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 (sulfonamide antibiotics) attending: chief complaint: cc: major surgical or invasive procedure: endoscopic ultrasound endoscopic retrograde cholangiopancreatography (ercp) interventional radiology drain placement history of present illness: mr. is a 66yo male with past medical history significant for diabetes, obesity and htn who presented to an outside hospital with complaints of jaundice and swollen lower extremities and found to have new lle dvt on imaging and new pancreatic head mass on ct scan with extensive liver metastasis. lung with additional spiculated density in rll noted on imaging. he is being transferred now for additional surgical and oncology consultations. of note, he states that he has lost about >140 lbs over the past year which he feels has been from diet and exercise. states his jaundice has gotten worse over the past 3 weeks. also having occasional non-bloody diarrhea and slight fatigue. at the outside hospital, vital signs recorded as : bp 106/58, weight 204 lbs but no hr or temperature recorded in transfer notes. osh labs also notable for anemia with hct 29.5, d-dimer 7075, hyperbilirubinemia of 20.9, inr elevation to 3.0, ast 147, alt 73 and alp 868. albumin 2.9 and total protein also low at 5.9. gallbladder us done and showed distended gb with sludge, mild prominence of common hepatic duct and intra-hepatic biliary ducts. le ultrasound of left leg revealed dvt involving the superficial femoral vein to the calf muscles. he was given iv heparin and transitioned to lovenox this morning prior to transfer, otherwise continued on his usual home diabetes medications and his lisinopril was held given his very mild blood pressures in low 100s systolic. on arrival to the medical floor at , initial vitals were: temp 96.7f, bp 118/68, hr 61, rr 18, 100% o2 sat ra. fsg was 174. patient appeared to be in no acute distress and was extremely jaundiced. review of systems: (+) per hpi, diarrhea, fatigue as above. (-) denies fevers,denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, constipation, bloody stools or abdominal pain. no recent change in bowel or bladder habits except darker urine. no dysuria. denied arthralgias or myalgias. past medical history: diabetes mellitus, on insulin obesity (now s/p significant weight loss) hypertension social history: social history: lives in where he works as a business manager, visiting on business. denies smoking cigarettes but smokes 1 cigar per month. he is divorced with 2 children. lost more than 140 lbs with diet and exercise over past year but more recent loss may be related to cancer. he has been visiting several business partners on the over the past few weeks. denies any etoh intake or illic substances. family history: family history: father died of "bone cancer", otherwise non-contributory. physical exam: admission examination: vitals: temp 96.7f, bp 118/68, hr 61, rr 18, 100% o2 sat ra. general: fully alert and oriented, no acute distress. very jaundiced diffusely. heent: sclera icteric bilaterally, dry mm, oropharynx clear and nares clear, eomi neck: supple, jvp not elevated, no lad, no thyromegaly lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops neuro: cns in tact. sensation to light touch in tact. gait wnl and full upper and lower extremity strength. abdomen: soft with very loose skin with multiple layers and stretch marks, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly noted, negative sign ext: well perfused, 2+ pulses, no clubbing, cyanosis. lle with 1+ edema and markedly larger than rle pertinent results: hematology: 07:25am blood wbc-6.9 rbc-3.01* hgb-9.0* hct-27.5* mcv-91 mch-30.0 mchc-32.8 rdw-25.3* plt ct-184 07:00am blood wbc-8.5 rbc-3.13* hgb-9.5* hct-29.1* mcv-93 mch-30.2 mchc-32.5 rdw-25.2* plt ct-195 03:00am blood wbc-8.0 rbc-3.56* hgb-10.6* hct-30.1* mcv-85 mch-29.7 mchc-35.1* rdw-24.1* plt ct-253 05:48am blood wbc-8.1 rbc-3.56* hgb-10.2* hct-30.5* mcv-86 mch-28.7 mchc-33.6 rdw-22.5* plt ct-279 06:00am blood wbc-7.2 rbc-3.42* hgb-9.8* hct-29.6* mcv-87 mch-28.7 mchc-33.2 rdw-22.1* plt ct-258 03:00am blood neuts-71* bands-1 lymphs-15* monos-6 eos-6* baso-0 atyps-0 metas-0 myelos-1* coagulation: 07:25am blood pt-23.2* inr(pt)-2.0* 07:00am blood pt-19.4* ptt-32.7 inr(pt)-1.8* 08:15am blood pt-16.9* ptt-30.5 inr(pt)-1.5* 04:45am blood pt-20.2* ptt-29.3 inr(pt)-1.9* 05:49am blood pt-19.6* ptt-33.8 inr(pt)-1.8* 06:00am blood pt-23.2* ptt-48.2* inr(pt)-2.2* chemistries: glucose-246* urean-13 creat-0.9 na-134 k-3.7 cl-101 hco3-25 glucose-184* urean-11 creat-0.8 na-134 k-3.9 cl-101 hco3-25 glucose-278* urean-11 creat-0.9 na-133 k-4.0 cl-99 hco3-26 07:25am blood alt-29 ast-65* alkphos-281* totbili-17.5* 07:00am blood alt-31 ast-55* ld(ldh)-180 alkphos-310* totbili-18.0* dirbili-13.8* indbili-4.2 08:15am blood alt-32 ast-58* ld(ldh)-204 alkphos-382* totbili-20.3* 05:49am blood alt-59* ast-109* ld(ldh)-173 alkphos-688* totbili-18.3* 06:00am blood alt-70* ast-138* ld(ldh)-190 alkphos-778* totbili-18.5* 08:15am