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 / sulfa (sulfonamide antibiotics) / tetracycline attending: chief complaint: abdominal pain major surgical or invasive procedure: coil embolization history of present illness: 53f with minimal past medical history went to an osh emergency department with nausea, vomitting and abdominal pain for 24 hours. on she developed a "stomach bug" with nausea. the pcp called in zofran and cipro for possible infection. then the next day she developed nausea, dry heaves, and abdominal pain. she went to osh ed where she was found to have a 17 x 19 x 8 cm retroperitoneal mass with extension through gerota's fascia around the right kidney, ivc compression, and possible aneurysm or pseudoaneurysm in central portion of the mass. ros revealed several week history of drenching night sweats but no fever. she was given levofloxacin and flagyl () and tranferred to for further management. . in the emergency department her initial vitals were 96.5, 90, 118/70, 18, 100% ra with a hematocrit of 32.4. at 11pm complained of more pain not responsive to morphine. started on 2l nc for o2 sat 89%. nausea and pain continued. surgery saw her. at midnight she became unresponsive, and hypoxic, and was emergently intubated. she then dropped her blood pressure to the 60s. right ij was placed. emergency prbcs given and levophed started. . repeat hct was 24 at 12:30. 3+ l ivfs, levophed continued, still dropped bp into 50s. neo transiently started but then able to be turned off. she was transfused total of 6u prbc, 4 ffp. ct was repeated, showing pseudoaneurysm with active blush, not present prior, concerning for a rp bleed. she was taken emergently to ir for mesenteric angiogram and possible coil embolization of the aneurysm. . in ir, she had coiling of pseudoaneurysm (with supply from sma or possibly gda), without any evidence of residual bleed. by the end of procedure, she had received total of units prbcs, 6 ffp, and 2 bags of plts. she was also given calcium. her bp improved and she was able to be weaned off vasopressors. she required some doses of lasix due to low urine output. her lactate peaked at 5.7, but trended down to 2.9 on transfer to the medial floor. her ph nadir was 7.11 (bicarb 15), but improved up to 7.36. her last whole blood hct was 31 prior to transfer to the medical floor. past medical history: hypertension chronic sinusitis chronic migraines chronic back pain h/o groin pain of unclear etiology ( hospital) h/o pneumonia social history: originally from . secretary, out of work x 1 year. rare glass of wine. smokes 10 cig/day, h/o smoking 1 ppd. remote h/o marijuana. family history: mother died of lung cancer in 70s, heavy smoker. father died of "gi problem." has 3 sisters (1 decreased), no known medical issues. physical exam: vitals: t: bp: p: r: 18 o2: general: intubated and deeply sedated, not currently responding. heent: sclera anicteric, pupils 3mm and minimally reactive right now, mmm, oropharynx clear neck: supple, rij line in place, difficult to appreciate jvd, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: hypoactive bowel sounds, slightly tense, appears non-tender, non-distended, no rebound tenderness or guarding, no organomegaly or masses able to be appreciated ext: warm and well perfused, angioseal in place in r groin. dp and pt pulses present bilaterally, left dp more easily palpable compared to right, no clubbing, cyanosis or edema neuro: limited by sedation, not responsive currently pertinent results: admission labs: wbc-14.6* hgb-10.6* hct-32.4* mcv-96 plt count-259 diff: neuts-81.4* lymphs-15.5* monos-2.8 eos-0.1 basos-0.2 pt-13.6* ptt-23.6 inr(pt)-1.2* glucose-165* urea n-28* creat-1.3* sodium-138 potassium-5.5* chloride-111* total co2-17* anion gap-16 alt(sgpt)-10 ast(sgot)-29 ld(ldh)-520* alk phos-59 tot bili-0.4 lipase-24 albumin-3.4* lactate-2.4 . discharge labs: wbc-11.5* hgb-12.7 hct-38.1 mcv-92 plt ct-395 pt-14.3* ptt-28.3 inr(pt)-1.2* glucose-97 urean-15 creat-0.6 na-142 k-3.8 cl-106 hco3-25 angap-15 alt-15 ast-12 ld(ldh)-628* alkphos-73 totbili-1.0 calcium-8.2* phos-4.2 mg-2.0 lipase-52 . imaging: ct torso : ct of the chest: there are several hypoattenuating nodules within the right lobe of the thyroid gland, the largest measuring 2.2 x 1.2 cm. the heart, pericardium, and great vessels are normal. there is no mediastinal or hilar lymphadenopathy. the lungs are clear. an endotracheal tube is in place, terminating just above the carina. . ct of the abdomen: initial non-contrast images through the abdomen demonstrate