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: lactose / heparin agents attending: chief complaint: left ankle and left shoulder pain major surgical or invasive procedure: -left ankle irrigation and debridement -left shoulder irrigation and debridement -left femoral cvvh catheter placed , pulled -left radial arterial line placed , pulled -right triple lumen ij placed , pulled -endotracheal intubation -bronchoscopy history of present illness: ms. is a 52 yo f with hiv and adult onset still's disease who presented to the ed with left shoulder pain and left ankle pain. her pain level at admission was in the l ankle and in the l shoulder. she described it as constant and exacerabeted by movement. she said the pain began 3 days prior to admission and had been increasing. she reported no other joint pain except that her knees were aching. she denied sore throat, cough, difficulty breathing, changes in urination or skin changes. she reported that she had not had any injection into her joints for several years. on the day of admission, she had the left ankle tapped by her rheumatologist which showed wbcs of 78k in turbid fluid. her pcp sent her to the ed. in the ed, initial vital signs were t99 p117 bp114/74 r16 o2 sat.99% x ray of the left shoulder and left ankle revealed no actue fracture or joint dislocation. patient was evaluated by orthopedics who recommended ankle and possibly shoulder i&d the next day. they asked to keep her npo after midnight and to hold antibiotics to increase yield of or joint cultures. she was given tylenol 1g po for pain control. of note, ms. was hospitalized with positive stool pcr for c.diff. during her hospital stay, she developed a flare of her still's disease with thrombocytopenia and anemia attributed to bone marrow suppression. she was discharged on 60 mg predinisone daily. past medical history: 1. hiv/aids diagnosed in , nadir cd4 count= 3, most recent cd4 784 on haart, vl undetectable 2. positive hbvc antibody, consider suppressed by the haart. 3. positive ppd, status post inh 12/. 4. hypothyroidism. s/p iodine ablation in , on replacement. 5. chronic anemia. 6. herpes zoster . 7. -chiari type 1 malformation. 8. hypophosphatemia and hypopotassemia. secondary to rta. 9. proximal renal tubular acidosis. secondary to tenofovir. 10. adult onset still's disease 11. osteopenia prior rheumatologic history: -- dx adult onset stills disease (fever, polyarthritis, rash, ferritin 32k). pred 60 to 7.5 in -> joint flare. pred 20, mtx 7.5/wk. -- icu for flare (fever, neck lad, hypotension, ferritin 82k) and ?viral diarrhea. h.d. steroids, then pred 40 x 2 mo, down to 20 in . joint flare x3 in 4 months. pred 40, mtx up to 25/wk in . -- infliximab 3 mg/kg q8wks added. -- icu for flare on pred 10 mg (fever, neck lad, hypotension, ferritin 22k). h.d. steroids, then pred 40. -- joint flares. infliximab up to 5.6 mg/kg q6wks, in to 7 mg/kg q6wks. -- icu with flare (fever, hypotension, neck lad, rash, ferritin 67k). intub for pulm edema. ivp steroids x3 days, then 60 mg qd. anakinra 100 qd started. mtx/infliximab d/c'd. -- stable. pred at 20 mg. anakinra continued. -- anakinra held one dose for wbc of 2.8, icu admission for systemic flare, pressors x2d, early signs of mas but no hsm, transient diarrhea. pred 60 mg, anakinra qd continued. bactrim switched to mepron. -- systemic flare on pred 30. icu admission (intubation, pressors x2d), ivp solumedrol x3d, anakinra qd continued. new hemolytic anemia/thrombocytopenia. ivig 2g/kg x1. rta, bicarb wasting, later diarrhea again. discharge on pred 60 mg. -- anakinra d/c'd, monthly tocilizumab 8 mg/kg infusions started at . monthly pred taper to 40 mg in , to 25 mg in , to 10 mg in . -- no manifestations of active still's disease, and was advised to taper the prednisone to 7 mg. -- seen by dr. and prednisone reduced to 5mg -- admitted