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: service: blue surgery history of present illness: mr. is a 36-year-old male with a past medical history of hodgkin's lymphoma treated approximately 15 years ago with staging laparotomy, splenectomy and nodal sampling followed by x-ray radiation therapy, the subsequent diagnosis two years ago of itp with evidence of splenosis by ct scan, which was treated with prednisone igg, and recently treated with rituxan with good effect. he presented approximately one month ago with severe abdominal pain and was diagnosed with portal vein thrombosis and started on coumadin after being heparinized. he presented to the emergency room at on with 2-3 day history of increasing abdominal pain on the right side. at this time he denies nausea, vomiting, positive flatus and still had a bowel movement at that time. ct scan was obtained from an outside hospital which demonstrated a focal area of small bowel wall thickening, portal vein thrombosis and superior mesenteric vein thrombosis. it was felt at that time that patient was experiencing worsening mesenteric ischemia and was admitted for exploratory laparotomy to assess the viability of his small bowel. past medical history: 1) hodgkin's lymphoma diagnosed 15 years ago. 2) itp diagnosed two years ago treated with igg and prednisone, recently treated with rituxan approximately one week prior to admission. 3) portal vein thrombosis diagnosed approximately one month ago. 4) hypothyroidism. 5) restless leg syndrome. 6) anxiety. medications: dilaudid 4 mg q 4 hours, prevacid 30 mg q day, levoxyl 250 mcg q day, mysoline 125 mg q d, paxil 40 mg q day, permax .015 mg q day, coumadin 5 mg q day. social history: a pack per day smoker times approximately 15 years, denies current alcohol use. physical examination: temperature 97, blood pressure 172/91, respiratory rate 22, oxygen saturation 93% on room air. he is an uncomfortable white male in apparent distress. respiratory exam was clear to auscultation bilaterally. cardiac, regular rate and rhythm, s1 and s2 appreciated. abdominal exam showed a firm abdomen with right sided tenderness, no shake tenderness, no cough tenderness. extremities were warm with palpable pulses distally. his rectal showed normal tone, and was guaiac negative at that time. laboratory data: on admission the patient had a white count of 13.1, hematocrit of 39.1, platelet count 148,000. electrolytes, sodium 141, potassium 3.3, bun and creatinine 14 and 0.9, glucose 112. at the time of admission prothrombin time of 23.3 and inr was 2.0. his liver function tests were all within normal limits with albumin of 3.2. the cat scan on admission from the outside hospital again showed small bowel wall thickening, portal vein thrombosis and superior mesenteric vein thrombosis. hospital course: the patient was admitted on for emergent exploratory laparotomy. he was evaluated by the general surgery service and the vascular surgery service. on admission the patient was begun on a heparin drip, iv antibiotics. the patient was taken for a repeat ct angiogram. this scan showed new free fluid within the abdomen with the same focal area of small bowel showing signs of ischemia. given the severe pain and clinical exam as well as ct findings, consent was obtained to proceed with the exploratory laparotomy. exploratory laparotomy was performed with the preoperative diagnosis of ischemic bowel. approximately a 50 cm segment of small bowel was found to be thickened/congested in the mid to distal ileum. it was found that all other small and large bowel was viable . the patient was admitted postoperatively from the operating room to the surgical icu. the patient was left intubated following his operation, given his bowel edema and otherwise guarded status. upon admission to the surgical intensive care unit the patient was noted to have laboratory values of white count 16.3, hematocrit 33.1, platelet count 99,000. , pt 15.5, ptt 29.2, inr 1.7, bun and creatinine were stable as were his liver function tests. once admitted to the surgical icu the patient was sedated on morphine and propofol. systolic blood pressure was maintained with fluid boluses and he was left intubated. he was admitted with an ng tube, central venous access. his coag values were followed q 6 hours and heparin drip was begun on the patient. overnight in the surgical icu from to the patient was left intubated on morphine and propofol drip. it was decided during the morning of to begin to wean his sedation. at that time it was also decided to pursue extubation of the patient. the patient's sedation was weaned. his ventilator support was weaned as well. in the surgical icu on values drawn at midnight showed a pt of 16.1, ptt 29.9, inr 1.8. on the patient's heparin drip pt was found to increase at 4 a.m. to 12.0, ptt was found to be 39.9 and the patient's inr was 2.0. on hematology consult was obtained. hematology/oncology was asked to see the patient for management of his portal vein and splenic vein thrombosis and his new diagnosis of superior mesenteric vein thrombosis given his history of hodgkin's disease and itp. at that time hematology/oncology service recommended continuation of the heparin drip for anticoagulation. it was unclear at this time why the patient developed spontaneous portal vein and splenic vein thrombosis. at that time they also decided to obtain the patient's outpatient records from hospital and spoke with his hematologist, dr. . at that time the patient's goal ptt should be 55, to maintain adequate anticoagulation