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: clindamycin / erythromycin base / amoxicillin / keflex / wellbutrin attending: chief complaint: syncope and hypotension on 4 major surgical or invasive procedure: central line attempted but never placed history of present illness: 57 y/o f with multiple medical problems including polyendocrine deficiency comprised of adrenal insufficiency, dm, premature ovarian failure, hypoparathyroidism, addison's disease and also breast ca and depression with multiple suicide attempts in the past who originally presented s/p tylenol with codeine overdose and hypotension, was intubated and admitted to the . she was eventually stabilized and transfered out of the icu to the medical . subsequently, she was transfered to the psychiatric in 4 for further psychiatric w/u. . this morning, , ms. feeling weaker than usual. she noted that she had increased pain in her lower back, which she attributed to her arthritis. she ate a normal breakfast of cereal and milk. later that am, she stood from her wheelchair, had a prodrome of lh and then reports loc and fall. she denies any tunnel vision, darkened vision, or focal weakness this morning. no bowel/bladder incont, no aura, no postictal state. she does not recall falling, but does recall waking up with people surrounding her. during the fall she hit her nose and her r knee. she does not recall hitting her head. she does not describe decreased po intake from her norm this morning, but did feel dehydrated at the time of her fall. loc was unwitnessed. . early this morning before breakfast her bs was reportedly 145, and after loc, her bs was reportedly 207. she reports that her bp was read at 60/48 after her fall. her systolic bp measurements have been running around 100-110 over the past few weeks. ms. has a history of "passing out" in of , (? 7 hours), and reports that this episode did not feel similar. . ros: she denies any recent nausea, but had an episode of vomiting last week. she denies any pain with urination or incontinence. she also denies any recent cough, chest pain, chest palpitations, heart racing. she reports 2 nights with soaking ns. denies subj/obj fevers or chills. she describes her mood as depressed, however she denies suicidal ideation at this time. she reports that she took all her medications as usual this morning, with no changes. past medical history: 1) polyendocrine deficiency syndrome type i which is comprised of the following: a) hypoparathyroidism, dxed b) addison's disease, dxed c) premature ovarian failure, dxed d) alopecia areata and totalis, dxed e) mucocutaneous candidiasis f) diabetes type i 2) colonic dysfunction alternating with diarrhea and constipation 3) ?unstable serum calcium since 4) generalized osteoarthritis 5) depression requiring ect therapy in the past 6) bilateral neuropathy of lower extremities 7) bilateral cataracts 8) pvd 9) spontaneous dislocation of left hip in 10) gerd 11) low grade anemia 12) elevated liver enzymes 13) h/o amputation of right 2nd toe secondary to osteomyelitis in 14) h/o hemorrhoidectomy in 15) h/o left hip joint replacement in 16) h/o total hysterectomy in 17) h/o breast ca s/p mastectomies 18) recent suicide attempt with tylenol #3 requiring micu admission but relatively transaminitis with full recovery pcp at dr. . has been hospitalized at and numerous times. social history: lives in . denies etoh, illicits. multiple past suicide attempts. medically savvy - has spent much of her life in the hospital with her multiple medical problems. family history: father with history of liver cancer at a late age physical exam: t 98.4 rr 20 sat 100% ra, p 100 in bed & same standing, bp=120/65 in bed, same standing. . gen: nad, cooperative and conversant, able to ambulate independently around room using crutches : ncat, no tenderness to palpation of scalp, perrl, eomi, alopecia, no scleral icterus, mucus membranes moderately dry, slight amount of crusted blood on tip of r nostril from fall injury neck: supple, no supraclavicular lad, no jvd cv: tachycardic, regular rhythm, iii/vi systolic, crescendo-decrescendo at usb bilaterally. harsher holosystolic murmur at the apex heard best with bell. pulm: ctab aside from slightly dull breath sounds at the bases abd: soft, slightly obese, nondistended, +bs ext: no edema/cyanosis, 2+ peripheral pulses, small 1 cm abrasion on r knee, no active bleeding, no brusing, no limited rom, no signs of effusion neuro: a&ox3, no asterixis, strength 4+/5 equal throughout, sensation light touch intact, toes upgoing bilaterally, no pronator drift. gait does not appear unsteady, uses crutches for support. pertinent results: admission labs: . 