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 / codeine / dilaudid / keflex / citalopram / erythromycin base attending: chief complaint: dyspnea,fatigue,pancytopenia major surgical or invasive procedure: splectomy history of present illness: 63f with a pmh of itp, hypogammaglobulinemia on monthly ivig, colon ca, s/p resection and 6 cycles of folfox,hypertension,dm1 with retinopathy, recurrent bronchitis with bronchiectasis, hepatic cirrhosis on recent biopsy and recent splenectomy for massive splenomegaly of unclear cause c/b shocked liver and arf now with altered mental status in the setting of persistent significant elevated lfts and worsening renal failure. patient has undergone numerous bone marrow biopsies, and per report, they have shown no evidence of malignancy. last year she was diagnosed with colonic mucinous adenocarcinoma, for which she underwent right hemicolectomy (, 5/). she completed 6 rounds of folfax (last round completed ), during which time she required multiple prbc transfusions. she was then recently admitted to the heme/onc service for symptomatic anemia (hct 17), for which she received several transfusions. continued pancytopenic workup was un revealing. during that admission, ct imaging showed an increase in splenomegaly to 23.8cm, prompting concern for splenic lymphoma versus hemophagocytic lymphohistiocytosis. she was discharged home with surgical referral for consideration of elective splenectomy. however,she was re-admitted on the medicine service on with increasing dyspnea and fatigue and was found to have a pancytopenic with hct of 13.2 wbc 1.3 and plt 40. bone marrow biopsy showed hypocellular marrow and mri abdomen showed evidence of chronic liver disease with an enlarged liver and enlarged portal and splenic veins suggestive of portal hypertension and massive splenomegaly. the cause of her splenomegaly is unclear and it was wondered whether this may have been related to portal hypertension. portal pressure measurement showed present but not severe portal hypertension and biopsy showed cirrhosis of unclear cause.patient elected to undergoe splenectomy. past medical history: pmh: - itp (, requiring ivig and steroids) - hypogammaglobulinemia - managed with monthly ivig - pancytopenia of unclear etiology (with bone marrow biopsies reporting hypercellular marrow) - splenomegaly of unclear etiology - colonic mucinous adenoca, s/p right hemicolectomy () and chemotherapy (folfox x6 cycles, last dose ) - hyperbilirubinemia initially suspected secondary to hemolytic anemia, however, etiology less clear currently - recurrent bronchitis with bronchiectasis - hypertension; hypercholesterolemia - type 1 dm c/b retinopathy - hx parapsoriasis - hx of pericardial effusion - hx left transudative pleural effusion s/p thoracentesis (, path: mesothelial cells, macrophages, and lymphocytes) psh: - right hemicolectomy for colon cancer () - right chest port-a-cath placement () - colonoscopy () - left thoracentesis () social history: lives with husband in , no smoking, etoh, ivdu, husband is hcp family history: mother - thyroid dz - still living, father - prostate cancer and "lung dz" physical exam: 98.5 98.5 63 118/49 18 96%ra general: awake, cooperative. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. pulmonary: clear,decreased bs left base. cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: abdomen soft,tender, minimal ascites on percussion. incision:steristrips in place, no erythema. extremities: + pitting edema to knees bilaterally, 2+ radial, dp pulses bilaterally skin: multiple bruises. pertinent results: micro/imaging: kub unremarkable bowel gas pattern ct a/p ? infarction l lobe liver. large amt ascites. liver duplex vessels patent ct head negative mass,infarction renal us no hydro or stones, diffuse enhancement, large amt free fluid ucx negative rue us no dvt, non-occlusive thrombus in r ijv likely from liver biopsy liver bx nodular hyperplasia. iron deposition and kuppfer cells. spleen large population of cd4/cd8 negative t cells c/w autoimmune egd grade 2 esophageal varices chest x-ray bibasilar atelectasis liver bx no cirrhosis, c/w with nodular regenerative hyperplasia. bone marrow bx pending. aspirate hypercellular. tte lvef 50-55%. + mr. . mild-mod pericardial effusion. mri prelim: ?liver cirrhosis, hepatosplenamogaly, portal htn brief hospital course: patient was taken to the operating room on with dr. and underwent a splenectomy (please refer to the operative note for further details).postoperatively patient was kept intubated due to fluid administration: 3u prbc, 2u platelets, 2 albumin. pod 1,patient was self extubated and after a short icu stay patient was transferred to the surgical floor. her postoperative course was complicated by altered mental status, shock liver with elevated lfts and acute kidney injury. pod the ngt was out and she was started sips. her hematocrit was 21 and she was transfused with 1 unit rbc and post transfusion ->24 postoperatively sbps for the past few days (on they had been in the 120's to 130's). however on pod 4 patient was noted to have brief hypotensive episodes with sbp 90s. she received albumin/blood transfusion as needed for hypovolemia. patient was noted to have worsening renal function with rising bun/creatinine. of note patient had a positive urinalysis and was currently being treated for a uti with po cipro. of note, patient had been on vancomycin cefepime pre-operatively when she was neutropenic and spiking fevers, however postoperatively she has been afebrile. thus the vancomycin and cefepime were subsequently discontinued. her urine culture eventually came back and was negative. her urine output was monitored closely and her creatinine were trended. serial abdominal exams were performed and of note over the next several days her abdominal distention gradually worsened. pod 5() patient was noted to have increase lethargy and confusion and was triggered due to change in mental status. per nursing staff, patient had intermittent episodes of hallucination. her morphine pca were subsequently discontinued as there were concerns of accumulation of morphine building up given arf. patient underwent a head ct which was negative and neurology was consulted. there was concern for hepatic encephalopathy given the acute rise in lfts although the ammonia level was only 35. regarless, the pt was started on rifaximin and lactulose. neurology recommendations were to continue to correct metabolic derangements and to increase lactulose titrating to symptomatic improvement and felt no further imaging was needed at this time. her ms cont to improve and was at baseline by the time of