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: patient recorded as having no known allergies to drugs attending: chief complaint: colitis/diarrhea major surgical or invasive procedure: flexible sigmoidoscopy x2 intubation bronchoscopy ivc filter history of present illness: patient is a 74 yo man with h/o non-specific colitisi in , pmh cad s/p mi, s/p prostatectomy, lung nodule/nsclc s/p vats removal in now with recurrent colitis, transferred to for further management of his colitis. history obtained from records, patient, and his wife. has a history of colitis (deemed ulcerative colitis), diagnosed in after having bout of diarrhea at that time, per report, diagnosed by colonoscopy (see below in pmh). at that time, was treated with prednisone with improvment in symptoms. was symptom free until when again developed diarrhea, gas, urgency. otherwise no abdominal pain, nausea/vomiting, fevers/chills. had progression of symptoms from to with increased urgency, going to bathroom up to every 15 minutes, awaking at night to go to bathroom, diarrhea, gas, non-bloody bowel movements. in per report had a ct scan that was negative for colitis, stool studies that were negative. patient was then admitted to the / hospital for removal of lung nodule via vats procedure on , symptoms of diarrhea/urgency were still ongoing at this time. post-procedure patient developed escalating amounts of diarrhea, without any unstable vital signs, but also developed severe abdominal distension. this required ngt placement and rectal tube placement. repeat ct scan per report demonstrated colitis, most prominent in sigmoid and left sided colon, without evidence of mechanical obstruction or ischemic bowel (per one report - but also demonstrated dilation of bowel loops in large and small intestine, no noted mechanical obstruction, per another report - awaiting fax of ct scan report). the patient was started on solumedrol, questran, and made npo and started on tpn. stool studies for c diff have been negative multiple times, but he was also started on iv flagyl. his symptoms improved with these measures and the ngt/rectal tube per report had a lot of drainage, and after a couple of days he had his ngt and rectal tube removed. however, he is still having loose bowel movements, poor po intake, urgency. patient is therefore transferred to for further evaluation and management of his colitis. besides the above complaints, pt denies nausea/vomiting. does report chills, denies fevers. also states has developed lower extremity edema during prolonged hospital course. also reports some dyspnea on exertion which he attributes to deconditioning, denies cp/pressure, orthopnea, pnd. past medical history: - colitis, ?uc, diagnosed in with colonoscopy (by dr. ) after presenting with diarrhea. per report that examination demonstrated colitis involving the rectum, sigmoid colon and left colon, with edema and erythema. inflammatory changes extended up to transverse colon with less involvement of the right colon, ileum not examined. left colon biopsies demonstrated active chronic colitis with low-grade dysplasia involving the left colon. right colon biopsies demonstrated focal mild acute colitis without dysplasia. of note, 2 prior colonoscopies performed by dr. in and showed only diverticulosis of sigmoid colon and a diminutive adenomatous polyp at 20cm. following colonoscopy in , pt was treated with prednisone at that time with improvement of symptoms. - non-small cell lung cancer s/p left upper lobe lobectomy in , clean margins - cad s/p mi and lad stent in 10/97 at - hypothyroid - tobacco use - possible history of pancreatitis - h/o prostate ca s/p removal (?) social history: patient is married, has 1 daughter. 80 pack year smoking history, occasional alcohol use. family history: 1 daughter died at age 35 from metastatic lung cancer. 1 brother died of mi at age 45. family history of colon cancer in his father who died at age 59. physical exam: vitals - t 96.5, hr 77, bp 112/78, rr 22, o2 96% ra general - patient is an ill appearing man, no acute distress ent - moist mucous membranes cvs - rrr, no noted m/r/g lungs - cta b/l abd - slightly distended, soft, midline scar noted (per patient from prostate removal for prostate ca), non-tender to palpation, hyperactive bowel sounds ext - 3+ lower extremity edema, doughy texture pertinent results: osh labs: na 137, k 4.2, cl 110, co2 20, ca 7.7, phos 3.2, tg 116, mg 2.3, bun 37, cr 0.7 wbc 10.4, hct 29.4, plt 335 somatostatin 18 ttg igg 1.4, tissue trans 0.7 gastrin 52 . osh microbiology: , , c diff - negative stool for o+p - negative . osh imaging: ct scan: diffuse small and large bowel dilation with mild wall thickening. the stomach is distended as well. there is trace amount of peri-hepatic ascites. ileus or infectious colitis are favored over obstruction. there is probably chronic pancreatitis. no adenopathy, no free air. admission: 06:10pm blood wbc-12.7* rbc-3.48* hgb-10.5* hct-31.3* mcv-90 mch-30.3 mchc-33.7 rdw-15.4 plt ct-357 06:10pm blood neuts-91.7* lymphs-5.7* monos-2.4 eos-0.1 baso-0.1 06:10pm blood pt-15.4* ptt-27.6 inr(pt)-1.4* 06:10pm blood glucose-100 urean-38* creat-0.7 na-140 k-4.2 cl-114* hco3-19* angap-11 06:10pm blood alt-13 ast-13 ld(ldh)-216 alkphos-78 totbili-0.3 06:10pm blood albumin-2.1* calcium-7.3* phos-3.1 mg-2.2 06:10pm blood tsh-4.1 06:10pm blood free t4-1.0 06:10pm blood ttg-iga-9 studies: ct abdomen with iv contrast: impression: 1. diffuse wall thickening and loss of haustra from splenic flexure to anus with adjacent fatty proliferation. findings consistent with ulcerative colitis, of indeterminate chronicity. no free air, free fluid or bowel obstruction seen. 2. status post prostatectomy. 