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 attending: chief complaint: left flank pain major surgical or invasive procedure: central line placement history of present illness: 54 yo woman with a pmh significant for dvt/pe, aortic atheroma c/b sma embolization requiring bowel resection who presented to with a 1 day h/o acute, sharp left flank pain. the patient had recently been taken off warfarin for a rectus sheath hematoma. she was in her usoh until the morning prior to presentation when she woke from sleep with 10/10 sharp, l sided flank pain. the pain started on her left side, with some radiation to her back. the pain was somewhat colicky, but mostly constant and sharp. the pain was somewhat relieved by sitting upright, but had few alleviating or exacerbating factors. the patient presented to where she was given dilaudid and zofran. a ct abdomen was done that showed a left renal artery infarct. the patient was transfered to our ed for more acute care. in the ed, the patient's vs: 98.5 84 139/85 20 98% 2l. a cta was repeated that once again showed non-enhancement of the left upper pole of the left kidney c/w renal infarct. the patient was given levaquin and vanco for leukocytosis and fever. the patient was seen by vascular surgery and ir and started on a heparin gtt before being transfered to the floor for further management. on the floor, the patient's vs 99.7, 124/88, 86, 18, 97% ra. the patient was still with 10/10 left sided pain with radiation to her back and abdomen. the patient is still making urine, no gross blood. otherwise, the patient's condition is unchanged. past medical history: left lower leg dvt pulmonary embolism (on coumadin, dx ) descending aortic arch thrombosis (dx ) mesenteric ischemia s/p embolectomy, hyperlipidemia psoriasis peripheral vascular disease (treated medically at by dr. past surgical history: appendectomy (remote) distal sma embolectomy (, ) ex-lap, ileocolectomy (resection from mid-ileum to mid-transverse colon) (, ) second-look exlap, packing removal and washout (, ) social history: smoking - 1 ppd x 36 years, occassional etoh (no longer drinking), no illicts, widowed without children family history: mother with dm physical exam: admission exam vs - temp 99.7 f, 124/88 bp , 86 hr , 18 r , 97 o2-sat % ra general - obese women in intermittent pain, sitting upright in bed heent - perrla, eomi, sclerae anicteric, dry mm neck - supple, no thyromegaly, no jvd, no carotid bruits lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - distant heart sounds, rrr, no mrg, nl s1-s2 abdomen - obvious bruising of rectus, more so on left side, exquisitely tender of left abdomen/flank, voluntary guarding, hypoactive bowel sounds extremities - wwp, 1+ pitting edema bilaterally neuro - awake, a&ox3, cns ii-xii grossly intact discharge exam vs: 98.2 112/62 75 18 98% ra general: obese woman sitting up comfortably in chair heent: perrla, eomi, sclerae anicteric, mmm lungs: ctab, good air movement without crackles/wheezes heart: distant heart sounds, rrr, no m/r/g, nl s1/s2 abdomen: large scattered ecchymoses on abdomen, very mild tenderness to palpation on exam extremities: wwp, 2+ pitting edema bilaterally neuro: awake, speech fluent, moving all extremities spontaneously pertinent results: admission labs 12:20am blood wbc-11.5*# rbc-3.85* hgb-12.1 hct-37.7# mcv-98 mch-31.5 mchc-32.2 rdw-14.0 plt ct-513* 12:20am blood neuts-85.9* lymphs-9.7* monos-3.2 eos-0.9 baso-0.3 12:20am blood pt-12.8 ptt-19.2* inr(pt)-1.1 12:20am blood glucose-135* urean-11 creat-0.7 na-139 k-3.6 cl-103 hco3-25 angap-15 12:28am blood alt-12 ast-16 alkphos-57 totbili-0.8 09:16pm blood calcium-8.4 phos-2.6* mg-1.6 09:16pm blood cortsol-11.4 pertinent studies cta abd/pelvis impression: 1. non-enhancement of portions of the renal parenchyma involving the left upper pole, large portions of the lateral and anterior mid kidney consistent with renal infarct. no obvious filling defect within the left renal artery to suggest thrombus. 2. stable-sized rectal sheath hematoma and intra-abdominal extraperitoneal hematoma. 