discharge. nephrology was consulted for further evaluation of patient worsening renal function. per nephrology, a renal ultrasound was obtained which showed bilateral kidneys without evidence of hydronephrosis or stones. there were large amount of free fluid is noted throughout the abdomen consistent with ascites. given the granular casts seen on ua, likely diagnosis of atn was presumed by renal. patient nadolol was discontinued due to continued bradycardia w/ episodes of hypotension. lasix was given prn as pt appeared volume overloaded w/ some le swellingon exam. heme oncology continued to follow patient postoperatively and reccommended treating with blood transfusion for a hemoglobin less than 7. hepatology continued to follow patient and recommended trending ammonia levels which was 35. patient received 1 dose of lactulose to treat possible hepatic encephalopathy. patient received additional lactulose which was titrated until she had several bowel movements. in addition rifaximin was also added. patient underwent an abdominal/pelvis ct which showed infarction left lobe liver. large amount of ascites. a doppler study was performed which showed patent portal vein. the pt's lfts peaked and started to downtrend during her stay. the rise was likely a reflection of her acute infarction. hepatology recommended repeating a ct scan; however, our team did not feel this was necessary as her lfts were downtrending and the pt was asymptomatic. there was also concern for pbc given the rise in alk phos, but given a negative liver biopsy and neg autoimmune antibodies, this diagnosis is much less likely and ursodiol was not initiated. pod 7 transfused 1u prbc for hct 23. tbili decreased. however her creatinine continued to rise to 3.7. however her lfts continued to trend downward and her mental status gradually improved. pod patient had intermittent complaints of nausea. a kub was performed which showed an unremarkable bowel gas pattern. patient received antiemetics as needed. the diet was advanced as tolerated and nutrition were consulted and she was started on calorie counts. she continued to have poor glycemic control (200's-300's). her insulin sliding scale and lantus dose were titrated. patient bun/creatinine however continued to rise slowly. her fluids were subsequently discontinued and she was diuresed with several doses of lasix iv over the next few days. patient continued to be managed conservatively. nephrology continued to follow and indicated that there were no immediate need for hemodialysis as creatinine will most likely peak and plateau which it eventually did.the foley catheter was discontinued and she voided without difficulty approximately 1 liter over 24 hours. pod 13 patient creatinine peaked at 5.3. she was diuresing well. by the time of discharge, the patient was doing well. her cr and lfts were downtrending. she was ambulating, tolerating a regular diet and urinating adequately. medications on admission: bupropion 150, lispro ss, bactrim ds, lisinopril 40, simvastatin 40, ivig monthly, iron, vit d, lantus 28u hs, clobetasol cream prn, lorazepam 0.5'' prn discharge medications: 1. outpatient lab work basic metabolic panel liver function tests please take this prescription to your pcp appointment with dr. . you should have labs drawn weekly. 2. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. insulin glargine 100 unit/ml solution sig: one (1) 28 subcutaneous at bedtime. 4. lactulose 20 gram/30 ml solution sig: one (1) po every eight (8) hours as needed for constipation. disp:*30 1* refills:*2* 5. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po once a day. 6. simvastatin 40 mg tablet sig: one (1) tablet po once a day. 7. oxycodone 5 mg tablet sig: 1-2 tablets po every four (4) hours. disp:*25 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: itp acute tubular necrosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you underwent a splectomy for treatment of your refractory itp. the procedure went well and was without complications, but you did have a few postoperative complications that kept you in the hospital. you kidney labs started to rise. nephrology (kidney doctors) were consulted to see you. they believe your kidney took a hit from low blood pressures and this caused some damage to your kidneys. you kidney labs peaked and were trending down at the time of discharge. it is important for you to have labs drawn weekly and the results sent to your pcp, . . please take the prescription given to you for labs to your appointment with dr. next week. you liver function studies were also found to be elevated. this was likely due to damage to your liver. hepatology (liver doctors) were consulted and followed you during your hospitalization. most of your labs were trending down at the time of discharge, but some remained elevated. these labs too should be monitored weekly. if you experience any significant abdominal pain, fevers, or any other symptoms concerning to you, please call or come into the ed for further evaluation. thank you for allowing us at the to participate in your care. followup instructions: name: , md when: tuesday at 10am location: address: , , phone: *please call registration to update before your appointments, the number is . thank you. department: surgical specialties when: monday at 10:45 am with: , m.d. building: campus: east best parking: garage department: west clinic when: monday at 4:30 pm with: , md building: de building ( complex) campus: west best parking: garage md, procedure: other endoscopy of small intestine biopsy of bone marrow total splenectomy open biopsy of liver transjugular liver biopsy diagnoses: acidosis pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified unspecified essential hypertension cirrhosis of liver without mention of alcohol acute and subacute necrosis of liver unspecified protein-calorie malnutrition portal hypertension defibrination syndrome long-term (current) use of insulin personal history of malignant neoplasm of large intestine other ascites hepatic encephalopathy varices of other sites bronchiectasis without acute exacerbation immune thrombocytopenic purpura splenomegaly background diabetic retinopathy diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled neutropenia, unspecified jaundice, unspecified, not of newborn hepatic infarction esophageal varices without mention of bleeding hypogammaglobulinemia, unspecified fever presenting with conditions classified elsewhere acute venous embolism and thrombosis of internal jugular veins acquired absence of intestine (large) (small) unspecified chronic bronchitis other pancytopenia 

Answer: The patient is high likely exposed to