10:40am blood wbc-17.1* rbc-3.37* hgb-10.1* hct-30.1* mcv-89 mch-30.0 mchc-33.6 rdw-18.8* plt ct-526* 10:40am blood neuts-86* bands-5 lymphs-4* monos-5 eos-0 baso-0 atyps-0 metas-0 myelos-0 10:40am blood plt smr-high plt ct-526* 05:30am blood pt-11.3 ptt-24.9 inr(pt)-1.0 08:00am blood glucose-137* urean-19 creat-1.0 na-142 k-4.0 cl-105 hco3-29 angap-12 05:30am blood alt-85* ast-238* ld(ldh)-316* ck(cpk)-55 alkphos-122* amylase-65 totbili-0.3 05:30am blood lipase-35 05:20am blood ck-mb-notdone ctropnt-<0.01 01:12pm blood ck-mb-2 ctropnt-<0.01 05:30am blood ck-mb-notdone ctropnt-<0.01 08:00am blood albumin-3.4 calcium-8.0* phos-5.0* mg-1.6 01:12pm blood hbsag-negative hbsab-negative hbcab-negative 05:30am blood acetmnp-neg 01:12pm blood hcv ab-negative 08:40am blood type-art po2-72* pco2-34* ph-7.46* calhco3-25 base xs-0 08:40am blood lactate-2.0 08:40am blood freeca-0.90* . studies: . ekg: nsr, normal axis, likely v1 and v2 reversal, twi in v2, ? st depr < 0.5mm in ii and v5/6 - repeat ekg without these changes. no change from prior ekg. . cxr : heart normal in size, mediastinal and hilar contours are normal. pulmonary vascularity is normal, lungs are clear. no effusions or pneumothorax. multiple healed bilateral rib fractures are demonstrated. clips in the left axilla demonstrate prior lymph node dissection. overall, no acute cardiopulmonary abnormality. . cxr: upright ap view of the chest: aside from low lung volumes, the lungs are clear. the heart size, and mediastinal and hilar contours are normal. the pleurae are normal. clips in the left axilla denote prior lymph node dissection. multiple bilateral healed rib fractures are present. . ruq u/s: impression: 1. normal liver. no evidence of bile duct dilatation. 2. gallbladder polyp and possible tiny stones. no cholecystitis. . echo: conclusions: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the report of the prior study (images unavailable for review) of , there is no significant change. . discharge labs: 04:50am blood wbc-7.2 rbc-2.69* hgb-8.0* hct-24.0* mcv-89 mch-29.7 mchc-33.3 rdw-18.7* plt ct-363 04:50am blood plt ct-363 04:50am blood glucose-60* urean-13 creat-0.9 na-147* k-3.0* cl-109* hco3-29 angap-12 04:50am blood alt-73* ast-50* ld(ldh)-195 alkphos-112 totbili-0.3 06:47am blood lipase-17 04:50am blood calcium-8.2* phos-3.2 mg-1.5* 01:12pm blood hbsag-negative hbsab-negative hbcab-negative 05:30am blood acetmnp-neg 01:12pm blood hcv ab-negative brief hospital course: brief overview: 57 yo f with h/o polyglandular autoimmune syndrome initially admitted in to for suicide overdose then transferred to 4 for depression, who was transferred to the medical floor for a syncopal episode and hypotension to 60 systolic that returned to baseline with 2.5l ivf who was subsequently transferred to the micu for a recurrent episode of hypotension, fevers and concern for sepsis. initially when she arrived to the floor she was afebrile, normotensive without signs of orthostasis, had a negative ua, a clear chest xray and no signs/symptoms of a fever. she was slightly tachycardic. she was initially not started on antibiotics. she was given a standing ivf order. overnight she became febrile to 102.3, increasingly tachycardic to 125, and hypotensive to 80 systolic. she was started on stress dose steroids and levo,flagyl, and vanco. she was given 4l of fluid boluses and transfered to the micu. in the micu, repeated attempts to place lines were unsuccessful. the above treatments were continued. urine cultures returned with 10-100,000 organisms coag negative staph. blood cultures remained negative. vital signs stabilized and she was transfered back to the medical floor after 2 days in the icu. stress dose steroids were planned for a 7 day course, antibiotics were peeled back to levofloxacin alone, and a r hip film revealed no loosening nor inflammation. echo showed normal function, trace ar, and no mr. she had a normal ruq us, as well. on the floor the patient remained stable hemodynamically without recurrent fever and was stable for transfer back to 4. at the time of discharge, her potassium had been low despite repletion, na was elevated, as was blood pressure. on recommendation from endocrine, her fludrocortisone was decreased from 0.2 to 0.1 (higher than required doses of fludrocort can cause these symptoms.). . 