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: no known allergies / adverse drug reactions attending: chief complaint: abdominal pain and diarrhea major surgical or invasive procedure: flexible sigmoidoscopy picc placement history of present illness: mr. is a 75m with history notable for metastatic prostate cancer, htn, cad s/p recent stenting, severe as, dchf, heart block s/p pacemaker, prior gastric ulcers, pancytopenia, and prior anemia felt secondary to gi bleed who presented to on with abdominal pain and diarrhea. for two days prior to presentation, patient had constipation, but no n/v. saw his pcp , and had kub which was c/w constipation. was started on bowel regimen with colace and mag citrate, and on the morning of , woke up with fecal urgency and had multiple large semi formed bowel movements. after multiple bowel movements, he was extremely fatigued prompting him to call 911. in addition to his fecal urgency, he also complained of worsening diffuse abdominal pain, worse with palpation/manipulation. he denied any melena, nausea or vomiting. he initially presented to , where per report he had guaic positive stools. his labs were notable for hct 28. plt 158, inr 1.1, cr 1.3 (up from baseline 1), slightly elevated tbili 1.67. lactate was 2.3. while at , the patient was transferred to the icu as his hct decreased from 28 to 22 and he was oliguric. rec'd transfusion. of note, he remained hemodynamcially stable he underwent a ct abd/pelvis which showed a multifocal small bowel abnormality with acute on chronic inflammation, and of note there were some intervening loops of small bowel that appeared normal, raising the question of possible crohn's. he was also noted to have a large amount of stranding in the left pelvic sidewall and left lower retroperitoneum of the abdomen, indicating acute inflammation. there was a distinct and abnormal portion of the sigmoid colon suggestive of focal colitis, possibly ischemic. he has extensive atherosclerotic disease with moderate-severe narrowing of the sma and possibly the celiac, but patent. also of note, he was found to have an isolated segment of peripheral portal vein thrombus without more proximal thrombus. ct scan also raised concern for left common femoral artery pseudoaneurysm that was not seen on ultrasound. he was evaluated by gi and surgery, who did not feel there was a need for acute surgical intervention. plan was to proceed with conservative measures including fluid resusictation and antibiotics. given rsk factors, gi didn not think he was a cnadidate for an egd or colonsocopy. per family's request, he was transfered to for further management. of note, the patient recently had multiple cardiac procedures, including a des to lad in mid by dr. , and a des to rca in late with a complication of a left groin hematoma post procedure. additionally, given bradycardia and wenkebach rhythm, had a pacemaker placed on . plans at that time were to continue asa and plavix for minimum of one year. regarding his aortic stenosis, he was deemed high risk and decision was made for valvulplasty at a later date. on arrival to the icu, patient is lethargic requesting fluids. complaining of moderate abdominal pain worse with manipulation. otherwise no other complaints. states last bowel movement was several hours ago. review of systems: (+) per hpi. also endorses 10 lbs weight loss in last 3 weeks, claiming general malaise for this period. also c/o l/r shoulder pain for last few days. endorses chronic left lower extremity swelling since lymph node removal in the 's. (-) denies recent travel, food aversion/abdominal angina. no fever, chills, night sweats, recent weight gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations. denies nausea, vomiting, changes in bowel habits. denies dysuria, frequency, or urgency. denies myalgias. denies rashes or skin changes. past medical history: 1. severe aortic stenosis. workup in process for valvuloplasty with dr. . 2. diastolic congestive heart failure with an ef of 70%. 3. hypertension. 4. metastatic prostate cancer on lupron. 5. gastroesophageal reflux disease. 6. gastric ulcer, details not very clear. 7. mild ascending aortic dilation. 8. lymphoma in , lymphedema of his right lower extremity status post lymph node removal in . 9. he has a history of testicular cancer (?). . other medical problems are: 1. cad status post stent. 2. left inguinal hernia. 3. advanced heart block status post pacemaker recently placed in . 4. anemia felt due to gi bleed. 5. ulcers. 6. lymphoma. 7. pancytopenia; was supposed to have a bone marrow biopsy. social history: the patient lives at home. no history of smoking. drinks 1 glass of wine a night. no illicit drug use. lives with wife and 2 dogs. works as insurance broker. 