with exacerbation of still's disease with polyarthritis and septic shock c.diff colitis while being on tocilicumab (ferritin 17.000) -> treated with prednisone 60 mg daily and antibiotics d/c -- seen by dr. in his office for follow up on -> l ankle pain and swelling appreciated -> dr. tapped her ankle: joint fluid: 78.000 wbc -> now ms. is admitted for concern for septic joint social history: from and emigrated to u.s. in . she has 2 daughters and 2 sons. : denies etoh: denies illicits: denies family history: daughter with possible rheumatoid arthritis physical exam: physical exam on admission: vitals- 101, 111/74, 110, 18, 100%ra general- somnolent, eyes closed, answers questions reluctantly, but arousable skin: iv skin, warm, bruises noted on arms, no rashes heent- sclera anicteric, mucus membranes slightly dry, oropharynx without lesions/rash neck- supple, no lymphadenopathy appreciated lungs- clear to auscultation bilaterally cv- tachycardic, regular rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen- obese, soft, non-tender, non-distended, bowel sounds present, no splenomegaly appreciated, liver border just below ribs and firm. no suprapubic tenderness. ext- warm, well perfused, no clubbing, cyanosis or edema neuro- sleepy but attentive, oriented x3, motor function grossly normal msk- left shoulder swollen, warm to touch, no erythema appreciated; passive rom limited by pain, full active rom but painful. left ankle swollen with point tenderness on the outside; limited passive rom, pain on active rom. physical exam on discharge: vs: temp 36.7 126/76 hr 101 rr 28 o2: 98% on 40% fio2 psv 10/5 general: intubated but arousable ,follows commands heent- right > left conjunctival injection, sclera icteric b/l, slightly dry, intubated tube in mouth neck- supple, no lymphadenopathy appreciated, central line in place on right ij lungs- clear to auscultation bilaterally cv- tachycardic, regular rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen- obese, soft, non-tender, non-distended, bs+. ext- warm, well perfused, no clubbing, cyanosis . 2 + pitting edema in lower extremities neuro- equal pupils 4mm skin: - thin with superficial desquamation and positive nicolsky sign - on the face, there is erythema and superficial necrolysis of the forehead and periorbital skin with edema. - on the upper chest, upper arms, thighs, lower abdomen, there is faint blanching erythema. - on the chest and upper arms, there are echymoses and superficial desquamation of the skin, in areas of trauma/tape placement - on the buttocks, there are superficial erosions and maceration. a rectal tube is in place, but some feces has leaked out - the patient is intubated, with superficial erosions on the lips as well as the buccal muscosa - no vaginal mucosal lesions - no bullae, target lesions pertinent results: lab results on admission: joint fluid analysis: 01:54pm joint fluid wbc-* rbc-* polys-90* lymphs-4 monos-5 macrophag-1 hemotology 10:35pm wbc-6.7# rbc-4.15*# hgb-11.8*# hct-37.7# mcv-91 mch-28.4 mchc-31.2 rdw-15.4 neuts-70.7* lymphs-23.2 monos-3.1 eos-2.1 basos-0.8 plt count-302# 11:30pm pt-13.1* ptt-29.0 inr(pt)-1.2* chemistry 11:41pm glucose-120* lactate-0.9 na+-130* k+-4.0 cl--108 tco2-15* 10:35pm calcium-8.0* phosphate-2.1* magnesium-1.6 10:35pm urea n-9 creat-0.7 cbc: 10:35pm wbc-6.7# rbc-4.15*# hgb-11.8*# hct-37.7# mcv-91 mch-28.4 mchc-31.2 rdw-15.4 plt ct-302# 07:50am wbc-6.4 rbc-3.50* hgb-9.8* hct-30.7* mcv-88 mch-28.0 mchc-31.9 rdw-15.6* plt ct-351 09:48pm wbc-1.2*# rbc-3.33* hgb-9.2* hct-28.9* mcv-87 mch-27.7 mchc-31.9 rdw-15.8* plt ct-233 04:47am wbc-1.7* rbc-3.44* hgb-9.6* hct-30.3* mcv-88 mch-27.9 mchc-31.6 rdw-15.9* plt ct-86*# 10:03am wbc-5.4# rbc-3.77* hgb-10.4* hct-33.9* mcv-90 mch-27.5 mchc-30.5* rdw-16.0* plt ct-72* 05:00pm wbc-9.9# rbc-3.08* hgb-8.4* hct-27.5* mcv-89 mch-27.3 