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: history of present illness: the patient is a 69 year old male with a past medical history significant for renal cell carcinoma, coronary artery disease status post myocardial infarction, deep venous thrombosis, hypertension, diabetes mellitus and pan-hypopituitarism, who was admitted to on , status post radiofrequency ablation of a residual renal mass. the patient was subsequently noted to be hypotensive after the procedure which was refractory to intravenous fluids and necessitated a medical intensive care unit admission. he was treated with stress dose steroids, initially, given his history of pan-hypopituitarism. his oxygen saturation decreased and he had a vq scan to rule out pulmonary embolism, which was indeterminate. on , the patient had stable blood pressures to the 120s and was transferred to the floor. here, his hydrocortisone was tapered. on , he was noted to be increasingly somnolent and tachypneic, with gross hematuria, decreased urine output and an increased creatinine from 1.4 to 2.4. his oxygen saturation was 84% on room air and his systolic blood pressure dropped to the 50s. serial arterial blood gases revealed a pco2 from 53 to 72 and a ph of 7.3 to 7.21, to 7.17. the patient was intubated emergently for hypercarbic respiratory failure. the patient subsequently had one out of four blood cultures positive for gram negative rods as well as e. coli in his urine. the patient was started on ceftriaxone on , for presumed urosepsis. his blood pressure subsequently improved, and his dopamine drip was discontinued on . a chest x-ray on , revealed left lower lobe consolidation and collapse and his sputum revealed a three plus gram negative rods. given his hypotension, his stress-dose steroids were continued. the patient was seen by the renal service for acute renal failure on . he was noted to have a ct scan with contrast on , and his acute renal failure was attributed both to hypotension as well as to contrast atn. on , he was transfused two units of packed red blood cells for a hematocrit of 25.4, was extubated successfully and was transferred to the floor on . the patient was continued on lovenox and his hydrocortisone was decreased to 50 mg intravenous q. eight hours. he then complained of increasing groin pain, and his hematocrit was noted to have dropped six points. a ct scan of his leg revealed a collection medial to the right femoral vein tracking down along the femur. he was seen by vascular surgery, who recommended direct pressure using a c-arm as well as multiple transfusions to maintain his hematocrits. they did not want to manage him surgically unless he became hemodynamically stable. he was thereafter transferred to the medical intensive care unit and to our medical service for further management. past medical history: 1. renal cell carcinoma status post left partial nephrectomy in . 2. coronary artery disease status post myocardial infarction and coronary artery bypass graft times four in ; this procedure was complicated by sternal dehiscence, status post partial sternotomy. the patient has an ejection fraction of 44%. 3. diabetes mellitus type 2 with neuropathy. 4. hypertension. 5. hypercholesterolemia. 6. atrial flutter status post dc cardioversion two years ago. 7. deep venous thrombosis in , on coumadin initially and subsequently lovenox for recurrence. 8. depression. 9. status post lower gastrointestinal bleed in , with colonoscopy revealing rectal ulcer and benign polyp. an esophagogastroduodenoscopy was negative. 10. spinal stenosis. 11. t10 compression fracture. 12. pituitary adenoma with pan-hypopituitarism. 13. chronic renal insufficiency with a baseline creatinine of 1.4 to 1.5. allergies: the patient has a questionable allergy to lasix; he reports a rash in response to this medication. medications on transfer: 1. hydrocortisone 100 mg intravenous q. eight hours. 2. lipitor 20 mg p.o. q. h.s. 3. tums 10 mg p.o. twice a day. 4. a multivitamin. 5. senna two pills p.o. q. day. 6. zoloft 100 mg p.o. q. day. 7. colace 100 mg p.o. twice a day. 8. lovenox 100 mg q. twice a day. 9. amiodarone 200 mg p.o. q. day. 10. neurontin 300 mg p.o. q. day. 11. synthroid 50 micrograms p.o. q. day. 12. lidoderm patch 5%. 13. protonix 40 mg p.o. q. day. 14. ceftriaxone one gram q. 24 hours. 15. glipizide 5 mg p.o. q. day. 16. morphine sulfate p.r.n. social history: the patient is a widower. his daughter, , works for . he denies any tobacco or alcohol use. he is a retired engineer. physical examination: the patient had a blood pressure of 178/74; heart rate of 103; saturation of 96% on two liters of oxygen; respiratory rate of 23; he was afebrile. in general, he was a very alert, pleasant and conversant male who was mildly dyspneic with conversation. heent examination: his pupils equally round and reactive to light. his extraocular movements are intact. his mucous membranes were moist. his oropharynx was benign. on neck examination, his neck was noted to be supple without lymphadenopathy or visible jugular venous distention. respiratory examination: the patient has soft rales over the left upper lung fields. cardiovascular examination: the patient had an irregularly irregular rhythm without murmurs, rubs or gallops. his abdomen was notable for normoactive bowel sounds. it was obese, soft, nontender, and nondistended, with no hepatosplenomegaly. his extremities were warm without visible cyanosis, clubbing or edema. his distal pulses were doppler-able bilaterally. he had right groin ecchymoses with a hematoma medially and posteriorly. laboratory: his laboratory data on , the patient had a white blood cell count of 11.7, hematocrit of 29.9, platelet count of 184. he had an inr of 1.0, ptt of 35.6, a sodium of 1.4, potassium of 3.9, chloride 108, co2 of 22, bun of 59, creatinine of 1.2, glucose of 207 and albumin of 2.3, calcium of 8.2, phosphate