blood albumin-2.9* calcium-8.5 phos-1.9* mg-2.1 01:17pm blood albumin-2.8* calcium-8.5 phos-2.8 mg-1.8 tumor markers: 06:00am blood cea-352* pathology: ir-guided biopsy results pending at discharge, includes brushings and fna. brief hospital course: the patient is a 66 year old man who was admitted with newly diagnosed pancreatic mass, concerning for malignancy. the patient had an extensive workup, and a series of attempts at obtaining pathology. several meetings with the patient and his family were conducted by the medical team, in order to clarify the current medical plans and recommended next steps. one meeting, including both of the patient's daughters at the bedside, occurred several days prior to admission. the family's questions were addressed, including those surrounding the pending pathology, and the procedures done to that point to both obtain pathology and relieve the patient's biliary obstruction. the patient expressed his interest at that time, and in two subsequent family meetings, that he wants to continue his medical treatment out of . he also stated that he would defer all medical appointments being made on his behalf at this time, in the area, and did not need the team to make any followup for him at this time. he did not have the name of the clinician who would be taking over his care, in the city where he hoped to obtain further care. he did feel strongly that the writer meet a trusted friend who would be helping him arrange care, through a holistic medicine group, during one of the latter family meetings. the patient was provided information to obtain his records for release to his new clinician, once he knew who he would be seeing. he was aware that his plan, including no planned followup, was not recommended by his medical team, and noted he was willing to accept the risk associated with his choice. he was felt to have capacity to make his decisions, on several assessments, lacking signs or symptoms of delirium or encephalopathy. his family felt his medical choices were in keeping with his usual wishes. #pancreatic mass / metastatic cancer: newly diagnosed metastatic pancreatic cancer at osh but not definitive with any biopsies just yet. he presented to new pcp c/o 2 weeks worse jaundice and new lle edema which was found to be new dvt. obstruction from pancreatic head mass is likely etiology of his jaundice with direct bilirubin in 18 -19 range now. metastatic lesions suspected on recent ct both throughout the liver and on rll area. the patient underwent an endoscopic u/s and fna of the pancreas, although biopsies were inconclusive. unable to biopsy liver mets. he had ercp x2 and during the second procedure there was significant bleeding following the procedure. the patient bled 250-500cc during the procedure, and subsequently bled further and required an icu stay for observation. he later stabilized and was transferred back to the medical service. he underwent a per cutaneous biliary drain placed by ir, which was later internalized during a followup procedure. his total bilirubin improved daily, although it remained elevated at the time of discharge. he remained on oral antibiotics for 8 days following discharge, after completing an iv antibiotics course during his admission. pathology from the ir-guided biopsy sample was pending at discharge, and the patient was given detailed instructions on how to call the pathology department (with the pathologist's verbal approval in advance) for the final result. the patient again noted that he did not have a clinician's name or contact information to provide the medical team, in order to ensure the results would be passed along to him. gi bleed: during work-up for pancreatic mass, pt had ercp x2 and during the second procedure a blood vessel was nicked and pt began bleeding. pt bled 250-500cc during the procedure. he was reportedly hemodynamically stable, but was transferred to the for further observation. pt had ptbd placed by ir. he had some post precudural pain, but was otherwise pt was hemodynamically stable and ready for call out back to the floor. lle dvt: most likely secondary to hypercoaguable state with pancreatic cancer. he also takes frequent long airplane flights between south america and us which is another risk factor that may have provoked his dvt. last inr 3 range. he was transitioned from iv heparin to lovenox at osh. ivc filter was placed. anticoagulation was not restarted after discussion with gi, advanced endoscopy and hematology teams prior to discharge, due to his high bleeding risk. the patient's inr was elevated during his stay, attributed to his liver synthetic dysfunction, but we did not feel this would be protective against further clotting. but since he lost more than 140 lbs his blood pressures have been low to normotensive ranges and he has not been taking his usual lisinopril. his lisinopril was held at this time and htn was not an active issue during the course of his stay. diabetes: longstanding type ii dm and he states he has been on lantus for