3. small-to-moderate right pleural effusion with related atelectasis. 4. bilateral peripheral reticular honeycombing in the visualized lung bases. comparison with prior study is recommended if available. 5. right lower lobe bronchiectasis with region of consolidation which could represent aspiration, atelectasis or infection. 6. region of spiculated nodular opacity in the right lower lobe and also subpleural nodule in the right middle lobe. again comparison with prior study would be useful for establishing stability. 7. scattered punctate calcifications in the pancreas could be related to chronic pancreatitis. 8. sub-millimeter hypodensities in the liver, too small to accurately characterize. 9. rounded hypodensity in the right common femoral vein, consistent with dvt, and appearing to extend from the deep femoral branch at the level of the greater saphenous origin. no evidence of thrombosis is seen in the common femoral vein below this level in the visualized distal common femoral vein. 10. sclerotic and lucent lesions in vertebral bodies. in this patient with history of prostate cancer, correlation with bone scan would be recommended in the absence of prior study to establish stability. : rectal bx: chronic active colitis with ulceration; no granulomas or dysplasia are identified. . ct a/p c contrast 1. diffuse wall thickening and loss of haustra from splenic flexure to anus, consistent with ulcerative colitis, of indeterminate chronicity, stable. there is no free air, no free fluid or bowel obstruction seen. no siginificant change in bowel apperance since . 2. status post prostatectomy. 3. left stable pleural effusion. there is adjacent atelectasis, but superimposed consolidation cannot be excluded. there are two tiny air pockets within the pleural fluid on the left, might be related to history of procedure in this area, but superinfection cannot be excluded. 4. bilateral peripheral reticular honeycombing in the lung bases, stable. 5. stable right lower lobe bronchiectasis. 6. scattered punctate calcification in the pancreas could be related to chronic pancreatitis. 7. stable tiny hypodensities in the liver, too small to characterize. 8. rounded hypodensity in the right femoral vein, seen also on the previous study, likely consistent with dvt, unchanged. 9. sclerotic and lucent lesions in the vertebral bodies in this patient with history of prostate cancer, correlation with bone scan is recommended for further followup. 10. nodular prominence in the left adrenal gland. attention on next follow up. colonoscopy : diagnosis: rectum: chronic active colitis with ulceration; no granulomas or dysplasia are identified. clinical: ulcerative colitis. gross: the specimen is received in one formalin container, labeled with the patient's name, ", r", the medical record number and additionally labeled "rectal biopsy". it consists of multiple tissue fragments measuring up to 0.4 cm, entirely submitted in cassette a. ================== cxr findings: in comparison with the earlier study of this date, there has been placement of a right subclavian picc line that extends to the mid portion of the svc. the patient has taken a better inspiration and there is still prominence of interstitial markings with elevation of the left hemidiaphragm. abd plain film impression: marked gaseous distention of the colon, with the transverse colon measuring up to 8 cm. no free air or pneumatosis. continued followup recommended to assess for interval changes. cxr right lung is clear. left hemidiaphragm remains elevated. opacification in the left lower lung could be atelectasis. there is no large pleural effusion or pneumothorax. heart size is normal : kub 1. little interval change in appearance of multiple dilated, air-filled colonic loops. featureless appearance of the descending and sigmoid colon are consistent with chronic ulcerative colitis. 2. there is no bowel wall thickening, pneumatosis, or free air appreciated. . chest ct noncontrast: 1. left hydropneumothorax raises concern for bronchial stump leak. no evidence of recurrent malignancy. 2. multifocal pneumonia, probably aspiration. 3. very small cavities in the right upper and middle lobe require followup. there is no evidence of active tuberculosis. 4. severe emphysema. possible pulmonary arterial hypertension. . . bone scan 1. focal focus of left anterior rib uptake which may correspond to a rib fracture. anatomic imaging is recommended as clinically indicated. 2. no corresponding abnormal uptake in the lower thoracic or lumbar spine to correlate with ct findings. 