of 3.4 and a magnesium of 1.9. he had an ekg which revealed normal sinus rhythm with supraventricular extra systoles. he has a right bundle branch morphology with a rate of 77. on studies on , he had a unilateral lower extremity vein ultrasound which did not reveal any evidence for deep venous thrombosis or pseudo-aneurysm. on , he had a ct scan of the abdomen which revealed a heterogeneous mass extending from the level of the pubic symphysis to the proximal femur posteriorly consistent with hematoma. the approximate measurements for this were 9.7 by 8.5 by 10 cm. on , he had a transesophageal echocardiogram which revealed an ejection fraction of 45%, mild left ventricular systolic dysfunction, left ventricular wall motion abnormalities with basal infero-septal and inferior and apical hypokinesis. he had asynchronous motion of the inferior wall possibly secondary to a conduction delay. on , he had a chest x-ray which revealed consolidation/collapse of the left lower lobe. on microbiologic data on , the patient had endotracheal sputum which revealed greater than 25 leukocytes and less than 10 epithelial cells. he grew out four plus oropharyngeal flora and three plus gram negative rods. a sputum culture revealed moderate growth of beta strep. he had a urine culture which revealed greater than 100,000 e. coli. blood cultures from , revealed one out four gram negative rods. hospital course: this is a 69 male with a history of coronary artery disease, renal cell carcinoma status post left partial nephrectomy, admitted for hypotension in the setting of urosepsis. now, he presents with a right groin hematoma and decreasing hematocrit status post right femoral line placement. 1. hematology: the patient was admitted to the vascular intensive care unit for close monitoring and follow-up by the vascular service. his hematocrit was checked every four hours with a goal level of greater than 27. we held all anti-platelet and anti-coagulation medications including his lovenox. we discussed his hospital management with the vascular surgery team who were very loathe to perform surgery on this patient given his multiple co-morbidities. on the evening of , the patient's hematocrit decreased to 26.6 after two units of packed red blood cells. we transfused the patient with an additional two units of blood. his hematocrit subsequently remained stable at approximately 30. we subsequently checked his hematocrits every 12 hours and they remained stable throughout his hospital stay. at the time of this dictation, the patient's hematocrit is 29.9. once his hematocrit was stable for 24 hours, he was restarted on his lovenox. the patient has remained stable without any evidence of bleeding. 2. cardiovascular: the patient was noted to be normotensive throughout his hospital stay. he had had atrial fibrillation in the setting of anemia and sepsis. upon transfer to our service, the patient has subsequently returned to sinus rhythm. we continued the amiodarone and added lopressor for additional rate control. the patient's primary cardiologist, dr. , was notified that his patient was on the hospital wards, and dr. agreed with continuation of his medical regimen. 3. gastrointestinal: the patient had a history of a lower gi bleed with a recent esophagogastroduodenoscopy and colonoscopy, which were negative. here he had guaiac positive stools. we will not evaluate the patient's gi tract during this hospital stay, however, we recommend that the patient have an outpatient gi evaluation. 4. endocrine: the patient was carefully tapered off the hydrocortisone per the endocrine service. he remained hemodynamically stable without any additional complication. the endocrine service recommended adding androgel to the patient's regimen once a baseline psa and prostate examination were obtained. the patient will be discharged on a prednisone taper with an eventual dose of 5 mg in the morning and 2.5 mg in the afternoon. he will continue his calcium supplementation and will be started on androgel per the endocrine service. 5. renal: the patient's creatinine subsequently decreased to 0.7 at the time of this admission. he did not have any further evidence of renal failure. 6. infectious disease: the patient was continued on ceftriaxone to complete a ten-day course for pneumonia and urosepsis. he remained afebrile throughout his hospital stay. his white blood cell count was elevated, but we attribute this to the steroids. we do not believe that the patient currently has a focus of infection. discharge diagnoses: 1. gram negative rod sepsis. 2. renal cell carcinoma. 3. deep venous thrombosis. 4. hypertension. 5. diabetes mellitus. 6. hypercholesterolemia. 7. atrial flutter. 8. depression. 9. spinal stenosis. 10. pan-hypopituitarism. 11. chronic renal insufficiency. discharge medications: 1. lipitor 10 mg p.o. q. h.s. 2. tums, two p.o. twice a day. 3. multivitamin. 4. senna two p.o. q. day. 5. zoloft 100 mg p.o. q. day. 6. lovenox 100 mg subcutaneously q. 12 hours. 7. neurontin 300 mg p.o. q. day. 8. amiodarone 200 mg p.o. q. day. 9. synthroid 50 micrograms p.o. q. day. 10. protonix 40 mg p.o. q. day. 11. glipizide 5 mg p.o. q. day. 12. ultram 50 to 100 mg p.o. q. four to six hours p.r.n. 13. zestoretic one p.o. q. day. 14. prednisone 10 mg p.o. twice a day from until ; 5 mg p.o. twice a day from until , and 5 mg p.o. q. a.m., 2.5 mg p.o. q. p.m. chronically. disposition: the patient will be discharged to center. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnostic ultrasound of heart insertion of endotracheal tube diagnoses: acute kidney failure with lesion of tubular necrosis malignant neoplasm of kidney, except pelvis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure other complications due to other vascular device, implant, and graft septicemia due to escherichia coli [e. coli] panhypopituitarism 

Answer: The patient is high likely exposed to