mchc-30.6* rdw-16.6* plt ct-42* 03:52am wbc-13.1* rbc-4.06*# hgb-11.4*# hct-35.8*# mcv-88 mch-28.2 mchc-31.9 rdw-16.6* plt ct-32* 10:51am wbc-16.6* rbc-4.01* hgb-11.2* hct-34.9* mcv-87 mch-28.0 mchc-32.1 rdw-16.6* plt ct-31* 03:54pm wbc-16.4* rbc-3.71* hgb-10.5* hct-31.8* mcv-86 mch-28.2 mchc-33.0 rdw-16.7* plt ct-27* 10:19pm wbc-17.4* rbc-4.03* hgb-11.4* hct-33.7* mcv-84 mch-28.3 mchc-33.9 rdw-16.8* plt ct-29* 05:10am wbc-24.1* rbc-4.04* hgb-11.4* hct-33.9* mcv-84 mch-28.2 mchc-33.6 rdw-17.0* plt ct-29* 12:34pm wbc-34.5* rbc-3.99* hgb-11.2* hct-33.9* mcv-85 mch-28.0 mchc-33.0 rdw-17.2* plt ct-18* 09:35pm wbc-31.1* rbc-2.94*# hgb-8.4* hct-24.8*# mcv-84 mch-28.6 mchc-33.9 rdw-17.5* plt ct-13* 10:29pm hct-23.6* 04:00am wbc-30.3* rbc-3.05* hgb-8.6* hct-25.6* mcv-84 mch-28.3 mchc-33.8 rdw-17.1* plt ct-38* 09:35am wbc-27.8* rbc-3.28* hgb-9.4* hct-27.4* mcv-84 mch-28.6 mchc-34.2 rdw-17.3* plt ct-28* 04:36pm wbc-29.0* rbc-3.45* hgb-9.7* hct-28.7* mcv-83 mch-28.2 mchc-33.9 rdw-17.5* plt ct-20* 09:49pm wbc-26.9* rbc-3.38* hgb-9.5* hct-28.0* mcv-83 mch-28.2 mchc-33.9 rdw-17.7* plt ct-16* 04:10am wbc-23.1* rbc-3.31* hgb-9.5* hct-27.6* mcv-83 mch-28.8 mchc-34.6 rdw-18.0* plt ct-14* 04:49pm wbc-17.6* rbc-3.34* hgb-9.9* hct-27.6* mcv-83 mch-29.6 mchc-35.8* rdw-18.2* plt ct-25* 04:29am wbc-18.8* rbc-3.49* hgb-10.0* hct-28.8* mcv-82 mch-28.6 mchc-34.8 rdw-18.7* plt ct-13* 03:47am wbc-23.0* rbc-3.52* hgb-9.9* hct-29.1* mcv-83 mch-28.2 mchc-34.0 rdw-18.9* plt ct-17* 04:17pm wbc-21.4* rbc-3.32* hgb-9.3* hct-27.5* mcv-83 mch-27.9 mchc-33.8 rdw-19.1* plt ct-15* 04:02am wbc-29.1* rbc-3.16* hgb-8.7* hct-25.9* mcv-82 mch-27.4 mchc-33.4 rdw-19.6* plt ct-25*# 10:32am wbc-28.1* rbc-2.84* hgb-8.1* hct-23.4* mcv-82 mch-28.7 mchc-34.8 rdw-19.4* plt ct-23* 04:46am wbc-24.0* rbc-2.78* hgb-7.6* hct-22.8* mcv-82 mch-27.5 mchc-33.4 rdw-19.7* plt ct-38*# chemistries: 07:50am glucose-111* urean-7 creat-0.6 na-127* k-3.9 cl-103 hco3-14* angap-14 09:48pm glucose-110* urean-9 creat-0.8 na-126* k-3.4 cl-103 hco3-9* angap-17 04:47am glucose-118* urean-12 creat-1.4* na-130* k-3.1* cl-109* hco3-7* angap-17 10:03am glucose-262* urean-19 creat-1.9* na-129* k-3.7 cl-107 hco3-6* angap-20 02:22pm glucose-376* urean-20 creat-2.3* na-125* k-3.6 cl-99 hco3-7* angap-23* 05:00pm glucose-389* urean-20 creat-2.0* na-125* k-3.6 cl-97 hco3-9* angap-23* 09:59pm glucose-533* urean-19 creat-1.8* na-124* k-3.6 cl-94* hco3-10* angap-24* 03:52am glucose-529* urean-18 creat-1.5* na-125* k-3.3 cl-92* hco3-11* angap-25* 10:51am glucose-442* urean-18 creat-1.5* na-126* k-3.5 cl-94* hco3-13* angap-23* 03:54pm glucose-232* urean-17 creat-1.4* na-129* k-3.4 cl-94* hco3-19* angap-19 10:19pm glucose-150* urean-17 creat-1.2* na-132* k-3.8 cl-96 hco3-19* angap-21* 04:49pm glucose-143* urean-26* creat-1.2* na-137 k-4.1 cl-95* hco3-27 angap-19 10:02pm glucose-133* na-139 k-4.0 cl-95* hco3-28 angap-20 04:29am glucose-130* urean-29* creat-1.2* na-140 k-4.0 cl-95* hco3-29 angap-20 09:59am glucose-140* na-141 k-4.1 cl-97 hco3-28 angap-20 04:02pm glucose-146* urean-31* creat-1.1 na-142 k-4.2 cl-101 hco3-29 angap-16 09:53pm glucose-142* urean-32* creat-1.1 na-140 k-4.2 cl-98 hco3-28 angap-18 03:47am glucose-220* urean-33* creat-1.2* na-142 k-4.4 cl-100 hco3-27 angap-19 09:36am glucose-221* urean-35* creat-1.1 na-140 k-4.4 cl-101 hco3-23 angap-20 04:15pm glucose-136* urean-34* creat-1.1 na-141 k-4.4 cl-101 hco3-26 angap-18 10:00pm glucose-183* na-141 k-4.3 cl-102 hco3-28 angap-15 10:32am glucose-183* urean-35* creat-1.0 na-140 k-4.9 cl-102 hco3-27 angap-16 04:46am glucose-121* urean-55* creat-1.8* na-142 k-5.1 cl-104 hco3-29 angap-14 liver enzymes 09:48pm alt-28 ast-94* ld(ldh)-555* ck(cpk)-53 alkphos-182* totbili-0.4 04:47am alt-16 ast-144* ld(ldh)-925* ck(cpk)-348* alkphos-153* totbili-0.7 05:00pm alt-92* ast-567* ld(ldh)-* alkphos-176* totbili-1.3 03:52am