3. stable-appearing paraumbilical hernia containing colon. echo the left atrium is mildly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: normal global and regional biventricular systolic function. study inadequate to exclude a patent foramen ovale. l upper extremity ultrasound : left upper extremity ultrasound: the left internal jugular vein could not be visualized on axial images for compression maneuvers. on sagittal images, the vein appears diminutive but patent. catheter is identified in the left subclavian vein, without surrounding thrombus. there is normal compressibility, flow, and augmentation in the bilateral subclavian and left axillary, brachial, basilic and cephalic veins. there is diffuse subcutaneous edema. impression: 1. no left upper extremity dvt. 2. diffuse subcutaneous edema. l lower extremity ultrasound : -scale and doppler images of the right and left common femoral, left superficial femoral, popliteal and proximal calf veins were obtained. there was wall-to-wall flow with normal response to compression and augmentation in all visible veins. the popliteal artery is superficial to the popliteal vein. impression: no dvt or fluid collections in left lower extremity. microbiology: blood culture : negative brief hospital course: 54 year-old woman with a history of dvt and pe on warfarin who was also on aspirin and cilostazol for pvd recently had been taken off warfarin for a rectus sheath hematoma presents with left renal infarction confirmed by cta of abdomen and pelvis. whether the renal infarct was caused by embolism or thrombosis is unknown. hematology and vascular surgery consults were obtained. she was started on heparin gtt. subsequently, she had a drop in hematocrit 36.6-->31.9 and was hypotensive, so was transferred to the micu for concern of active bleeding. she received 2 units of prbcs. repeat ct abdomen did not show any enlargement of rectus sheath hematoma. hematocrit stabilized and patient was transferred back to the floor. she was continued on heparin gtt until her inr was therapeutic. the decision was made to not restart aspirin or cilostazol for pvd for now given her recent spontaneous rectus sheath hematoma. hematocrit was stable for 3 days at a level of about 36. problem list: # renal infarct: patient presented from with diagnosis of left renal infarct, which was confirmed on cta of abdomen and pelvis. it remains unclear whether the infarct of the left renal artery is from an embolic source or is thrombotic. both hematology and vascular surgeries were consulted. of note, prior coagulation workup has been negative for lupus anticoagulant, anticardiolipin, anti-beta2-glycoprotein-1 antibodies and factor v leiden were negative. pt has an atheroma at the descedning aorta right beneath the aortic arch, which was considered as possible embolic source. she was continued on simvastatin. heparin gtt was continued until inr therapeutic. dilaudid po was used for pain. # anticoagulation: given her extensive history of arterial and venous clots, she will likely require lifelong anticoagulation. patient was started on heparin gtt and bridged over to coumadin. on the day of discharge, patient's inr was 2.1. patient will follow up with her pcp for inr checks. given her recent bleeding, her aspirin and cilostazol were held on discharge. # rectus sheath hematoma: patient was recently taken off her coumadin after developing hematoma. there was concern for enlarging hematoma as described above, but the hematoma remained stable in appearance both in exam and on ct scans. # fever: patient had fever on admission and it was thought to be secondary to renal infarct or her hematoma, without any evident infectious source. patient denies cough, dysuria, diarrhea, or change in mental status. her only complaint is abdominal pain, which is associated with her known renal infarct. given multiple recent hospitalizations and instrumentation along with fevers and embolic event, diagnosis of endocarditis was considered, but her echo was negative. she was empirically covered with vancomycin and meropenem in the micu, but it was discontinued on the floor. the fevers resolved on their own and her blood culture are negative at the time of discharge. # anemia: patient developed 7 pt hct drop after being started on heparin drip on the floor, which was concerning for hemorrhage. patient did not have any melena/hematochezia/hemetemesis. she was transferred to micu for monitoring and her heparin gtt was initially discontinued while work up was done for source of bleed. pt received 2 units prbcs. her hct remained stable afterwards and she was restarted on heparin gtt and coumadin bridge. # hypotension: pt developed hypotension on the floor with anemia as above, most likely related to bleeding. a-line and central venous line were placed in the micu and pt received 2 u prbc. no pressor was given during her micu stay. her hypotension resolved on the floor. # copd: pt was continued on spiriva # pvd: aspirin was held on admission. she was initially continued on cilostazol, but upon discussion with the vascular surgery team and the patient, decision was made to stop cilostazol as it added to the bleeding risk that she has and patient did not feel that she derived much symptomatic benefit from the medication. # constipation: patient developed constipation while in the hospital. she was given senna, docusate and home miralax without effect. it was thought to be due to the increase in narcotics that she was receiving for l renal infarct. lactulose was added to her bowel regimen with good effect. she was given prescription for lactulose on discharge. medications on admission: aspirin 325mg po pletal 100mg po bid clobetasol 0.05% cream pepcid 20mg po bid folic acid 1mg po qday miralax 17g po qday zocor 40mg qday spiriva qday lasix 40mg qday prn for fluid retention nitro q5min for chest pain atarax 10mg po 1-2 tabs tid prn anxiety oxycodone 5/325 1-2 tabs q6hrs prn pain coumadin recently held discharge medications: 1. clobetasol 0.05 % cream sig: one (1) appl topical (2 times a day). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. furosemide 40 mg tablet sig: one (1) tablet po once a day as needed for fluid retention/leg swelling. 7. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet sublingual every 5 mins as needed for chest pain: take one tablet, if chest pain does not get better, call 911. 8. atarax sig: one (1) tablet three times a day as needed for anxiety. 9. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*0* 10. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 11. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*20 tablet(s)* refills:*0* 12. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po twice a day as needed for constipation. disp:*300 ml(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnoses: - left renal infarct - abdominal rectus sheath hematoma - acute blood loss anemia secondary diagnoses: - deep venous thrombosis - pulmonary embolism - peripheral vascular disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , you were transferred to the for decreased blood supply to your left kidney, which caused a lot of pain. our vascular doctors saw and recommended that you start anticoagulation to prevent further kidney damage. on anticoagulation, your blood pressure dropped as did your red blood cell count, which was concerning for bleeding. as you had a known abdominal hematoma, the thought was that you had some bleeding into your abdomen. you were transfered to the icu for stabilization and received some blood. once your blood counts stabilized, you were started back on warfarin and your inr was monitored. given swelling in your leg, ultrasound of your legs were done and did not show any hematoma or clot. on the day of your discharge, your inr was 2.1. please get your inr checked on thursday when you follow up with dr. . because of your repeated clots, you will likely need to be on lifelong coumadin. please speak with your pcp about getting referral to a local hematologist who can follow you. stop taking these medications: - pletal 100 mg by mouth twice daily - aspirin 325 mg daily - percocet 5/325 for pain as needed these new medications were started for you: - coumadin 5 mg by mouth every evening. please follow up with your pcp to follow your inr level and follow his directions on how to take coumadin. - dilaudid 2 mg tablet: take tablet every 4 hours by mouth as needed for pain - lactulose 10 mg (15 ml = 1 tablespoonful) as needed for constipation complete medication list: - clobetasol 0.05 % cream: apply to affected area 2 times a day - folic acid 1 mg tablet: one tablet by mouth daily - simvastatin (zocor) 40 mg tablet: one tablet by mouth every evening - tiotropium bromide (spiriva) 18 mcg capsule: one capsule by inhalation every day - famotidine (pepcid) 20 mg tablet: one tablet by mouth twice daily - furosemide (lasix) 40 mg tablet: one tablet by mouth once a day as needed for fluid retention/leg swelling. - nitroglycerin 0.4 mg tablet, sublingual: one tablet under the tongue every 5 mins as needed for chest pain; take one tablet, if chest pain does not get better, call 911. - atarax 10 mg tablet: one tablet three times a day as needed for anxiety. - polyethylene glycol (miralax) 17 gram/dose powder: dissolve 1 tablespoonful powder in water and drink daily as needed for constipation. - warfarin (coumadin) 5 mg tablet: one tablet by mouth daily at 4 pm. - hydromorphone (dilaudid) 2 mg tablet: take 1-2 tablets by mouth every 4 hours as needed for pain. - lactulose 10 gram/15 ml syrup: take fifteen (15) ml by mouth twice a day as needed for constipation. followup instructions: name: , e. location: chc address: , , phone: appointment: thursday at 9am procedure: venous catheterization, not elsewhere classified diagnoses: acute posthemorrhagic anemia peripheral vascular disease, unspecified other and unspecified hyperlipidemia personal history of venous thrombosis and embolism primary hypercoagulable state nontraumatic hematoma of soft tissue chronic obstructive asthma, unspecified other psoriasis vascular disorders of kidney embolism and thrombosis of thoracic aorta 

Answer: The patient is high likely exposed to