: one (1) tablet po daily (daily) as needed for anxiety. 14. dilaudid 2 mg tablet sig: 0.5 tablet po every six (6) hours as needed for pain. 15. xalatan 0.005 % drops sig: one (1) drop ophthalmic qhs. 16. aspirin 81 mg tablet sig: one (1) tablet po once a day. 17. fludrocortisone 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 18. renagel 800 mg tablet sig: three (3) tablet po three times a day. 19. atorvastatin 40 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: nursing and rehab center - discharge diagnosis: - end stage renal disease on hemodialysis - autonomic dysfunction - type i diabetes discharge condition: mental status: clear and coherent. level of consciousness: lethargic but arousable. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , you were admitted to the hospital with abdominal pain and low blood pressure. in the intensive care unit, you were given fluids and medication to help maintain your blood pressure. we also ruled out the possibility of infection. after leaving the intensive care unit, you continued to have lower blood pressures. we started you on a new medication called fludrocortisone in order to prevent this from happening again. you were also found to have vaginal bleeding during your hospital stay. this is likely related to a polyp which was discovered on ultrasound. you will need to follow-up with ob-gyn as an outpatient in order to further evaluate this issue. please start the following medication after discharge: fluorinef (fludrocortisone acetate) 0.1 mg by mouth twice daily (for your blood pressure) atorvastatin 40 mg daily aspirin 81 mg daily please increase the following medication: from sevelamer 800 mg tid to 2400 mg tid should you experience dizziness, lightheadedness, fevers, chills, or additional heavy bleeding after discharge, please call your doctor or return to the emergency room as soon as possible. followup instructions: please follow-up with your physician at the care facility. you are also scheduled for an appointment with the gynecologist: department: obstetrics and gynecology when: tuesday at 10:15 am with: , md building: campus: east best parking: garage procedure: hemodialysis diagnoses: anemia in chronic kidney disease end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery esophageal reflux polyneuropathy in diabetes hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia long-term (current) use of insulin old myocardial infarction long-term (current) use of anticoagulants personal history of venous thrombosis and embolism glucocorticoid deficiency background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled gastroparesis diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled peripheral autonomic neuropathy in disorders classified elsewhere abdominal pain, right lower quadrant polyp of corpus uteri 

Answer: The patient is high likely exposed to