alt-158* ast-872* ld(ldh)-3515* ck(cpk)-584* alkphos-206* totbili-2.2* 03:54pm ld(ldh)-2990* totbili-2.1* 05:10am alt-135* ast-485* alkphos-197* totbili-3.0* 12:34pm alt-135* ast-422* ld(ldh)-2560* alkphos-217* totbili-4.1* 09:35pm alt-86* ast-287* ld(ldh)-* alkphos-156* totbili-4.5* 04:00am alt-74* ast-259* ld(ldh)-1710* alkphos-150* totbili-5.0* 04:10am alt-56* ast-200* ld(ldh)-1728* alkphos-219* totbili-9.6* dirbili-7.0* indbili-2.6 04:29am alt-58* ast-188* ld(ldh)-1609* alkphos-398* totbili-13.9* 03:47am alt-62* ast-173* ld(ldh)-1310* ck(cpk)-174 alkphos-461* totbili-13.7* 04:02am alt-56* ast-138* ld(ldh)-1129* alkphos-461* totbili-6.7* 04:46am alt-49* ast-123* alkphos-471* totbili-3.9* brief hospital course: brief summary: ms. is a 52 year old female with history of hiv (on haart with last cd4 in 782 and viral load undetectable) and adult still's disease (on chronic steroids) who presented with l shoulder and l ankle pain and had a complicated hospital course requiring ongoing intensive care as detailed below. the patient was seen in clinic on with left shoulder and ankle pain. she underwent an arthrocentesis which showed very high neutrophil count and therefore she was admitted with concern for septic arthritis. on , the patient was taken to the or for i&d of her l ankle and l shoulder. soon after the surgery, the patient rapidly deteriorated and became unstable with fever, hypotension, tachycardia, and lactic acidosis. she was then transferred to the micu. she required intubation, pressors, and cvvh for oliguric renal failure. she also had developed pancytopenia, dic, and transaminitis. she was treated empirically with broad spectrum antibiotics although no source was found and antibiotics were discontined. the source of her acute illness appears to be a flare of still's disease. she was treated with high dose steroids and anakinra with some improvement. however on she worsened and had yeast growing in her . then on she developed skin sloughing concerning for sjs/ten and she was transferred to a burn unit for further management. detailed micu course: # hypotension: suspect still's crisis as she has had similar episodes in past with hypotension. broad spectrum antibiotics started on were discontinued on . she was weaned off pressors on . she was initially treated with iv hydrocortisone on which was increased to methylprednisone 125 mg q6 on afternoon for treatment of still's crisis/mas. due to insufficient response methylprednisone was increased to 1 gm daily on for 5 days (day 5 = ). she was also started on anakinra (which she had been on in the past, but was discontined). anakinra was started on and was given qod. her lactate, ferritin and dic labs along with pressure improved with iv solumedrol and anakinra. she was started on bactrim ss daily (patient was on this med in the past) for pcp . this was stopped on with concern for sjs/ten. steroid taper began on with drop to methylprednisolone 50mg iv bid. --> continue to taper steroids as tolerated, recommend 40mg iv bid on to minimize infection risk from skin breakdown --> continue vitamin d + calcium and ppi --> will need to start alternative pcp # hypoxemic respiratory failure: most likely ards from stills flaure. imaging showed bilateral infiltrates with normal cardiac function. pao2/fio < 200. --> ards protocol for lower tidal volumes. --> psv weaned now to with fio2 of 40%. continue to wean as tolerated. --> vap bundle --> remove fluid as pressures tolerate on cvvh to improve lung dynamics # sjs/ten: on dermatology was consulted for an evolving rash. on the rash had worsened with desquamation of the skin and positive nicolsky sign. there were also oral lesions and diffuse ulcerations of the tracheobronchial epithelium seen during bronchoscopy. --> patient being transferred to a burn unit. # coagulopathy: likely dic from underlying still's. improving. hit