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: sulfa (sulfonamides) attending: chief complaint: hypotension, jaundice major surgical or invasive procedure: us guided placement of cholecystostomy tube ct guided placement of biloma drain history of present illness: 51 y/o m with h/o pvd p/w 2 weeks of decreased appetite and 3 day hx ruq pain and increasing jaundice at osh on admission last week. he also p/w 20-30 pound weight loss. . of note, on the day of admission, the pt was initially sent to the ercp suite for procedure from hospital with plan of returning him post-procedure. however, on arrival, he was reportedly obtunded, hypoglycemic and hypotensive to 70/40. he was given d5w and sent back to hospital. he was reportedly fluid responsive there but was sent back to for further management. . ros: unable to fully obtain, pt denied sob/cp, had severe abd pain and little appetite. past medical history: etoh abuse (confirmed by father) rheumatoid arthritis pvd c/b amputations social history: no sig other or children, father lives in . did not answer questions re: etoh or smoking family history: brother with adv esophageal ca physical exam: vitals: t 99.4// bp 71/47// hr 94// rr 32// o2 sat 100%2l gen: cachetic, jaundiced agitated man, appears older than stated age heent: adentulous, mm dry, scleral icterus neck: supple, no lad, scars midline heart: rr no m/g/r lungs: diffusely rhonchorous a/l abd: distended, tender esp in ruq with guarding no rebound, hypoactive but present bs ext: warm well-perfused, b/l tmas, 2+ dps psych: a&o to self, year, hospital pertinent results: 08:05pm glucose-86 urea n-4* creat-0.3* sodium-134 potassium-3.1* chloride-106 total co2-22 anion gap-9 08:05pm alt(sgpt)-162* ast(sgot)-443* ld(ldh)-223 alk phos-1501* amylase-26 tot bili-13.3* 08:05pm lipase-32 08:05pm albumin-1.6* calcium-6.3* phosphate-2.3* magnesium-1.5* 08:05pm hbsag-negative hbs ab-negative hbc ab-negative hav ab-negative 08:05pm hcv ab-negative 08:05pm wbc-9.1 rbc-2.87* hgb-8.8* hct-26.8* mcv-94 mch-30.6 mchc-32.7 rdw-23.2* 08:05pm neuts-92* bands-0 lymphs-1* monos-3 eos-0 basos-2 atyps-1* metas-0 myelos-1* 08:05pm hypochrom-3+ anisocyt-2+ poikilocy-occasional macrocyt-occasional microcyt-occasional polychrom-normal target-occasional teardrop-occasional how-jol-occasional bite-occasional fragment-occasional 08:05pm plt smr-very low plt count-55* 08:05pm pt-14.9* ptt-60.8* inr(pt)-1.3* 08:05pm fdp-0-10 08:05pm fibrinoge-380 d-dimer-1115* 07:33pm urine hours-random creat-108 sodium-90 07:33pm urine color-brown appear-cloudy sp -1.010 07:33pm urine blood-lge nitrite-neg protein-30 glucose-neg ketone-50 bilirubin-lg urobilngn-4* ph-7.0 leuk-sm 07:33pm urine rbc-880* wbc-15* bacteria-mod yeast-none epi-2 07:33pm urine mucous-rare comment-due to abnormal urine color interpret dipstick with caution gb us: 1. distended gallbladder with edematous wall which, in the correct setting, may represent acute acalculous cholecystitis. correlation with patient's clinical status and lab values recommended. alternatively, hida scan could be obtained. 2. diffusely echogenic liver, compatible with patient's known history of hepatitis c. no ascites or evidence of portal venous hypertension. more serious forms of liver disease cannot be excluded on the basis of this study. ct abd: successful readjustment of percutaneous cholecystotomy tube with the pigtail well formed within the gallbladder. abd us: a limited ultrasound examination was performed of the right upper quadrant. the cholecystostomy tube was seen entering the gallbladder, although its course within the gallbladder and extension through the posterior wall was not well visualized on ultrasound despite multiple attempts. heterogeneously echoic material was identified within the gallbladder consistent with hemorrhage/clot. it was decided that due to the lack of visualization of the catheter that readjustment of the catheter would be better performed using ct guidance. therefore, ultrasound-guided adjustment of the catheter was aborted. ct abd: 1. errant course of cholecystostomy tube as described. repositioning is suggested. small collection of blood both within the gallbladder and moderate- sized around the liver. 