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: this is a 56-year-old male with no significant past medical history who presented to with acute onset of numbness and weakness on the left upper extremity. he initially noted paresthesias in the left lateral shoulder while working on his computer on the evening of admission. within 5-10 minutes of onset, his entire left upper extremity became numb and paralyzed. he immediately went to , where his left upper extremity was noted to be cold, pale, and pulseless from the axilla distally. he had no sensation from the forearm to the fingers. he was sent to for insufficiency and vascular surgery consult. on arrival to the emergency department, he subjectively noted improvement in his symptoms, but persistent absent radial pulse in the left upper extremity and no pulse in the dorsalis pedis, posterior tibialis in the right lower extremity. his blood pressure was 183/141, and therefore he was taken for a cta to rule out aortic dissection. he was found to have very large bilateral pulmonary embolism, splenic infarct, chronic infrarenal aortic and right common iliac dissections. he denied any trauma to the arm or shoulder. he had a 10 day history of dyspnea on exertion complaining of shortness of breath with two flights of stairs. he denies any chest pain, nausea, vomiting, or diaphoresis. there is no other weakness or numbness elsewhere on his body. he denies any bright red blood per rectum, melena, or bleeding gums. there is no recent history of travel, plane flights or long car rides. again, he denies any fever, chills, night sweats, or weight loss. past medical history: 1. gout. 2. left bell's palsy 10 years resolved after one year. 3. hernia repair as a child. 4. sciatica. 5. questionable hypertension. 6. no history of coronary disease or coagulopathies. social history: he has smoked for the past 40 years anywhere from half to of a pack per day. he has episodically tried to quit smoking. he socially uses alcohol. he has a history of experiment drug use as a teenager which includes marijuana, cocaine, and lsd, but no current experimental drug use at this time. he denies any iv drug use. he works as a computer engineer living at home with his three children. he recently separated from his wife and moved into the area. he is not sexually active. family medical history: mother died of brain cancer at age . father with arrhythmia and died with a complication of a hernia repair, no bleeding disorders. allergies: none. outpatient medication: indocin prn for gout, last use was a month ago. physical exam upon admission: temperature is 96.6, blood pressure 175/128, pulse 92, respiratory rate 16, and 96% on room air. generally, this is a pleasant male in no acute distress who is resting comfortably in bed. heent: mucous membranes are moist and oropharynx is clear. jugular venous pressure is not elevated. the neck is supple and without carotid bruits. his sclerae is anicteric. chest was clear to auscultation bilaterally. cardiovascular: regular, rate, and rhythm. normal s1, s2, no murmurs or gallops noted. abdomen is soft, nontender, and nondistended with normoactive bowel sounds. no hepatosplenomegaly felt. extremities: pale left hand with capillary refill greater than three seconds. there is no radial pulse in the left upper extremity. there is presence of an ulnar pulse in the left upper extremity. there is also a presence of a dorsalis pedis and posterior tibial pulses bilaterally. neurologically, the patient is alert and oriented times three. cranial nerves ii through xii intact except for the left lower facial weakness. the left is 4+/5 and left upper extremity flexion and extension is 4+/5. right upper extremity is . decreased sensation in the left hand and forearm which have been improving. white count 10.8, hematocrit 45.8, platelets 154, chloride 142, potassium 3.9, 105 for chloride, bicarb of 22, bun of 11, creatinine 0.9, glucose 110. differential on the white count was 82% neutrophils, 12% lymphocytes, 4% monocytes, 1.5% eosinophils. pt is 13.6, ptt is 28.9, inr 1.2. chest x-ray showed no infiltrate or effusion. ct scan showed bilateral large pulmonary embolism, splenic infarct, and chronic infrarenal, aortic, or right common iliac dissection. electrocardiogram: normal sinus rhythm at a rate of 84. there is a right heart strain pattern in v2 through v4 with t-wave inversion in iii. right bundle branch is noted. hospital course: 1. pulmonary system. pulmonary embolism. given that the patient had bilateral pulmonary embolism discovered on cta, patient was put on heparin for a ptt of 60-80. doppler of the lower extremities showed a right popliteal deep venous thrombosis, but no deep venous thrombosis on the left. patient was then sent for mri of the pelvis which showed no evidence of clot in the femoral vein or ivc. therefore, the patient did not require any ivc filters at this time. it is unusual why the patient would have pulmonary embolism since there is no recent history of travel or long car rides. his extensive smoking history may predispose him to neoplasm hypercoagulable state. subsequent studies that his protein-c