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 / sulfa (sulfonamide antibiotics) attending: chief complaint: chest pain, hypertension major surgical or invasive procedure: esophagoduodenoscopy cardiac catheterization renal biopsy history of present illness: 25 year-old w with pmhx of dm1 (dx @ 15yo), htn, chronic renal insufficiency, and psoriasis, who was transferred from osh for evaluation of episodic chest pain x 2-4 months. the chest pain is , left-sided, pressure-like, non-radiating that occurs sporadically, with exertion or at rest, even awakening her from sleep. it lasts for hours until alleviated by morphine or dilaudid. it is associated with nausea and emesis, which occasionally precede the chest pain. she has been evaluated multiple times for this pain, and reports a history of 8 recent hospital admissions with no conclusive diagnosis. she has been treated for gastroparesis with no improvement in her chest pain. according to prior notes, her pain was well controlled with dilaudid as an outpatient; however, when this was abruptly stopped the chest pains returned. she also notes that she becomes hyperglycemic during these episodes despite taking her insulin and not tolerating po. . of note, in the patient began to have "grand mal seizures" which were diagnosed on clinical grounds and thought to be due to hypoglycemic episodes at night. she had tonic clonic movements and occassional loss of bladder and bowel control. her insulin regimen was changed, and the seizures stopped in . she then began to have increasing abdominal pain thought to be due to gastroparesis. in of , she underwent laparoscopic cholecystectomy to treat her gastroparesis. she developed psoriasis during the same month. . in the ed, initial vs were: t 99.1 p106 bp 192/104 r 20 o2 sat 100 ra. patient was experiencing intermittant chest pain, controlled with morphine prn. labs were notable for elevated d-dimer of 1059, creatinine 2.0, leukocytosis 17.2 and mild anemia. ekg showed sinus tachycardia. she was initially started on heparin gtt for suspicion of pe, but was found to have guaiac + stools. ng withdrew coffee grounds, 250cc lavage was clear with trace blood. heparin gtt was stopped. egd was performed by gi and showed an esophageal ulcer and erosions in the stomach and duodenum. the patient was started on a ppi. her hct remained stable. bilateral le doppler's were negative for dvt. chest x-ray with no infiltrate, effusion or acute process. per report, cta at osh was negative. . in the icu the patient developed chest pain, and was tachycardic with blood pressures greater than 200/100. she was given iv morphine and iv metoprolol, with improvement of bp to systolic 130s. her pain improved, but was not alleviated. her ekg was unremarkable. cardiac enzymes were sent and were negative for acs. tte demonstrated ef 35-40%, and cardiolgoy was . she had coronary catheterization which demonstrated no hemodynamically significant lesions. she was stable and transferred to the floor for further evaluation. . past medical history: - diabetes mellitus type 1 - hypertension - renal insufficiency secondary to diabetic nephropathy - gastroparesis - psoriasis social history: patient teaches pre-kindergarten. lives at home with her parents and younger siblings in . moved back from nc recently. denies tobacco use, etoh and drugs/ivdu. reports she feels safe at home. denies any recent family, work, or relationship stress. family history: mother: sickle cell trait father: healthy maternal grandmother: thyroid disease paternal grandfather: diabetes type unknown, uses insulin brother: "some kind of sickle cell disease" maternal uncle: died of "sickle cell" at age 42 physical exam: gen: well-developed, well-nourished female, lying comfortably in bed, in no acute distress heent: normocephalic, perrl, eomi, vfi, sclera aniceteric, pink conjunctiva, mmm, oropharynx clear, no lymphadenopathy cv: nl s1, s2, regular rhythm, increased rate, no murmurs, rubs, gallops appreciated resp: ctab without wheezes, crackles, or rhonchi abd: +bs, soft, non-tender, non-distended, no masses or organomegaly ext: warm, well-perfused, psoriasis plaques on anterior shins, 2+ dp pulses neuro: a&ox3, cn 2-12 intact, intact, upper and lower extremity strength, senstation grossly intact psych: appropriate mood and affect pertinent results: ttecho: global hypokinesis, ef 35-40%; 06:01am blood wbc-8.6 rbc-2.70* hgb-8.0* hct-23.0* mcv-85 mch-29.7 mchc-34.9 rdw-14.7 plt ct-353 05:30am blood neuts-62.7 lymphs-31.7 monos-4.2 eos-1.3 baso-0.2 06:17am blood hypochr-normal anisocy-1+ poiklo-normal macrocy-normal microcy-normal polychr-1+ schisto-occasional 06:17am blood hgb a-100 hgb s-0 hgb c-0 06:17am blood ret aut-2.4 06:01am