over 6 months. fsg now in 170s range. recent weight loss may have impacted his need for lantus 40 units which he had taken at home. have changes also due to insulin production impairment due to destruction at level of pancreas from primary malignancy. pt was placed on an insuling sliding scale in the icu, and his lantus dosing was later restarted prior to discharge, when the patient was taking adequate oral intake. prophylaxis: no indication for ppi, bowel regimen prn code: full, confirmed with patient and family. communication: patient, daughters. h-. c-. medications on admission: medications on transfer from outide facility: -lovenox 90mg q12 hrs -glucophage 500mg -lisinopril --states he has not been taking (does not know old dose) -lantus 40 units qhs (patient has been taking this medication long-standing) discharge medications: 1. lantus 100 unit/ml solution sig: forty (40) units subcutaneous at bedtime. 2. augmentin 250-125 mg tablet sig: one (1) tablet po twice a day for 8 days. disp:*16 tablet(s)* refills:*0* 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day for 1 weeks. disp:*7 capsule, delayed release(e.c.)(s)* refills:*0* 4. oxycodone 5 mg tablet sig: one (1) tablet po every six (6) hours for 4 days. disp:*16 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: pancreatic mass with probable metastases gastrointestinal bleeding, resolved jaundice, hyperbilirubinemia secondary: left leg blood clot diabetes mellitus discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure caring for you at . you were admitted to as a transfer from another hospital. you came to for referral regarding the management of your newly diagnosed pancreatic tumor with liver masses. you were seen by our oncologists, as well as gastroenterologists and radiologists. you had a procedure performed called an "endoscopic ultrasound" or "eus" where biopsies of the tumor were taken for tissue identification. additionally, you had an "endoscopic retrograde cholangiopancreatography" or "ercp" performed. you later had an interventional radiology procedure that was able to develop way to drain your bile despite the blockage. your biliary ducts were blocked by the mass, and that obstruction from the tumor caused your skin to be yellow, or "jaundiced". we think it is not advisable to leave the hospital without plans to see any of the doctors that have the specialized procedures while you were here, including the interventional radiology doctors and the specialists. we have cancelled the followup appointment with oncology that we previously scheduled, at your request. we have developed some recommendations that apply to the current issues you are facing, but it is extremely important that you see a doctor as soon as possible, to continue workup and treatment of your medical conditions. we changed the following medications: 1. added augmentin for 8 more days, to complete a 14 day course. 2. please discontinue your metformin, due to liver dysfunction that you are having. 3. do not take aspirin or other blood thinners. 4. we have given you 4 days of oxycodone, for pain at the drain site. we have not scheduled any followup appointments at your request. your pathology specimen is still under evaluation at the pathology department. you can call the pathology department at , once you have a new doctor, and ask them to release the results to you. we would normally have your new doctor make this call, but since you do not know that doctor's name or information, we cannot follow our usual protocols. there is a pathology doctor, dr who is overseeing your case, and you can ask to speak with him. we have also provided you with the adequate information to obtain a records release, so that you can have access to your records. followup instructions: you have not been scheduled for followup, at your specific request. we have cancelled the previous appointments we made for you with oncology, at your request. we are strongly recommending that you seek medical attention as soon as possible. we are also recommending that you not travel any long distances, given your acute medical conditions. procedure: interruption of the vena cava endoscopic sphincterotomy and papillotomy closed [aspiration] [needle] [percutaneous] biopsy of pancreas other percutaneous procedures on biliary tract other percutaneous procedures on biliary tract endoscopic retrograde cholangiopancreatography [ercp] other closed [endoscopic] biopsy of biliary duct or sphincter of oddi diagnoses: malignant neoplasm of liver, secondary unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled accidental puncture or laceration during a procedure, not elsewhere classified hemorrhage complicating a procedure malignant neoplasm of head of pancreas other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation obesity, unspecified secondary malignant neoplasm of lung acute venous embolism and thrombosis of deep vessels of proximal lower extremity cholangitis obstruction of bile duct 

Answer: The patient is high likely exposed to