iv contrast material within the renal cortices bilaterally as well as vicarious excretion of contrast in the gallbladder and biliary system. both of these findings of retained contrast from prior ct performed at the outside hospital 7 hours prior are consistent with acute renal failure. prior to contrast administration, there is extensive heterogeneous material in the retroperitoneum and extending into the paracolic gutters consistent with extensive retroperitoneal hematoma. post-contrast images demonstrate the hematoma anterior to the aorta extending from the level of the celiac origin to the pelvis. the hematoma displaces the pancreas and sma/smv anteriorly and superiorly and surrounds the retroperitoneal duodenum. the mesenteric vessels and ivc are markedly compressed; however, remain patent. on the arterial phase imaging, there is a well-defined rounded focus of enhancement within the hematoma to the right of midline, just posterior/inferior to the pancreatic head. there is also a blush of contrast extending to the left of midline. both areas do not change significantly in configuration on delayed images, and are concerning for a large pseudoaneurysm potentially from one of the sma or celiac axis branches (4:76). no definite mass lesion is identified. . there is a 7-mm hypoattenuating lesion within segment of the liver (4:52) which is too small to further characterize. the spleen and adrenal glands are unremarkable. the kidneys are hyperenhancing due to acute renal compromise. there are multiple hypoattenuating lesions within the kidneys, which are likely simple cysts but too small to further characterize. as noted previously, the gallbladder is heterogeneous and filled with previously administered contrast. the pancreas is enlarged and the head is distorted and compressed by the hematoma. the uncinate process is not clearly identified. hemorrhage extends into the paracolic gutters and into the pelvis. the intra-abdominal small and large bowel loops are unremarkable. . ct of the pelvis: again complex fluid extends into the pelvis. the sigmoid colon, rectum, and bladder are unremarkable. the uterus is poorly visualized. the osseous structures are unremarkable with no lytic or sclerotic lesions. . impression: 1. extensive retroperitoneal hemorrhage with iv contrast extravasation posterior to the pancreas suggestive of a large pseudoaneurysm. etiology of this pseudoaneurysm is unclear and may relate to prior trauma, pancreatitis or duodenal ulceration/inflammation. no definite retroperitoneal mass is identified. these findings were discussed urgently between radiology resident dr. and surgical resident dr. , and the patient was referred to interventional radiology for intervention. 2. marked narrowing of the mesenteric vessels, presumably due to compression by the large hematoma, however these vessels should also be evaluated during angiography. 3. ct findings of acute renal compromise. 4. incidentally noted thyroid nodules, the largest measuring up to 2.2 cm, for which thyroid ultrasound is recommended on a non-emergent basis. . mesenteric angiogram : findings: 1. large 2.8 x 1.8 cm pseudoaneurysm arising off of a sma branch contributory to the pancreaticoduodenal arcade. active extravasation is identified. 2. successful coil embolization across the neck of the pseudoaneurysm, with absence of filling on post-embolization angiography. 3. no evidence of tumor blush or abnormal arterial vasculature in the region of the pseudoaneurysm. 4. high-grade stenosis of the celiac artery. the celiac artery ostium is patent, however, there is significant collateral flow from the sma into celiac arterial system on sma angiography, consistent with high-grade celiac artery stenosis. after embolization of a prominent collateral, angiography demonstrates continued high flow into the celiac system via the gda, with filling of the hepatic and splenic arterial beds. this is consistent with patent collateralization and good arterial flow into the celiac arterial system. impression: 1. 2.8 x 1.7 cm pseudoaneurysm arising off of a sma branch contributing to the pancreaticoduodenal arterial system, with successful coil embolization across the pseudoaneurysm neck. 2. patent but high-grade stenosis of the celiac artery origin, with prominent collateral flow from the sma, which continues after embolization. 