3. some limited assessment of the pelvis as described above. brief hospital course: patient is a 74 year old man with history of cad, nsclc, who presents with evidence of chronic diarrhea/colitis, transferred from outside hospital after worsening of symptoms after lobectomy (for nsclc). 1. colitis/diarrhea: on transfer here, patient was initially maintained on solumedrol (for ?ulcerative colitis flare), iv flagyl (for ?c diff colitis, ruled out by c.diff toxin x3 negative), and gi was consulted and involved throughout his hospital course. he had a repeat ct scan here that demonstrated bowel wall edema from anus to sigmoid colon. he therefore underwent a sigmoidoscopy for further evaluation that demonstrated very friable erythematous mucosa consistent with colitis. he continued on bowel rest and iv solumedrol until , when repeat flexible sigmoidoscopy showed worsened friable mucosa and colitis. cyclosprine was initiated at that time at 1.5mg/kg/day divided in two doses and then discontinued and steroids were decreased. on , the patient had significant lower gi bleed (approx 4-5l blood pouring from rectum). at that time the patient's family was contact and we discussed the difficulty of resusitating him and necessity of pressors and large volume transfusion. given the patient's very grave situation and family discussion, the patient was not resusitated with blood. 2. ards/hypoxia: pt had increasing o2 requirement and on hd 3 required transfer to icu. ct chest with multifocal opacities thought due to infection. on the patient had a witnessed aspiration and required intubation on for tachypnea. eventually the patient's hypoxia was thought to be due to ards secondary to pneumonia and intraabdominal inflammation. the patient was managed with iv antibiotics, but the patient's poor pulmonary status persisted. additionally, the patient was difficult to ventilate being frequently asynchronous with the vent except in the case of high amounts of sedation. his respiratory status remained tenuous. sputum cultures were positive for aspergillous. bronchoscopy was performed and bal was negative for pcp. was started on caspofungin for treatment of his fungal infection. 3. dvt, rle: incidental finding on ct scan. the patient was started on coumadin but this was discontinued in the setting of his continued gi blood loss. once stable, he was started on heparin, but noted to have low platelet count and transitioned to argatroban for possible hit. 4. malnutrition/stage ii sacral/buttock decubitus: noted on admission. pt was started on wound care, turn q2, nutrition, on vitamin c and zinc tpn at 75cc/hr. give small po liquids only if pt is awake. 5. hypothyroid: continue synthroid 6. coronary artery disease s/p myocardial infarction: during the hospital course he was kept on asa 81 and beta-blocker when he tolerated it. 7. nsclc s/p resection: his lung cancer was not an active issue. end of life care: as the patient continued his hospital course he had several episodes of massive gi bleeding. the gi team was consulted and felt that the patient required immediate surgical intervention. the surgery team evaluated the patient and found that the patient was too unstable and ill to undergo surgical intervention. on hd 22, a family meeting was held and goals of care were discussed. that evening, the patient again developed extensive gi bleeding. the family was consulted and requested that no resusitation measures be made. medications on admission: outpatient medications: asacol 800mg tid prednisone prn for colitis symptoms synthroid 88mcg daily asa 325mg daily loratidine 10mg daily simvastatin 40mg daily lopressor 50mg . medications on transfer: ceftriaxone 1gm iv daily (started ) metronidazole 500mg iv q 8hr (started ) solu-medrol 60mg iv q 8hr (started ) cholestyramine 4gm packet po tid epo 4000 units sc q week guafenesin prn sc heparin levothyroxine 0.088mg daily metoprolol 50mg po bid nystatin cream to buttocks omeprazole 20mg daily trypsin ointment to back discharge disposition: expired discharge diagnosis: cardiopulmoary arrest massive gi bleed severe colitis ards discharge condition: deceased procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube interruption of the vena cava fiber-optic bronchoscopy flexible sigmoidoscopy transfusion of packed cells transfusion of platelets closed [endoscopic] biopsy of rectum diagnoses: thrombocytopenia, unspecified acute posthemorrhagic anemia unspecified acquired hypothyroidism personal history of malignant neoplasm of prostate personal history of malignant neoplasm of bronchus and lung personal history of tobacco use percutaneous transluminal coronary angioplasty status acute respiratory failure cardiac arrest alkalosis blood in stool old myocardial infarction other emphysema paralytic ileus pressure ulcer, lower back encounter for palliative care acute venous embolism and thrombosis of deep vessels of proximal lower extremity other disorders of plasma protein metabolism pressure ulcer, heel aspergillosis pneumonia in aspergillosis pressure ulcer, stage ii nutritional marasmus edema other specified forms of effusion, except tuberculous other ulcerative colitis 

Answer: The patient is high likely exposed to