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 / percocet attending: chief complaint: headache, abdominal pain major surgical or invasive procedure: hemodialysis history of present illness: 24yo f w/pmhx of esrd on hd, sle, malignant htn presents with headache and abdominal pain beginning this morning, awakening her from sleep. had been previously discharged from yesterday after being admitted for hypertension and abdominal pain. has had extensive work-up for abdominal pain including ex-lap on which was negative. upon discharge yesterday she states her abdominal pain had subsided. she had hd yesterday without complications. she awoke at 6am with a headache and crampy, stabbing abdominal pain. took 2mg po dilaudid without relief and came to ed. no nausea/vomiting, no changes in vision, no fevers, chills, night sweats. no chest pain, sob, diarrhea. in the ed, initial vitals were t98.7, bp260/130, hr70, rr16. was initially given 10mg iv labetalol x 2, 4mg zofran for nausea. no improvement in bp and started on labetolol gtt. got 1mg iv dilaudid for pain. currently, patient continues to complain of headache and abdominal pain, both . no vision changes, chest pain or shortness of breath. has been feeling increased anxiety recently and saw psychiatrist, was put on celexa. past medical history: 1. systemic lupus erythematosus: - diagnosed (16 years old) when she had swollen fingers, arm rash and arthralgias - previous treatment with cytoxan, cellcept; currently on prednisone - complicated by uveitis () and esrd () 2. ckd/esrd: - diagosed - initiated dialysis but refused it as of , has survived despite this - pd catheter placement 3. malignant hypertension - baseline bps 180's - 120's - history of hypertensive crisis with seizures - history of two intraparenchymal hemorrhages that were thought due to the posterior reversible leukoencephalopathy syndrome, associated with le paresis in that resolved 4. thrombocytopenia: - ttp (got plasmapheresisis) versus malignant htn 5. thrombotic events: - svc thrombosis (); related to a catheter - negative lupus anticoagulant (, , ) - negative anticardiolipin antibodies igg and igm x4 (-) - negative beta-2 glycoprotein antibody (, ) 6. hocm: last noted on echo 7. anemia 8. history of left eye enucleation for fungal infection 9. history of vaginal bleeding lasting 2 months s/p depoprovera injection requiring transfusion 10. history of coag negative staph bacteremia and hd line infection - and 11. thrombotic microangiopathy: may be etiology of episodes of worse hypertension given appears quite labile . pshx: 1. placement of multiple catheters including dialysis. 2. tonsillectomy. 3. left eye enucleation in . 4. pd catheter placement in . 5. s/p ex-lap for free air in abdomen, ex-lap normal social history: single and lives with her mother and a brother. she graduated from high school. the patient is on disability. the patient does not drink alcohol or smoke, and has never used recreational drugs. family history: negative for autoimmune diseases including sle, thrombophilic disorders. maternal grandfather with htn, mi, stroke in 70s. physical exam: t98.2, bp176/135, hr94, rr 22, 100% ra gen: well-appearing african-american woman, lying comfortably heent: anicteric, l eye prosthetic non-reactive, r pupil reactive, mmm, neck supple with submanibular lad cv: rrr, ii/vi sem best heard at apex pulm: cta b/l abd: hyperactive bowel sounds, midline scar well-healed, soft, diffusely tender to palpation, +rebound, no guarding. pd catheter in llq without erythema or purulent material draining. +dullness on percusion with evidence of clinical ascites. ext: no edema, no clubbing, 2+ peripheral pulses dp and radial. r femoral hd in place without erythema, purulance neuro: a&o x 3, cn intact ii-xii, motor strength in upper and lower extremities pertinent results: admission labs: cbc: 05:21am blood wbc-3.5* rbc-3.07* hgb-9.3* hct-27.5* mcv-90 mch-30.1 mchc-33.6 rdw-17.6* plt ct-180 chem 10: 01:16pm blood glucose-87 urean-17 creat-4.0* na-136 k-5.2* cl-106 hco3-23 angap-12 09:20pm blood calcium-7.6* phos-3.8 mg-1.8 coags: 01:16pm blood pt-23.9* ptt-40.2* inr(pt)-2.3* studies: 1)peritoneal fluid (): negative for malignant cells. reactive mesothelial cells, macrophages, eosinophils and lymphocytes. 2)bilat up ext veins us (): no evidence of deep vein thrombosis of the right or left upper extremity. 3) mri/mra (): findings: examination is somewhat limited by patient motion. t2/flair sequences are unremarkable with interval resolve of previously noted posterior abnormalities. the major vessels appear patent proximally. there are stable areas of low signal in the left frontal and right occipetal/temporal lobes. impression: 1. interval resolution of previously noted posterior white matter abnormalities. 