2 daughters that live near by and 1 son who is a colorectal surgeon in family history: mother passed away age from multiple comorbidities. father passed away in his 50's from heart disease. brother passed away age 69 from complications of diabetes. sister passed away age 70 from mi and had a history of etoh abuse. denies history of ibd/celiacs/liver disease. physical exam: admission examination vitals: t:100 bp: 139/54 p: 77 r: 28 o2 94% on 2l general: alert but lethargic, oriented, no acute distress. ashen appearing. heent: sclera anicteric, dry mucous membranes, oropharynx clear neck: jvp not elevated, no lad. supple neck. no supraclavicular lad. lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, loud crescendo decrescendo murmur, late peaking with blurring of s2 with carotid radiations best auscultated in aortic region. otherwise no other adventitious heart sounds appreciate. pmi slightly lateralized towards axilla. abdomen: ventral hernia appreciated in the midline. tenderness to moderate palpation, worst in the llq. soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: dark yellow urine ext: warm, well perfused, 2+ pulses, rle with indurated nonpitting edema 2-3x larger than lle. no pain in calf. pertinent results: admission labs: 05:30pm blood wbc-8.0# rbc-3.30* hgb-10.0* hct-29.5* mcv-89 mch-30.3 mchc-34.0 rdw-15.2 plt ct-141* 05:30pm blood neuts-95* bands-1 lymphs-0 monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-0 05:30pm blood hypochr-normal anisocy-2+ poiklo-normal macrocy-normal microcy-occasional polychr-normal ovalocy-1+ burr-occasional 05:30pm blood pt-16.7* ptt-29.1 inr(pt)-1.6* 05:30pm blood glucose-115* urean-41* creat-1.2 na-142 k-4.8 cl-112* hco3-21* angap-14 05:30pm blood alt-18 ast-21 ld(ldh)-148 alkphos-105 totbili-4.7* dirbili-1.1* indbili-3.6 05:30pm blood albumin-3.4* calcium-8.0* phos-4.1 mg-2.7* 05:30pm blood hapto-140 05:57pm blood lactate-1.0 micro: blood cultures , (): pending urine culture (): <10,000 org/ml gnrs images: cxr (): the lungs are clear. heart size is within normal limits. pulse generator in the left chest with electrodes in the right atrium and right ventricle has the expected appearance. aortic arch calcification indicates atherosclerosis. mediastinal contour is normal. no suspicious bone findings or degenerative changes in the left ac joint. ct abd/pelvis w/contrast (): 1. multifocal small bowel abnormality suggesting acute on chronic inflammation. as there do appear to be normal intervening loops of small bowel, this raises the question of crohn's disease. the enteropathy appears to be limited to the wall for the most part with only minimal areas of inflammation that extend into the serosa but there is no mesenteritis or abscess. 2. large amount of stranding in the left pelvic sidewall and left lower retroperitoneum of the abdomen, indicating acute inflammation. distinct and abnormal portion of the sigmoid colon within the pelvis suggests focal colitis of which ischemic colitis is possible. no perforation or pneumatosis. 3. extensive atherosclerotic disease with moderate-severe narrowing of the sma and possibly of the celiac artery but patent . this would raise the patient's risk for ischemic bowel disease. 4. extensive coronary artery disease and aortic valve calcification, likely reflecting aortic stenosis, as suggested on cta chest from in . 5. bilateral renal infarcts subacute and chronic in appearance. extensive atherosclerosis bilateral renal arteries as well. 6. isolated segment 5 peripheral portal vein branch thrombus without more proximal thrombus. markedly atrophic left lobe of the liver. 7. concern for left common femoral artery pseudoaneurysm. this was not seen at ultrasound at and findings appear to have evolved since that time and the left common femoral artery appears slightly larger, though it is difficult to compare between the modalities. 8. left pubis heterogeneous sclerosis likely reflects prostate . impression: ct abd/pelvis 1. no evidence of visceral perforation as questioned. 2. interval increased segmental small bowel thickening and dilatation up to 4-cm extending to the terminal ileum with increased ascites and subtle relative mucosal of bowel loops in left upper quadrant. no transition point identified. persistent stable sigmoid and descending colitis. overall, findings are compatible with known ischemic colitis and enteritis. 3. persistent ascites and anasarca. 4. unchanged moderate bilateral pleural effusions with atelectasis. 5. fluid layering in the lower esophagus, placing patient at increased risk for aspiration. 6. severe hepatosteatosis. 7. bilateral cortical and parapelvic renal cysts. left renal cortical thinning. 8. severe diffuse atherosclerotic disease, without evidence of frank vessel occlusion. 