1. hypotension: patient presented after episode of hypotension and syncope on 5. initially it was felt that this was a result of poor po intake. she was afebrile without orthostatic vital signs nor hypotension. she had no symptoms of infectious source, normal ua, normal chest xray, and no symptoms nor signs of injury after her fall with syncope. neuro exam was normal. subsequently overnight, she developed a fever to 102.3 and recurrent hypotension in the setting of fevers and tachycardia that was concerning for an infectious source. she still had no localizing signs of infection and culture data was negative to be negative. ruq us was ordered and returned without signs of infection later. she was started on stress dose steroids. she had cultures drawn, was given tylenol (tylenol screen prior to this dose was negative, as was a urine tox), was started on levofloxacin, metronidazole, and vancomycin to cover emperically for hospital aquired pneumonia, gi sources, and a potential hip infection. her transaminases were slightly elevated, which was later attributed to shock liver as a result of her period of hypotension. lipase and amylase remained normal. in the icu she also received an echo that revealed normal function and little valvular disease (she has two loud systolic murmurs on exam), and a hip film revealing no inflammation nor loosening. urine culture twice grew 10-100,000 coag negative staph. a line could not be placed for technical reasons, however after 4l ns on the floor and more in the icu via peripheral iv's she was stable. she remained hemodynamically stable with good uop in the setting of being started on abx and stress dose steroids. the steroids were thought to have helped significantly in in the setting of addison's with possibely superimposed infection. the patient was planned for a 7 day course of stress dose steroids followed by a return to her basal predinisone/fludrocortisone dose. . 2. elevated lfts: lfts wre elevated at presentation. initially the differential was thought to include shock liver from hypotension, hepatitis, cholangitis or choledocholithiasis. hepatitis serologies were negative and the pt was eventually felt to have had shock liver from her hypotensive episode as the transaminitis resolved over time. . 3. hypoparathyroidism: this is a chronic problem. calcium levels were followed with a goal to keep them around 8.0 by continuing calcium carbonate, calcitriol. the pt required calcium gluconate x1 the day prior to discharge. per endocrine at the time of discharge, the pt may need an increase in calcium po, but at this time they recommended no change. it will need to be monitored over time. . 4. addison's- the patient is on basal prednisone/fludrocortisone. these were initially continued as above and later, when she became hypotensive and febrile, stress dose steroids were started and planned for a 7 day course followed by a return to her prior dose of prednisone. at the time of discharge, her potassium had been low despite repletion, na was elevated, as was blood pressure. on recommendation from endocrine, her fludrocortisone was decreased from 0.2 to 0.1 (higher than required doses of fludrocort can cause these symptoms.). . 5. dm: followed the patient. she was continued on her prior dose of steroids with sliding scale per patient using a 1:15 carb counting scheme with a 1:30 correction factor. on the day of discharge her glargine was decreased by one unit because her glucose remained somewhat low in the mornings. . 6. r hip pain: later in her hospital course, the pt complained of hip pain. a r hip film was negative for pathology or failure of her hip replacement. pain was controlled with tylenol and the pt was reassured. pt was consulted. the pt uses a wheelchair often at baseline due to pain from arthritis. . 7. depression: the pt was being treated at 4 for suicidal ideation and a suicide attempt on original admission with tylenol and oxycodone. she had planned this attempt carefully without the knowledge of those close to her and very much expected her attempt to work. she had been depressed for some time but her loved ones were very surprised at her attempt. she remained very depressed at her inpatient admission and refractory to treatment. one day prior to her transfer to the medical floor she was sectioned to initiate ect, which she had previously refused. as a result, she was maintained on her ativan, mirtazapine, risperidone, duloxetine. she did not exhibit psychotic symptoms. she had a 1:1 sitter at all times. she denied any but did endorse depression. she denied hi, si, and illusions/hallucinations. her mood appeared stable throughout her hospitalization. she was followed by psychiatry in consultation while she was on the medical floor. . the patient did have heparin subcutaneously while on the medical floor and in the