3. no evidence of abnormal enhancement to suggest an underlying tumor/mass in the location of the pseudoaneurysm. . egd : findings: esophagus: normal esophagus. stomach: mucosa: patchy erythema in the antrum of the stomach consistent with gastritis. cold forceps biopsies were performed for histology at the antrum. other no mass seen. duodenum: mucosa: area of erythema and mild edema of the mucosa was noted on folds in the second port of the duodenum. cold forceps biopsies were performed for histology at the duodenum. impression: abnormal mucosa in the stomach (biopsy) abnormal mucosa in the duodenum (biopsy) no mass seen. otherwise normal egd to second part of the duodenum . path biopsies : antrum, biopsy (a): chemical (reactive) gastropathy. duodenum, biopsy (b): small intestinal mucosa with features suggestive of chronic inactive duodenitis. . cta torso : 1. acute pulmonary embolism involving the right upper lobe pulmonary artery. 2. small bilateral pleural effusion and adjacent compressive atelectasis. 3. interval organization and evolution of extensive retroperitoneal hematoma, status post coiling of a large pseudoaneurysm. no evidence of extension of the retroperitoneal hematoma. 4. enlarged common bile duct measuring 10 mm in diameter with stable prominence of the pancreatic duct. correlation with lfts is recommended. 5. air within the bladder lumen. correlation for recent foley catheterization is recommended. . cytology of hematoma : hematoma (right abdomen, retroperitoneal), aspirate: negative for malignant cells. (see note.) blood with degenerated mixed inflammatory cells. note: evaluation is limited by degenerative changes. brief hospital course: this is a 53 year old female who presented from an osh for further evaluation of a right retroperitoneal mass with involvement of the right kidney and ivc compression, found to have hypotension and hemorrhagic shock from an acute rp bleed, who later developed a newly diagnosed pe on lovenox, and difficult to control abdominal pain. . #. retroperitoneal bleed/hematoma. the patient was found to be in hemorrhagic shock due to acute blood loss from a spontaneous rp bleed with the likely bleeding source being a pseudoaneursym. she was admitted to the micu s/p emergent angiogram and coiling of a sma branch pseudoaneurysm by interventional radiology. she had been hypotensive, hypoxic, with a lactic acidosis likely due to acute blood loss from a retroperitoneal bleed but by the time she was transferred to the floor was hemodynamically stable and off vasopressors following successful coil embolization. she received a total of 9 units of packed red blood cells, 6 units of ffp, and 2 units of platelets. following coiling, she remained hemodynamically stable with a stable hematocrit. she was monitored on telemetry closely for any tachycardia that would indicate re-bleeding. initially there was concern about the blood supply to the duodenum and potential for bowel necrosis s/p coiling, but there was no evidence of this during her stay. an egd was performed and showed chemical gastritis and duodenitis. due to the patient's discomfort and suspicion for rp space infection, a jp drain was placed into the rp space by ir on which drained clotted blood. the jp drain was pulled prior to discharge. repeat ct imaging of the abdomen was suggested within 3-6 months as an outpatient. . #. abdominal pain. at first, the patient developed ruq abdominal pain which she described as new since her rp bleed. a ruq u/s showed intrahepatic biliary ductal dilatation with diffuse dilatation of the common bile duct which tapered to the level of the pancreas. these findings were likely related to extrinsic compression from the large retroperitoneal hematoma. a heterogeneous area around the pancreatic head is likely secondary to the known retroperitoneal hematoma. at this time, a mass was not identified. cholelithiasis was noted. the patient later also experienced mid epigastric and luq pain similar to her chronic abdominal pain which was relieved with maalox/lidocaine prn. she was transitioned from dilaudid po/iv for pain control to oxycodone 5mg po prn which also seemed to cause less stomach upset and improve her pain control. otherwise, she was continued on a ppi q12 as well as ranitidine 150mg given her refractory symptoms. . #. pulmonary embolus. the patient became tachycardic to the 120s and developed a new o2 requirement on . initially a pe vs. a repeat rp bleed was suspected, and a ct torso with contrast was performed which showed an acute pulmonary embolism involving the right upper lobe pulmonary artery. the patient did not have physical exam findings consistent with a dvt in the lower extremities, which increased the concern for an occult