2. heterogeneous pelvic presacral retroperitoneal masses with adjacent lymphadenopathy. areas of low attenuation consistent with fat narrows the differential to include liposarcoma or teratoma. extramedullary hematopoiesis would also be a possibility in the appropriate clinical setting 3. heavily calcified internal and external iliac vessels consistent with underlying atherosclerotic disease. 4. degenerative changes of lower thoracic and lumbar spine. 5. bilateral pleural effusions and associated atelectasis. 6. free fluid within both the pelvis and abdomen. gb drainage us: ultrasound-guided cholecystostomy tube placement: written informed consent was obtained by the icu/surgical house staff. the procedure was performed emergently at bedside in the intensive care unit. ultrasound was used to select an appropriate spot for percutaneous cholecystostomy tube placement. the area was prepped and draped in sterile fashion. the skin and subcutaneous tissues were anesthetized using 7 cc of 1% lidocaine. using continuous son guidance, a 8 french catheter was advanced into the gallbladder. aspiration yielded clear dark brown fluid. the needle and stiffener were then removed. the pigtail was deployed. approximately 100 cc of additional bilious fluid was then aspirated and removed to bag drainage. post-procedure imaging showed the catheter within a nearly collapsed gallbladder. dr. , the attending radiologist, performed the procedure. the patient tolerated the procedure well without immediate complication. icu nursing provided sedation throughout the procedure, during which the patient was under continuous hemodynamic monitoring. a total of 75 mcg of fentanyl and 1 mg of versed were administered. impression: bedside placement of percutaneous cholecystostomy tube. pcxr: cardiac silhouette is enlarged. there is a left retrocardiac opacity with obscuration of the left medial hemidiaphragm. there is also some atelectasis seen in the right mid lung field. no focal consolidation is seen. the patient has a right ij central line with distal tip at the mid svc. there is fixation plate in the lower cervical spine. a left humeral prosthesis is seen. mrcp within the lesser sac, there is a 7.3 x 10.5 x 10.8 cm, loculated fluid collection with thin septations and a thickened enhancing wall, which is slightly increased in size compared to the prior ct study of . a separate component extends through the esophageal hiatus into the left chest, unchanged from the cect. a portion of the collection surrounds the caudate lobe of the liver. the stomach is draped over this collection superiorly and anteriorly, and its inferior aspect is bounded by the transverse colon. as such, an accessible window for drainage by cross sectional imaging is limited. a ct study after decompression of the stomach with an ng tube to evaluate for a possible accessible percutaneous drainage window could be attempted. alternatively, an endoscopic approach could be performed. previously placed cholecystostomy catheter is seen through the liver to the gallbladder wall, it's tip is not well identified, though some images suggest it is within the gallbladder. there is a tiny 2-cm collection within segment v of the liver and the gallbladder, unchanged (series 200, image 20). small-to-moderate amount of ascites has slightly increased in the interval. no focal liver lesions are seen. the spleen, adrenal glands, and kidneys are normal in appearance. findings were discussed with dr. . on at 3:30 p.m. impression: mildly complex organized fluid collection in the lesser sac, likely representing a biloma, which has slightly increased in size from the ct study of one week prior. no definite percutaneous accessible drainage window is readily identified. ct hepatic drainage: 1. successful placement of abdominal fluid collection drainage catheter. 2. multiple presacral heterogeneous masses suggestive of liposarcoma, teratoma, nerve sheath tumors or possibly extramedullary hematopoiesis as previously indicated. given profound osteopenia, extraosseous myeloma is considered. mr would be helpful in further evaluation.biopsy could be performed when the patients acute condition allows 3. dense atherosclerotic calcification and marked degenerative osseous changes as described above. 