9. left superior pubic ramus sclerosis may represent metastatic disease in the setting of known prostate cancer. , ekg (): sinus rhythm with rate of 76. lad. poor rwp. twi in avl, v1, flattening in v2 (changed from prior, may be lead placement). pr interval 0.24 msec, normal qt. no evidence of ste/flattening. . echo : the left atrium is elongated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef 70%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (valve area 0.7 cm2). moderate (2+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is borderline/mild functional mitral stenosis (mean gradient 4 mmhg) due to mitral annular calcification. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. brief hospital course: the patient is a 75 year old man with known severe aortic stenosis, diastolic hf, hypertension, metastatic prostate cancer, distant past lymphoma, s/p recent 2 stents several weeks prior to presentation, now here with likely diffuse ischemic injury to his small bowel and colon. the patient was initially transferred from with abdominal pain and diarrhea after being diagnosed with colitis. unclear cause, but some concern for either embolic vs vascular insult, as atypical distribution of areas of involvement. the patient intially improved on bowel rest, but his pain worsened after a trial of liquids and strict bowel rest was resumed. increasing abdominal pain in the setting of po intake, but has not improved significantly since transition back to npo status. a picc was placed with plans for initation of tpn on . fever to 101f on , without focal identifiable source beyond the potential for translocation of bacteria from the ischemic bowel. we continue to discuss with the patient and his family regarding the severity of his illness and his wishes for his care. #abdominal pain/patchy colitis and bowel necrosis: patient's pain symptoms staretd after diarrhea. radiographic imaging at osh confirmed patchy acute on chronic small intestin inflammation with possible question of inflammatory disease. additionally, stranding on the left pelvic sidewall and lower retroperitoneum suggestive of focal colitis to which ischemic colitis was entertained. while theoretical the patient may have had poor forward flow in the presence of diarrhea and severe as, the patient's presentation is not necessarily consistent with ischemic etiology. while sigmoid involvement is possible in the rectalsigmoid area (sudeck's point), distribution of inflammation of the small intestine with patchy inflammation is not consistent with a vascular territory or watershed area. additionally, ct read showed a patent with thrombosis downstream less likely. lastly, lactate was initially elevated above 2, but decreased with rehydration to less than 1. other possibilities included diverticulitis, but would not explain small intestinal findings. ibd is possible although less likely for initial occurrence to be in a patient in his 70's. infectious colitis possible, however stooling has stopped with decreased po intake and c.diff negative at osh. stool studies were negative for cdiff and ova and parasites while here. bilirubin initially elevated but this was indirect hyperbilirubinemia with benign ultrasound and resolved without particular intervention. while gastritis is possible and his history is unclear regarding pud, this would not explain his ct findings. antibiotics were held (was given ertapenem at osh) as it was felt the patient was not actually experiencing bowel necrosis. cbc was trended and no evidence for infection. iv ppi was dcd as he had received 48 hours of iv ppi and no evidence of further bleeding. abdominal exam remained relatively benign although he did have pain the night of admission. gi was consulted and recommended flexible sigmoidoscopy, which showed extensive bowel necrosis. colorectal surgery felt the patient was not an operative candidate due to the small and large bowel distribution. after transfer to the floor pt was on tube feeds, and abdominal pain progressed. repeat abdominal ct showed worsening of bowel wall edema/necrosis. his prognosis appeared quite limited, given the extent of the ischemic colitis and necrosis, as well as his underlying medical conditions. ongoing discussion regarding the patient's wishes and hopes for his treatment, especially in the setting of a poor prognosis. pallative care was consulted. see goals of care below. # hyoxia - day prior to death pt was developed acute onset wheezing and subsequent hypoxia requiring transfer to the icu. pt developed wheezing which was initially responsive to albuterol, but subsequently became more hypoxic and dyspneic. in the setting of severe as, dchf and several liters positive over los, high likelihood that pulmonary edema/flash edema were a component. other possibilities included ischemic event vs ossible albuterol induced tachycardia with subsequent flash. pt was given lasix 20mg iv x1, with significant improvement in symptoms. pt also became febrile to 101 peripherally with shaking chills and new obscuration of l hemidiaphragm concerning from evolving hap (at that time was on vanc/cipro/flagyl), though this doesn't exactly fit with