malignancy. she was cautiously started on a heparin gtt given her recent bleed which was transitioned to lovenox on . she was carefully monitored for clinical signs of bleeding and her hct was trended closely with no signs of repeat bleeding after several days of antocoagulation prior to discharge. she was discharged on lovenox given the concern for an occult malignancy. colonoscopy, evaluation of her known thyroid nodules, and mammography should all be pursued as part of cancer screening work-up as an outpatient. . #. fever. the patient developed several days of low grade fevers and leukocytosis, but both were improving upon discharge. a full infectious work-up was performed several times and all cultures were negative. her central line was removed and the tip culture was also negative. these findings may have all been related to her acute pe diagnosed . there was no evidence of pneumonia on serial cxrs. it was also suspected that her rp hematoma may have become infected. therefore, the patient had an ir procedure to place a jp drain into the rp space and the clotted blood that was aspirated was sent for gram stain, culture, and cytology on which were all negative. . #. hypertension. the patient's blood pressure increased to the 190s systolic at times. she was on atenolol only at home. her home atenolol was initially discontinued given her gi bleed. once her hct stabilized, she was transitioned to metoprolol 25mg and she was discharged on metoprolol succinate 50mg daily. despite her beta blocker, her pressures were still elevated and she was started on captopril which was titrated to 50mg tid which was then transitioned to lisinopril 30mg daily prior to discharge. . #. chronic pain. the patient has chronic pain issues and migraines at home. at home she was on topamax 50mg tid, tramadol 200mg daily, vicodin prn (~40 tabs a month), excedrin xs 100 tab bottle q 3weeks, carisoprodol 350mg , diclofenac 50mg prn pain, and gabapentin 600mg 1-2 tabs tid prn. she was only continued on tramadol and gabapentin and was instructed to discontinue the rest of the meds listed above. nsaids were avoided given her chemical gastritis and recent rp bleed. . #. anemia. likely secondary to massive gi bleed. iron studies were checked and essentially unremarkable. her retic count was not as high as expected given massive hemorrhage. her folate was borderline low and she was started on folate supplementation. . #. respiratory failure. the patient developed hypoxic respiratory failure in the setting of an acute bleed and shock that required intubation on admission. she was extubated on after 2 days. she had significant atelectasis due to splinting from her abdominal pain which improved with pain control and incentive spirometry. . # hypothermia. her temperature was 95 on arrival to the icu. she was placed on a bair hugger to maintain normothermia, which was stopped after 12 hours. there was no evidence of infection clinically or on imaging or cultures. . #. acute kidney injury. her creatinine peaked at 1.5 on but quickly resolved back to a normal value. the etiology was likely prerenal given hemorrhagic shock from an rp bleed and it resolved with fluid resuscitation. . #. thyroid nodules. the patient was noted to have multiple thyroid nodules, with the largest measuring 2.2 cm, that were incidentatlly found on ct imaging on admission. tsh and t4 were wnls and t3 level was low at 57. a thyroid u/s should be completed as an outpatient for further work-up. . #. communication: with patient and (husband) cell - . #. code: confirmed full code. medications on admission: - topamax 50mg tid - tramadol 200mg daily - prochlorperazine 5mg q6h prn nausea () - cipro 500mg - carisoprodol 350mg - atenolol 25mg daily - diclofenac 50mg prn pain () - ?using - gabapentin 600mg 1-2 tabs tid prn (used) - excedrin xs 100 tab bottle q 3weeks - vicodin prn for several years (husband's rx'd 100/month for ra), ~40 tabs a month - sudafed discharge medications: 1. tramadol 50 mg tablet sig: one (1) tablet po qid (4 times a day) as needed for pain. 2. gabapentin 400 mg capsule sig: three (3) capsule po tid (3 times a day). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*60 capsule(s)* refills:*0* 7. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. disp:*60 tablet(s)* refills:*0* 8. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) grams po daily (daily) as needed for constipation. disp:*255 grams* refills:*2* 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po hs (at bedtime) as needed for constipation. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 10. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas. disp:*60 tablet, chewable(s)* refills:*0* 11. lisinopril 30 mg tablet sig: one (1) tablet po once a day. disp:*90 tablet(s)* refills:*0* 12. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*30 tablet(s)* refills:*0* 13. enoxaparin 80 mg/0.8 ml syringe sig: one (1) injection subcutaneous q12h (every 12 hours). disp:*60 injection* refills:*2* 14. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 15. magic mouthwash- please mix equal parts maalox and lidocaine, take 30cc qid prn for adbominal discomfort, dispense 8oz, refill-1 16. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. disp:*30 tablet, rapid dissolve(s)* refills:*0* 17. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. disp:*30 capsule(s)* refills:*0* 18. dextromethorphan poly complex 30 mg/5 ml suspension, sust.release 12 hr sig: five (5) mls po q12h (every 12 hours) as needed for cough. disp:*120 mls* refills:*0* 19. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal (2 times a day). disp:*1 bottle* refills:*2* 20. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po at bedtime as needed for cough. disp:*120 ml(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: retroperitoneal bleed hemorrhagic shock pulmonary embolus secondary: thyroid nodules hypertension chronic abdominal pain discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to for further evaluation of a retroperitoneal mass, nausea, and abdominal pain. your blood pressure and blood levels were dropping quickly and you were diagnosed with a retroperitoneal bleed. a special interventional radiology procedure was performed which was able to isolate and stop the blood vessel that was bleeding into your retroperitoneal space. you lost a tremendous amount of blood into this space and required several blood product transfusions. you were also briefly intubated on a ventilator to protect your airway. your blood levels have remained stable for several days. you also developed a pulmonary embolus which is a blood clot in your lungs. you will need to be on lovenox which is a blood thinner to prevent further clots from happening. incidentally, some thyroid nodules were seen on a ct scan and will need to be followed up as an outpatient. you will also need a repeat ct scan of your abdomen in a month to re-evaluate the size of your retroperitoneal hematoma. . the following changes have been made to your home medication regimen: -you should stop taking your home excedrin, sudafed, topamax, vicodin, carisoprodol, diclofenac, and atenolol -you should start folic acid, pantoprazole, metoprolol succinate, docusate/senna/miralax/dulcolax as needed for constipation, simethicone as needed for gas, lisinopril, oxycodone as needed for pain, lovenox, ranitidine, maalox/lidocaine as needed for abdominal discomfort, ondansetron odt as needed for nausea, benzonatate/delsym/guaifenesin with codeine as needed for cough, and flonase for nasal congestion. followup instructions: #. please follow-up with your primary care physician . . his office phone number is . i have made an appointment for you on wednesday at 4pm. . #. please get a follow-up ct scan in one month to re-evaluate the size of your retroperitoneal hematoma. . #. thyroid nodules noted on ct torso. - you will need to schedule an ultrasound through your pcp to have these nodules evaluated further as an outpatient. . #. please schedule an outpatient colonoscopy through your pcp's office. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube percutaneous abdominal drainage insertion of other (naso-)gastric tube esophagogastroduodenoscopy [egd] with closed biopsy arteriography of other intra-abdominal arteries other endovascular procedures on other vessels computerized axial tomography of abdomen diagnoses: acidosis other chronic pain unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified constipation, unspecified acute respiratory failure other shock without mention of trauma other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation iatrogenic pulmonary embolism and infarction other postprocedural status backache, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus unspecified gastritis and gastroduodenitis, without mention of hemorrhage hemoperitoneum (nontraumatic) unspecified sinusitis (chronic) unspecified disorder of stomach and duodenum nontoxic uninodular goiter celiac artery compression syndrome aneurysm of other specified artery 

Answer: The patient is high likely exposed to