given his venous thrombosis. overnight from to the patient was extubated and began to complain of pain at incision. he was also transferred from the icu to the floor overnight between to . on exam the morning of the patient was found to be stable, good urine output, we continued to check hematocrit q 6 hours. it was decided at this time to start tpn on the patient to increase his heparin to maintain a goal ptt of 55 to 70. heparin previously at 1400 units had only elevated his ptt to a value of 45.2. the patient was also noted to have a declining platelet count from 88 to 66. there is concern at this time that given the patient's history of prior exposure to heparin, his current heparin drip, the patient might be experiencing heparin induced thrombocytopenia. complicating this picture was also the patient's history of itp. hematology/oncology was again asked to address this issue. at this time a heparin induced thrombocytopenia panel was obtained. this was eventually shown to be negative. the patient continued to do well the day of with continued complaints of incisional pain. at this time the patient's dilaudid pca was increased to cover his pain. on exam the patient's abdomen was found to be markedly distended. the plan at the time was just to await return of bowel function with this patient. we continued to check his hematocrit q 6 hours which was found to be fairly stable throughout his hospitalization. during the day, however, his platelet count continued to decline to a value in the 50's. overnight from to the patient was noted to have a mild amount of delirium. the patient spontaneously pulled his nasogastric tube which was replaced on the floor without difficulty. it was felt at the time the delirium was probably secondary to the ativan that was being given at that time and to hold the ativan. on laboratory values demonstrated a platelet count of 30 with demonstrating an adequate ptt of 55. given the concern about the patient's possible platelet decline being due to heparin induced thrombocytopenia, the patient was begun on lepirudin on tuesday, and was continued to . at this time patient's ptt value of 55 was found to be adequate with a prudent anticoagulation. on day of the patient continued to do well, his pain was better controlled with increased pca dose. dressing was removed. the incision was found to be dry and intact. the patient continued with good urine output, had a moderate amount of ng output. the ng tube was putting out approximately 640 cc on the 19th, 350 cc overnight from to after the tube was replaced. overnight from to the patient continued to do well. the patient's platelet count, however, was noted to be declining to a value of 16 from 20 from the previous check. the patient's ptt was also found to be declining to a value of 49 and it was decided at this point to increase the patient's lepirudin dose. also on the patient's heparin induced thrombocytopenia came back negative and it was decided to restart his heparin at that time. the patient's ng tube continued to have a moderate amount of output, putting out approximately 1220 cc total overnight from to . the patient was also noted to be coughing up a small amount of bright red blood on and it was felt at this time this was old clot and did not represent active bleeding in this patient. the patient's hematocrit continued to be stable at 26.3. on the patient's negative heparin induced thrombocytopenia panel was felt that his platelet drop was most likely due to recurrence of his itp and it was decided at that time to give ivig of 1 gm/kg in a divided dose over approximately two days. overnight from to the patient continued to do well. he was comfortable, however, his bowel function was slow to return. he was still without flatus. his pain control continued to be with a dilaudid pca. half his dose of ivig was given on with the other half given on . the patient's platelet count was found to respond to this ivig regimen increasing to a value of 53. the patient was also restarted on his heparin drip which was elevated to 1800 units per hour at which time was found to have a ptt of 47.9 and it was decided at this point to increase heparin dose to units per hour. on the day of the patient continued to do well, however, his bowel function was again found to be slow to return. he denied flatus over the day of . his ng output was noted to be moderately decreased over the day and it was decided at that point to discontinue his foley catheter and continue to try and get his heparin to a therapeutic ptt value. overnight from to the patient continued to do well, however, he was still found to be without flatus. he was burping with ng tube clamped. he was having low residuals from his ng tube, however, his abdomen was still distended. his platelets continued to respond well to the ivig treatment increasing to a value of 86 from 53 the day before. it was felt at that time that his low platelets were truly consistent with itp. on the patient continued to do well. however, complained of increased abdominal distention during the day. he was having low residuals from his clamped ng tube but it was at that time just replaced back to continue suction. after replacing the tube to continuous suction approximately 200 cc of bilious fluid was obtained. overnight from to the patient continued to do well. he was found to be more comfortable although he was still without flatus. the morning of the patient was given a dulcolax suppository which induced good bowel function. the patient had a bowel movement shortly