4. bilateral pleural effusions and associated atelectasis. ct of the abdomen with iv contrast: the lung bases reveal bilateral improvement in pleural effusions with small fluid collections within the pleurae persisting bilaterally. no nodules, opacities, or infiltrates are noted at the lung bases bilaterally. the visualized heart and pericardium are unremarkable. no focal lesions are identified within the liver. the cholecystostomy tube is again identified and is coiled within the gallbladder. the pancreas, spleen, adrenal glands, and kidneys are unremarkable. fluid collection within the lesser sac is again identified and measures approximately 8 x 5.5 cm. this is smaller than on the previous study where it measured 11 x 7 cm. a draining catheter is noted in the anterior aspect of the collection. visualized loops of small and large bowel are unremarkable. no free air is identified. another small fluid collection is seen in series 2, image 44 in the right side of the abdomen measuring approximately 22 x 26 mm. of note, fluid is seen tracking into the esophageal hiatus and is stable when compared to previous study. also noted multiple soft tissue densities likely representing lymph nodes were identified near the left crux of the diaphragm retroperitoneally. these are best seen in series 2, images 5 through 12. again note is made of dense atherosclerotic calcification of the aorta and its branches. ct of the pelvis with contrast: again the pelvis is poorly visualized secondary to artifact from bilateral femoral prostheses. again identified are two heterogeneous retroperitoneal masses located presacrally with a third smaller similar-appearing heterogeneous mass noted superiorly lateral to the iliac vessels. these are unchanged in appearance compared to previous exam. surgical clips are again identified in the right pelvis. small amount of pelvic fluid is again identified. bone windows: osseous structures are significant for bilateral hip prostheses and diffuse osteopenia. multiple compression deformities of the thoracic and lumbar spine are noted on sagittal images. multiple previous healed pelvic fractures are also again noted. impression: 1. interval successful partial drainage of abdominal fluid collection. catheter is located in more anterior aspect of remaining fluid, which seems to be located more posteriorly. since the anterior and posterior aspects of this fluid collection seem to communicate adjusting patient position may assist in further drainagei(ie prone position) . if this is unsuccessful, advancement of the catheter is an option. this was discussed with dr. at the time of this dictation. 2. previously defined multiple presacral heterogeneous masses with the differential including liposarcoma, teratoma, extramedullary hematopoiesis, and nerve sheath tumors. recommend biopsy as patient's condition allows. soft tissue masses likely representing lymphadenopathy also noted in the retroperitoneum near the left diaphragmatic crux. . 3. improvement in bilateral pleural effusions. 4. marked osteopenia and degenerative changes of lumbar and thoracic spine including compression deformities. brief hospital course: 1. hypotension: presented as high co state and low svr, consistent with sepsis. given transaminitis, found to have acalculous cholecystitis. an us guided cholecystostomy tube was placed. he continued to have severe abdominal pain and a ct was checked which showed the cholecytostomy tube went all the way through the gallbladder. the tube was then pulled back under guidance, and follow up ct showed correct placement. gallbladder aspirate grew pansensitive klebsiella. pt. was treated with levofloxacin and flagyl and will continue this for a total of 2 weeks. on the floor pt. improved initially but then developed persistent abdominal pain/nausea, f/u ct showed interval development of extracholecystic biloma. a drainage tube was inserted under ct guidance. the patient then improved greatly with improved abdominal pain and began tolerating a regular diet. pt. then accidentally pulled out the cholecystostomy tube, but his abdominal pain remained improved. a follow up ct showed interval decrease in size of his biloma. pt. will need to have a follow up ct in 2 weeks () after discharge to evaluate his biloma, if this is improved and the drain is putting out less than 10cc/d his drain will be pulled by ct radiology. . 