the reportedly acute time course. further, pt with chronic rle lymphedema appearing enlarged, mildly erythematous and tender, in setting of no dvt ppx, concern for vte. also of note, pt with persistent bilateral pleural effusions. abx coverage broadened to vanc/zosyn. . #gi bleed: guiac positive stools at osh in presence of hct drop from 28 to 22. reported history of gastritis/pud. this was also in the presence of fluid resuscitation. per report, patient did receive 2 u prbc transfusiion. hct appears to have stabalized in house without further epsiodes of diarrhea or suggestions of gib. was continued on omeprazole 20mg daily. hct was monitored closely without signs of further bleeding. . #as/diastolic chf: per reports severe as 0.8-1.0 aortic valve area. future plans might include valuvloplasty if patient continues to have cad symptoms per dr. note in 3/. i's and os carefully monitored with pt positive 1l over the first 2 days of hospitalization but developed no signs of acute on chronic diastolic chf. initially started on metoprolol then switched to carvedilol for better blood pressure control to help minimize afterload and strain on ventricle. #cad s/p recent : the patient had two des placed in the last month, one in the rca and one in the lad. on presentation to the osh had a mild troponin elevation but ekg appeared improved from with resolution of previous q waves and elevation likely due to procedure <10 days before given troponin stays in system for two weeks. at initial hct drop at osh asa and clopidogrel were held but then restarted soon after with stable hct given high risks of stent rethrombosis. he never had chest pain or clear signs of acs. #normocytic anemia with concurrent pancytopenia: per prior reports has a history of pancytopenia. prior heme onc notes from during patient's admission for catherizations/pacemaker placement discuss likely marrow suppression from lupron use or mds. coupled with history of radiation for metastatic prostate cancer, further marrow dysfunction is possible. coupled with low reticulocyte counts, mds high on differential. interestingly, white count while in normal limits, was elevated about 2x higher than baseline. haptoglobin/ldh did not suggest hemolysis, although he did have an elevated bilirubin with the majority being indirect, but this rapidly resolved as quickly as it presented. it was considered that he may have an underlying gilberts, but unclear. . #hypotension - on return to the pt was hypotensive requiring 3 pressors. dr. had discussions with the patient's son, who is -rectal surgeon, by phone (son in ). aggressive therapy was maintained until the son could travel to . the following day his son came and family decided to turn off pressors. pt within the hour. . #fever: presumed related to ischemic bowel and progression of necrosis. started on cipro/metronidazole when abdominal pain worsened, then added vancomycin with pending blood cultures. . #: likely prerenal. improved with ivf. pt was hydrated judiciously and resolved. . #question pseudoaneursym on ct: no evidence on physical exam. hct drop may be related to aneursym pooling. serial exams were not concerning for further enlargement/bleed. . #1st degree av blockade: s/p pacemaker dcci recently. . #history of prostate cancer: has been on lupron previously. followed by dr. . . pt . medications on admission: home medications: -meclizine 12.5 q.8 hours (listed in omr, patient denies) -omeprazole 20 mg p.o. daily -ferrous sulfate 300 mg p.o. b.i.d. -lisinopril 20 mg p.o. daily -plavix 75 mg p.o. daily -multivitamin 1 tablet once daily -aspirin 325 mg p.o. daily . medications on transfer: ertapenem 1 gram iv qday (day 1 ) aspirin 81 mg qday sennosides 2 tabs po qday prn ondansetron 4 mg iv q8hrs prn morphine sulfate 2 mg iv q4 hours prn docusate sodium 100 mg prn acetaminophen 1000 mg q6 hr prn pain esomperzaole 40 mg iv bid clopidogrel 75 mg po qday aspirin 324 mg po qday discharge medications: pt discharge disposition: discharge diagnosis: pt primary diagnoses: regional enteritis (ischemic bowel) anemia dehydration critical aortic stenosis coronary artery disease discharge condition: pt discharge instructions: pt procedure: parenteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of large intestine closed [endoscopic] biopsy of rectum central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified aortic valve disorders percutaneous transluminal coronary angioplasty status constipation, unspecified hypotension, unspecified alkalosis unspecified disorder of kidney and ureter iron deficiency anemia, unspecified cardiac pacemaker in situ encounter for palliative care dehydration precipitous drop in hematocrit chronic diastolic heart failure jaundice, unspecified, not of newborn benign essential hypertension unspecified vascular insufficiency of intestine other pancytopenia 

Answer: The patient is high likely exposed to