2. stable prior areas of hemorrhage within the left frontal and right occipital/temporal regions. 3. very limited mra as above. brief hospital course: 24yo f with sle, esrd on hd and malignant hypertension who presented with abdominal pain and headache and was admitted for hypertensive urgency. course: the patient was admitted for blood pressure management and evaluation of abd pain. an a-line was placed. ekg showed no change from prior, and abd x-ray showed a suggestion of rll/r diaphragm haziness. iv labetalol was started, and sbps dropped from 200s to 130s-160s. the patient had no symptoms of end-organ damage. the renal team was consulted, and recommended no change to home med regimen. the patient was found to be hypocalcemic, and was started on calcium replacement therapy. when stable, patient succesfully switched to po meds and transferred to the floor. upon transfer to the floor, the following was her course: 1. hypertensive urgency: pt had had hemodialysis one day prior to admission, so unlikely that she was volume overloaded. unclear what precipitated this episode of hypertensive urgency, although suspect secondary to abdominal pain leading to an anxiety which then precipitates hypertension. she may not have been taking her medications secondary to pain. negative serum tox. on the floor, we continued hemodialysis tu, th, sat. she was initially continued on po labetolol 400mg tid, hydralazine 100mg po q8h, nifedipine 90mg po qday and clonidine; she received hydralazine 10mg iv for goal bp < 180/100. renal team followed patient during this hospitalization. per renal team recs, labetalol was increased to 800mg tid due to poor blood pressure control. pt discharged on clonidine 0.3mg patch, hydralazine 100mg three times a day, aliskiren 150mg twice a day, nifedipine 90mg daily and lobatalol 800mg tid. this regimen worked well. 2. abdominal pain: extensive prior workup unrevealing. pt had recent ct scan during prior admission which did not show source of abdominal pain. on admission, lfts were normal except for slightly low albumin, lipase was slightly elevated and kub was negative for free air or evidence of sbo. peritoneal fluid was negative for malignant cells but showed reactive mesothelial cells, macrophages, eosinophils and lymphocytes. negative gram stain or peritoneal fluid cultures, excluding sbp as a cause of the abdominal pain. pd catheter was not removed. pt was continued on po dilaudid 1-2mg q6h and pain resolved. she denied n/v/diarrhea or constipation. 3. esrd: pt on hemodialysis, on t/th/sat schedule. renal following patient closely throughout this hospitalization. lytes were checked frequently and kayexalate given prn. 4. hx of svc/brachiocephalic dvt: pt was initially subtherapeutic on coumadin. unclear if she had not been taking coumadin although patient reported that she has been taking all home meds. we started heparin gtt to bridge to coumadin. once therapeutic, continued coumadin 5mg po qday. 5. anxiety: likely contributing to medical problems and could have very well been the etiology of this admission. although pt stated she was taking her current medications, she did report increased anxiety which can lead to medication non-compliance and hypertension. pt recently saw psychiatrist who started her on celexa. she was continued on celexa 20mg po qday, ativan 1mg po q8hours prn and psychiatry was re-consulted. per psych recs, started standing clonazepam. pt refused psych vna. outpatient pcp followup recommended. 6. headache nos: pt complained of r-sided ha for several weeks, radiating to r jaw where patient had previous tooth extraction. right upper extremity ultrasound was negative for dvt. she did not have any focal neuro findings, no visual deficits. she was initially treated with tylenol prn q6h; pt requested iv dilaudid for ha, but use of this medication by iv route was limited by team. it was felt by the pain service that her ha did not fit migraine, tension type ha or rebound ha. they recommended increasing dilaudid to 4-6mg q6h prn, continuing tylenol and starting neurontin 300mg qhs which was slowly titrated to 300mg for better control. per pain recs, a neurology consult was also obtained during this admission. mri/mra showed interval resolution of previously noted posterior white matter abnormalities and stable prior areas of hemorrhage within the left frontal and right occipital/temporal regions, but very limited mra as above. per pain recs, dilaudid was further increased to 4mg q4h for better control of her ha. neurology recommended outpt f/u and pt scheduled with clinic with dr. on . 