2. bilateral heterogenous retroperitoneal masses: discovered incidentally on ct abdomen. appearance c/w either teratomas or lipomyosarcomas. oncology consulted and hcg and afp levels checked and found to be normal, rec f/u as outpatient for ct guided biopsy when acute illness resolved. . 3. adrenal insufficiency: found to be persisitently hypotensive to 70-80/40-50, but asymptomatic. stim test showed inappropriate response, with baseline low cortisol. seen by endocrine service and started on prednisone 10 mg daily. they felt it may be difficult to ever take him off this given his long h/o steroid use. his aldosterone levels were appropriate and he was felt not to need florinef. . 4. etoh dependence: initially put on ciwa scale in icu but never required much benzodiazepine. no clear signs of etoh withdrawl. . 5. : rec'd heparin gtt, bb, asa at osh for ce elevation. ce's positive there. trop i elevated here and trending up, despite normal ck. likely to hypovolemia and sepsis picture. not c/w acs. ce trended down eventually. . 6. bowel movements: loose stool. ? infection vs. obstruction c diff negative but given empiric course of flagyl. . 7. thrombocytopenia: ddx incl hypersplenism (though no portal htn on u/s), marrow suppression etoh. hit neg. platelets improved on discharge. . 8. anemia: likely in part dilutional, may be related to bm suppression. phlebotomy, as well as chronic oozing. not c/w acute dic. iron studies c/w anemia of chronic disease. b12/folate wnl. given 1 unit prbcs on , subsequently hct remained stable. . 10) ppx: pneumoboots, ppi . 12) code: full . 13) comm: pt and father cell medications on admission: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. disp:*qs 1 month* refills:*2* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 7. oxycodone 5 mg tablet sig: two (2) tablet po q3h (every 3 hours) as needed. disp:*30 tablet(s)* refills:*0* 8. gabapentin 300 mg capsule sig: two (2) capsule po q8h (every 8 hours). disp:*qs 1 month* refills:*2* discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. disp:*qs 1 month* refills:*2* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 10 days. disp:*10 tablet(s)* refills:*0* 6. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 10 days. disp:*30 tablet(s)* refills:*0* 7. oxycodone 5 mg tablet sig: two (2) tablet po q3h (every 3 hours) as needed. disp:*30 tablet(s)* refills:*0* 8. gabapentin 300 mg capsule sig: two (2) capsule po q8h (every 8 hours). disp:*qs 1 month* refills:*2* 9. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: acalculous cholecystitis intrabdominal biloma bilateral retroperiteal masses discharge condition: stable discharge instructions: please continue your regular medications. please follow up with your pcp in the next week. please follow up for your ct scan of your abdomen on the 22nd. the radiologists will tell you at that time if your tube can come out. please change your drain dressing daily and empty your bag daily. followup instructions: 1. please have your follow up ct scan of your abdomen on at 9am in the , . you can call if you have questions. make sure you have nothing to eat/drink 3 hours prior to exam. they will use this scan to determine if your biloma drain can be removed. 2. please follow up with your pcp in the next week. you will need to have your bilateral retroperitoneal masses followed up with either ct guided biopsy or serial imaging. procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances percutaneous abdominal drainage transfusion of packed cells other cholecystostomy diagnoses: thrombocytopenia, unspecified anemia of other chronic disease subendocardial infarction, initial episode of care chronic hepatitis c without mention of hepatic coma aortic valve disorders peripheral vascular disease, unspecified sepsis other specified septicemias mechanical complication due to other implant and internal device, not elsewhere classified rheumatoid arthritis cholangitis other and unspecified alcohol dependence, unspecified family history of malignant neoplasm of gastrointestinal tract other specified disorders of peritoneum cholecystitis, unspecified 

Answer: The patient is high likely exposed to