icu. . she remained full code throughout the hospitalization. as on prior hospitalization, her hcp was shared by . . medications on admission: meds on transfer: fludrocortisone acetate 0.2 mg po daily @ 1033 acetaminophen 650 mg po bid @ 1503 view ibuprofen 400 mg po bid @ 1503 view ibuprofen 400 mg po q8h:prn @ 1503 view insulin sc (per insulin flowsheet) risperidone 1 mg po hs @ 1135 view risperidone 0.5 mg po daily @ 1135 view potassium chloride 20 meq po bid calcium carbonate 1500 mg po tid @ 1126 view mirtazapine 15 mg po hs @ 1220 view duloxetine 30 mg po bid start: in am @ 1214 psyllium 1 pkt po tid:prn @ 1248 view memantine *nf* 10 mg oral daily @ 1124 view calcitriol 0.25 mcg po every other day t/th/s/s calcitriol 0.5 mcg po every other day @ 1051 lorazepam 2 mg po hs @ 1215 view alendronate sodium 70 mg po qsun @ 1106 view lactulose 60 ml po qthur @ 1600 view milk of magnesia 60 ml po qthur @ 1600 view arimidex *nf* 1 mg oral daily @ 1414 view magnesium oxide 400 mg po bid @ view atorvastatin 20 mg po daily @ view docusate sodium 100 mg po tid @ view pantoprazole 40 mg po q24h @ view prednisone 2.5 mg po q3pm @ view prednisone 5 mg po qam @ view chlorothiazide 500 mg po daily @ view aspirin 81 mg po daily multivitamins 1 cap po daily . allergies: clindamycin / erythromycin base / amoxicillin / keflex / wellbutrin discharge medications: 1. risperidone 0.5 mg tablet sig: two (2) tablet po hs (at bedtime). 2. risperidone 0.5 mg tablet sig: one (1) tablet po daily (daily). 3. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 4. duloxetine 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 5. calcitriol 0.25 mcg capsule sig: one (1) capsule po every other day (every other day). 6. calcitriol 0.5 mcg capsule sig: one (1) capsule po every other day (every other day). 7. alendronate 70 mg tablet sig: one (1) tablet po qsun (every sunday). 8. lactulose 10 g/15 ml syrup sig: sixty (60) ml po every thursday (). 9. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. 10. anastrozole 1 mg tablet sig: one (1) tablet po daily (). 11. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 12. docusate sodium 100 mg capsule sig: one (1) capsule po tid (3 times a day). 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 14. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 15. multivitamin capsule sig: one (1) cap po daily (daily). 16. ibuprofen 400 mg tablet sig: one (1) tablet po bid (2 times a day). 17. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 18. maalox 200-200-20 mg/5 ml suspension sig: fifteen (15) ml po prn (as needed). 19. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 days. 20. calcium carbonate 500 mg tablet, chewable sig: three (3) tablet, chewable po tid (3 times a day). 21. calcium carbonate 500 mg tablet, chewable sig: three (3) tablet, chewable po qid (4 times a day). 22. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 23. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 24. prednisone 2.5 mg tablet sig: one (1) tablet po q 3pm (). 25. chlorothiazide 250 mg tablet sig: two (2) tablet po daily (daily). 26. fludrocortisone 0.1 mg tablet sig: one (1) tablet po daily (daily). 27. potassium chloride 10 meq capsule, sustained release sig: four (4) capsule, sustained release po daily (daily). 28. lorazepam 1 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed. 29. memantine 5 mg tablet sig: one (1) tablet po daily (). 30. insulin glargine 100 unit/ml solution sig: as instructed subcutaneous twice a day: 7 units in the morning, 18 units in the evening. discharge disposition: extended care facility: 4 discharge diagnosis: hypotension early sepsis adrenal insufficiency diabetes i hypocalcemia (hypoparathyroidism) depression transaminitis discharge condition: stable vitals, depressed. discharge instructions: you were admitted with a low blood pressure and developed a fever. you are finishing a course of antibiotics and have been stable for days. . if you lose consciousness, develop a low bp, have lightheadedness with standing, develop a fever, or have other worrisome symptoms, please seek medical care. followup instructions: as planned - continued consultation by and endocrine md procedure: venous catheterization, not elsewhere classified diagnoses: esophageal reflux acute kidney failure, unspecified unspecified septicemia other chronic pulmonary heart diseases personal history of malignant neoplasm of breast sepsis diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled hypoparathyroidism cholesterolosis of gallbladder other specified polyglandular dysfunction 

Answer: The patient is high likely exposed to