ab neg. not getting heparin. labs have been stable. --> trending daily cbc, inr, ptt, fibrinogen # fungemia: cultures growing yeast in one bottle starting . id consulted and micafungin started. ophtho consulted and no evidence of endophthalmitis. removed all lines on and cultured tips (results still pending at time of transfer). --> patient should have tte to evaluate for valvular seeding --> yeast speciation still pending at time of transfer # cmv viremia in setting of still's flare. case reports of cmv as the etiology or consequence (reactivation) of still's disease. --> held off on ganciclovir to help with underlying anemia/thrombocytopenia due to risk of worsening bone marrow suppression. --> trend cmv viral load # acute kidney injury: pt developed renal failure, thought due to atn from prolonged hypotension. muddy brown casts on urine. renal consulted and cvvh was started on and stopped on when all lines removed for fungemia as above. --> she will need a new hd line on to start hd # anemia with guiaic positive stools in setting of coagulopathy and thrombocytopenia. hct stable. there was no evidence of gross bleeding or melena. patient was treated emprically with pantoprazole iv bid which was stopped on in case it was related to sjs/ten. --> continue to monitor # thromocytopenia: due to still's flare/mas vs medication related (stopped linezolid) vs cmv --> continue to monitor and treat underlying etiology as above --> transfuse for platelet < 10 --> f/u cmv vl (if very high, consider treating) # leukocytosis: due to stress response and high dose steroids, worsened with appearance of yeast in . --> follow surveillance cultures #lfts: transaminases improved but ap and bili trended up during admission (direct bilirubinemia). differential was due to ischemic injury vs cmv vs still's flair. ruq us was normal on and . bili began trending down again on . --> continue to trend # hiv: holding haart regimen for now given level of illness and potential drug interactions. # hypothyroidism: continued home synthroid # recent c. diff infection: during her last admission she was diagnosed with cdif and treated with po vanc. she was scheduled to finish her course of antibiotic soon. --> we are continuing po vancomycin for now given recent antibiotics to prevent recurrence transitional issues: =========================== - patient was intubated on . if not able to extubate in the next few days patient likely will need tracheostomy. - patient was receiving cvvh but had yeast (not yet speciated) grow in bottles on . therefore all lines were pulled on . plan was to put in new hd line (with vip port or picc line as well) on . - steroid course: methylprednisolone 125mg iv q6 x 2 days methylprednisolone 1gm iv q24 x 6 days metyhlprednisolone 50mg iv q12 until now - studies pending at time of transfer: - cmv viral load from - culture from growing budding yeast, speciation and sensitivity still pending - catheter tip cultures x 3 from - cultures x 2 from - bal results from - beta glucan - there were some areas of pigmented retina seen on dilated fundoscopic exam and should be evaluated as an outpatient by ophthamology - if there are questions, please call the micu 7 at and ask for the oncall resident medications on admission: preadmissions medications listed are incomplete and require futher investigation. information was obtained from webomr. 