after insertion of the dulcolax suppository. overnight from to the patient continued to do well, continued to have bowel movements, was reporting good flatus. it was decided on the morning of to discontinue the patient's ng tube. the patient's heparin dose was running at a value of 2100 units per hour, ptt was found to be value of 52.2. the patient was showing good signs of bowel function and it was decided at that time to also start the patient on a clear liquid diet. the patient was noted to have elevated white count to a value of 24 on . it was decided at that time to change his central line to check a clostridium difficile toxin assay. the patient was also started on flagyl 500 mg tid. the patient's central line was changed on . culture of the central line tip was negative. additionally, the patient's clostridium difficile toxin assay was negative. following changing the patient's central line, chest x-ray was obtained. this demonstrated the new central line to be positioned within the right atrium. the line was withdrawn 3 cm and was used again. following the patient's procedure, central line was changed. the patient's heparin was stopped for approximately two hours. laboratory values after changing this line demonstrated ptt of 26.3 and the patient was restarted on his usual dose of coumadin. a recheck of the patient's ptt several hours later demonstrated a value of 46. it was decided at this time to increase the patient's heparin drip to a value of 2400 units per hour, rechecking the laboratory values on the morning of demonstrating ptt of 60.6. the patient's hematocrit was again noted to be stable. the patient was tolerating his clear liquid diet. on the morning of it was decided to advance the patient's diet to a full liquid diet with a regular house diet to begin that evening. the patient continued to do well, continued to pass flatus and bowel function was thought to be good. at this time the patient was started on his home medications of paxil and permax. on the evening of it was also decided to begin patient back on his dose of coumadin for consideration of long-term anticoagulation. the patient was given a dose of 7.5 mg of coumadin this evening. overnight from to the patient continued to do well. he was tolerating a solid diet and it was decided at this time to discharge the patient home on lovenox and coumadin with follow-up until his coumadin is therapeutic. the patient is to continue taking his lovenox. the patient demonstrated good bowel function. on the patient's staples were taken out and the plan was discussed with hematology oncology for long-term anticoagulation in this otherwise complex patient. condition on discharge: good. he was tolerating full liquid diet, his pain control is with oral pain medications, he is therapeutic on a heparin drip with a ptt value of 84 this morning. by review of systems: 1. from a gi standpoint the patient is status post exploratory laparotomy with resection of 50 cm of mid to distal ileum for mesenteric ischemia, most likely induced by venous congestion. the patient is currently taking a regular diet with good bowel function. pathology showed no evidence of recurrent lymphoma. 2. hematology: the patient has itp. the patient had a low platelet count down into the value of the teens. this was treated with ivig with good response. the patient was to follow-up with his regular hematology oncologist as an outpatient for consideration of rituxan treatment. 3. from an anticoagulation standpoint the patient was noted to have ptt value with a slightly elevated stay into the 80's. it was decided that the patient will need long-term anticoagulation given his history of a portal venous splenic vein thrombosis and superior mesenteric vein thrombosis. this will be accomplished with coumadin as per the hematology oncology service who has been in touch with his regular hematologist, dr. . currently the patient has just begun on his dose of coumadin. the patient is to be discharged on a dose of 1 mg/kg, approximately 120 mg of lovenox q 12 hours to be injected subcutaneously. until his coumadin dose is therapeutic with an inr of 2.5. the patient is to follow-up at hospital for laboratory draws tomorrow. the patient has a follow-up appointment with his hematologist, dr. on thursday morning at approximately 7:15. the patient's wife has demonstrated proficiency with administering the subcutaneous lovenox in the past. she has administered this to both the patient's father and the patient. the patient was given his first dose of lovenox here in the hospital. the patient's wife demonstrated that she was able to give the dose to the patient with the nurse present. it was decided at this time the patient will not need vna services for administration of lovenox. he is to follow-up with his regular hematologist tomorrow. discharge medications: percocet 5/325 mg 1-2 tabs po q 4 hours prn pain, colace 100 mg po bid prn constipation, lovenox 120 mg q 12 hours to be administered subcutaneously, coumadin 5 mg q day, protonix 40 mg q day. patient's home medications which he is to begin taking again include paxil 40 mg q day, permax .01 mg q day, levoxyl 250 mcg q day. follow-up: with dr. and dr. . , m.d. dictated by: medquist36 d: 11:56 t: 19:57 job#: procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other partial resection of small intestine other lysis of peritoneal adhesions diagnoses: hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites acute vascular insufficiency of intestine 

Answer: The patient is high likely exposed to