7. anemia: likely related to esrd. no evidence of acute bleeding. hct remained stable during this hospitalization. 8. sle: no acute issues. continued prednisone 4mg po qday 9. fen: tolerated regular diet, repleted lytes prn 9. prophylaxis: heparin gtt, then coumadin, bowel regigmen medications on admission: (from prior discharge summary) bisacodyl 10mg po qday prn prednisone 4mg po qday aliskiren 150mg po bid clonidine 0.3mg / 24 hr patch weekly qmonday labetalol 400mg po tid warfarin 4mg po qday nifedipine 90mg po qday hydralazine 100mg po q8h hydromorphone 2-4mg po q4h prn lorazepam 1mg po q8h celexa 20mg po qday prochlorperazine 10mg po q6h colace 100mg po bid hydralazine 25mg po q30min prn for htn discharge medications: 1. prednisone 1 mg tablet sig: four (4) tablet po daily (daily). 2. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmon (every ). 3. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po qmonth (). 4. nifedipine 90 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). 5. hydralazine 100 mg tablet sig: one (1) tablet po every eight (8) hours. 6. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 7. warfarin 2 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). :*100 tablet(s)* refills:*2* 8. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). :*90 capsule(s)* refills:*2* 9. hydromorphone 4 mg tablet sig: one (1) tablet po every four (4) hours as needed for headache. :*84 tablet(s)* refills:*0* 10. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). :*60 tablet(s)* refills:*0* 11. aliskiren 150 mg tablet sig: one (1) tablet po bid (2 times a day). 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). :*60 capsule(s)* refills:*2* 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. :*60 tablet(s)* refills:*0* 14. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 15. labetalol 200 mg tablet sig: four (4) tablet po every eight (8) hours. :*360 tablet(s)* refills:*2* 16. bisacodyl 5 mg tablet sig: one (1) tablet po once a day as needed for constipation. :*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: 1. hypertensive emergency 2. sle 3. headache, nos 4. abdominal pain discharge condition: bp better controlled. headache managed on oral meds discharge instructions: you were admitted with abdominal pain, high blood pressure, and headache. your abdominal pain resolved - no serious cause of this pain was found. your blood pressure medications were continued, and with an increased in one medication, the labetalol. your blood pressure improved. you should continue the clonidine 0.3mg patch changed on , hydralazine 100mg three times a day, aliskiren 150mg twice a day, and nifedipine 90mg daily. the dose of labetalol was increased to 800 mg three times daily by you kidney doctor and you are given a new prescription. please take all medications as listed below. for your headache, you had an mri and mra of the head, which did not show a new or serious abnormality. you were seen by the neurology and pain services. you should follow up at clinic with dr. on at 6:30 pm (in the evening). your pain was managed by oral dilaudid, 4mg. you should take this medication every 4 hours as needed. you were also started on gabapentin (also called neurontin) for the headache. the dose was slowly increased to twice a day. you may not need as much dilaudid for your headache and should wean this medication as tolerated, given it's potential for side effects (constipation, lethargy, dependence). finally, you will likely need medications for constipation while you take dilaudid. take colace (a stool softener), senna (a laxative), and bisacodyl (another laxative), as needed. it is really important that you have a primary care doctor. you are scheduled with dr. (see below) next tuesday. you will need your inr checked since you are on coumadin. call your doctor if you have worsened headache, chest pain, confusion, or any other concerning symptom. followup instructions: please make sure you attend the following doctor appointments: 1) dr. (nephrologist) on tuesday, at 10am. phone number . 2) dr. , at , center, . phone:. date/time: 3:20 3) neurology: dr. . he is located on the of the building. phone: date/time: 6:30 pm md procedure: hemodialysis diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease systemic lupus erythematosus anemia in chronic kidney disease end stage renal disease renal dialysis status anxiety state, unspecified long-term (current) use of anticoagulants other chest pain personal history of venous thrombosis and embolism other ascites acquired absence of organ, eye headache 

Answer: The patient is high likely exposed to