1. alendronate sodium 70 mg po frequency is unknown 2. efavirenz 600 mg po daily 3. emtricitabine 200 mg po q24h 4. levothyroxine sodium 150 mcg po daily 5. omeprazole 20 mg po daily 6. oxybutynin 10 mg po daily 7. potassium chloride 40 meq po daily duration: 24 hours 8. prednisone 50 mg po daily 9. raltegravir 400 mg po bid 10. sulfameth/trimethoprim ss 1 tab po daily 11. vancomycin oral liquid 125 mg po q6h 12. acetaminophen 650 mg po q6h:prn pain 13. calcium carbonate dose is unknown po frequency is unknown 14. vitamin d dose is unknown po daily 15. sodium bicarbonate 650 mg po tid discharge medications: 1. acetaminophen 650 mg po q6h:prn pain 2. levothyroxine sodium 150 mcg po daily 3. vancomycin oral liquid 125 mg po q6h 4. vitamin d unit po daily 5. alendronate sodium 70 mg po 1x/week (mo) 6. calcium carbonate 500 mg po bid 7. artificial tear ointment 1 appl both eyes q4h 8. erythromycin 0.5% ophth oint 0.5 in both eyes hs duration: 7 days 9. chlorhexidine gluconate 0.12% oral rinse 15 ml oral 10. fentanyl citrate 25-100 mcg iv q4h:prn pain 11. maalox/diphenhydramine/lidocaine 15-30 ml po qid:prn mucositis 12. methylprednisolone sodium succ 50 mg iv q12h 13. micafungin 100 mg iv q24h 14. ondansetron 4 mg iv q8h:prn nausea 15. insulin sc sliding scale fingerstick q4 insulin sc sliding scale using hum insulin 16. anakinra *nf* 100 mg/0.67 ml subcutaneous qod reason for ordering: no other appropriate medications for this condition discharge disposition: extended care discharge diagnosis: primary: - still's disease - hypotension - ards - fungemia - sjs/ten - acute renal failure secondary: - thrombocytopenia - discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: dear ms. , you were admitted to the hospital by your rheumatology doctor because we thought you had an infection in your ankle. we were also concerned about an infection in your shoulder, so we also took a sample to find out if it was infected. you were taken to the operating room by orthopedics to clean out the ankle joint. your procedure was complicated by low pressure and high rate of breathing after the surgery. you were taken to the intensive care unit for further care. in the intensive care unit you developed damage to many of your organs including your liver and kindeys. you required dialysis to help remove toxins from your body. we believe that you had a flare of your still's disease. you were treated with high doses of steroids and your condition improved. however as you were improving you started to develop skin breakdown. we were concerned for a serious condition called toxic epidermal necrolysis and therefore you are being transferred to a specialized unit to help care for this condition. followup instructions: department: nephrology when: thursday at 1 pm with: dr. building: de building ( complex) campus: west best parking: garage department: rheumatology when: friday at 11:00 am with: , md building: lm bldg () campus: west best parking: garage md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis other bronchoscopy injection or infusion of oxazolidinone class of antibiotics other arthrotomy, shoulder other arthrotomy, ankle diagnoses: hypocalcemia acute kidney failure with lesion of tubular necrosis long-term (current) use of steroids acute and subacute necrosis of liver hyposmolality and/or hyponatremia human immunodeficiency virus [hiv] disease other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure defibrination syndrome other shock without mention of trauma disorders of phosphorus metabolism intestinal infection due to clostridium difficile other specified antibiotics causing adverse effects in therapeutic use other candidiasis of other specified sites systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction disorder of bone and cartilage, unspecified mixed acid-base balance disorder other postablative hypothyroidism bloodstream infection due to central venous catheter other pancytopenia other pulmonary insufficiency, not elsewhere classified, following trauma and surgery hemophagocytic syndromes stevens-johnson syndrome-toxic epidermal necrolysis overlap syndrome other rheumatoid arthritis with visceral or systemic involvement exfoliation due to erythematous condition involving 10-19 percent of body surface 

Answer: The patient is high likely exposed to