was normal at 66, protein-s at 139, anticardiolipin igg as well as igm were normal at 1.2 and 4.3 respectively. however, he was found to have high levels of homocystine at 70.5, where the high range of normal is 12.4. he was therefore then started on vitamin b6, vitamin b12, and folate. his prothrombin gene mutation and factor- were still pending. he was then started on coumadin 5 mg to reach an inr between . he eventually reached 2.2 on the day of discharge with a regimen of coumadin 5 and 7.5 mg alternating days. 2. vascular system. left subclavian artery clot status post embolectomy. given the patient's symptoms of neurological and vascular compromise in his left upper extremity, vascular surgery was consulted. they eventually took him for embolectomy of a very large subclavian artery clot. after the embolectomy, neurological and vascular functions were returned to the patient's left upper extremity. 3. cardiovascular. patent foramen ovale status post clam-shell placement. given that the patient had all of these clots, thrombolysis was a consideration, therefore cardiology consult was called to do an echocardiogram. the echocardiogram actually revealed a patent foramen ovale with a right-to-left shunt in light of a normal pulmonary pressure with pr gradient of 17 mm hg. also noted on the echocardiogram was preserved left ventricular ejection fraction, mild right ventricular dilation, mildly depressed right ventricular function, and apical-septal aneurysm. given the right-to-left shunting and embolization without elevated pulmonary artery pressure along with his known deep venous thrombosis, it was felt that a pf closure with a clam-shell would be best. the clam-shell was placed without complications. however, on hospital day five, the patient did spike a fever of 101.3. he was given 48 hours of vancomycin along with other antibiotics which he was taking for his pneumonia until blood cultures were clear for 48 hours. the blood cultures did remain negative for 48 hours, so the vancomycin was discontinued. given the clam-shell placement, the patient should be on 75 mg of plavix for the next three months. 4. hematology. homocystinemia. given that the patient had many clots in a situation, where he did not have many risk factors that led to the tests that were mentioned above in the course of finding the etiology of the pulmonary embolism. it was discovered that he had elevated homocystine levels of 70.5. at that time, hematology recommended starting vitamin b6, vitamin b12, and folate. he is to remain on these cofactors for breaking down the homocystine for life. he is to be on coumadin with inr of 2.3 for at least six months. at that time, it should be reassessed whether the patient should be on life-long coumadin. there is no literature mentioning whether life-long anticoagulation would be called for in the state of homocystinemia. 5. infectious disease. pneumonia. when the patient spiked a fever on hospital day five, a chest x-ray was obtained along with blood and urine cultures. the chest x-ray revealed a left basilar infiltrate and left pleural effusion. patient was empirically started on azithromycin for five days and ceftriaxone for 14 days. however, the course of ceftriaxone was decreased down to seven days given that the fever may also be due to the gout that the patient was having. 6. rheumatology. gout. in the middle of the hospital course, the patient complained of right ankle and right first metatarsal erythema, swelling, and pain. he says that these symptoms were similar to his gout flares, so he was given indomethacin. the indomethacin helped resolve the symptoms on the right foot, but then he started noticing pain, swelling, and erythema with his left first metatarsal. he was continued on indomethacin until a day before discharge, where his gout flare had resolved. discharge diagnoses: 1. pulmonary embolism. 2. patent foramen ovale status post clam-shell placement. 3. homocystinemia. 4. left subclavian artery clot status post embolectomy. 5. pneumonia. 6. gout. discharge medications: 1. protonix 40 mg po q day. 2. indomethacin 25-75 mg po tid prn gout. 3. folate 2 mg po q day. 4. pyridoxine 50 mg po q day. 5. .................... 400 mcg po q day. 6. thiamine 100 mg po q day. 7. plavix 75 mg po q day. 8. aspirin 81 mg po q day. 9. lisinopril 5 mg po q day. 10. atenolol 100 mg po q day. 11. warfarin 5 and 7.5 mg po alternating. discharge condition: stable. discharge status: home. follow-up appointment: the patient is to followup with dr. on for blood pressure and inr check. , m.d. dictated by: medquist36 procedure: diagnostic ultrasound of heart right heart cardiac catheterization incision of vessel, upper limb vessels repair of atrial septal defect with prosthesis, closed technique diagnoses: pneumonia, organism unspecified atrial fibrillation ostium secundum type atrial septal defect embolism and thrombosis of other specified artery other pulmonary embolism and infarction dissection of aorta, abdominal arterial embolism and thrombosis of upper extremity disturbances of sulphur-bearing amino-acid metabolism 

Answer: The patient is high likely exposed to