blood glucose-72 urean-28* creat-1.7* na-136 k-4.4 cl-106 hco3-26 angap-8 06:17am blood ld(ldh)-219 06:17am blood totbili-0.1 07:21pm blood ck(cpk)-53 04:20pm blood alt-13 ast-19 ld(ldh)-261* alkphos-90 totbili-0.1 04:20pm blood lipase-18 07:21pm blood ck-mb-2 ctropnt-<0.01 12:50pm blood ck-mb-2 ctropnt-<0.01 11:50pm blood ck-mb-2 ctropnt-<0.01 06:01am blood calcium-8.5 phos-5.3* mg-2.4 06:17am blood cryoglb-negative 06:17am blood hapto-143 01:00am blood caltibc-157* ferritn-139 trf-121* 05:37pm blood d-dimer-1059* 12:50pm blood %hba1c-6.8* eag-148* 06:17am blood triglyc-189* hdl-60 chol/hd-3.9 ldlcalc-134* 05:18am blood tsh-5.8* 05:18am blood free t4-1.1 08:01am blood cortsol-1.3* 06:17am blood hbsag-negative 01:00am blood hbsab-positive hav ab-negative igm hbc-negative 12:50pm blood -negative 05:30am blood iga-244 06:17am blood pep-no specifi 06:17am blood c3-124 c4-46* 04:37am blood hiv ab-negative 05:30am blood ttg-iga-8 01:00am blood hcv ab-negative 06:17am blood aldosterone-test 06:17am blood renin-test 07:31pm blood gastrin-test 12:50pm blood metanephrines (plasma)-test name 07:05pm urine blood-neg nitrite-neg protein-500 glucose-250 ketone-neg bilirub-neg urobiln-neg ph-8.0 leuks-sm 10:14am urine eos-negative 09:23pm urine hours-random creat-47 totprot-532 prot/cr-11.3* 09:23pm urine u-pep-multiple p ife-no monoclo 03:10pm urine ucg-negative 05:14am urine 24creat-943 05:37pm urine barbitr-neg cocaine-neg amphetm-neg 05:14am urine metanephrines, fractionated, 24hr urine-test brief hospital course: # episodes of chest pain, nausea & vomiting, tachycardia and hypertension: these episodes are still of unclear etiology. a number of services were and testing performed, which did not reveal a clear explaination. only dilaudid reliably relieved her pain, and only ativan relieved her nausea. our best guess is that these episodes are related to autonomic dysfunction secondary to a history of brittle diabetes. we have made an outpatient appointment for her with dr. , who is an autonomic specialist. of note, pheochromocytoma was ruled out by both plasma and urine metanephrine measures. at the time of discharge the patient had not experienced one of these episodes for at least 72 hours. . - chest pain: the patient had a thorough work-up to ensure the cause of her chest pain was not cardiac in nature. she was ruled out for acs and never had ekg changes. her echo did show lv dysfunction, which may be related to her elevated blood pressures and tachycardia, as she had clean coronaries on cardiac catheterization. the cardiology consult suggested a number of labs looking for evidence of lyme, hemachromatosis, hiv, and hepatitis, which were all negative. she was started on a statin and an acei. she will need to follow up with cardiology as an outpatient. this appointment was made for her. the patient's pain did not respond to nitroglycerin, nor a calcium channel blocker so it is likely not secondary to esophageal or coronary artery vasospasm. her hemaglobin electrophoresis was negative for sickle cell disease or trait. at discharge she was given a prescription for a short course of po dilaudid to alleviate her chest pain until she follows up with her primary care physician. . - nausea/vomiting: the patient's nausea and vomiting is likely secondary to gastroparesis and gastroesophgeal reflux. gastroenterology was twice during her admission. she received an egd, which demonstrated esophagitis and stomach/duodenal erosions, as well as a gastric emptying study that showed gastroparesis. she was started on reglan, liquid sucralfate, and a ppi. her gastrin level was elevated, but not extremely so and she had been on a ppi. she will need to follow up with gastroenterology as an outpatient. this appointment was made for her. she had no neurologic deficits on exam, and an opthalmoscopic exam was negative for papilledema. records of imaging studies from her osh were negative for intracranial abnormality one year ago. at discharge the patient was given a short course of ativan to take when nauseated. . - hypertension: the patient's blood pressure was elevated at baseline, and would rise to systolic pressures in the 200s and diastolic in the 100s during her episodes of pain. it was best controlled on a combination of lisinopril, carvedilol, and a 0.1 mg clonidine patch. . - tachycardia: the patient's baseline heart rate was in the mid 80s-90s. it would increase up to the 130s during her episodes of pain, nausea and vomiting. controlling her pain prevented her heart rate from increasing. . # diabetes mellitus i- regular accuchecks were performed and the patient was given basal lantus and sliding scale humalog as needed. we for diabetes recomendations and followed their daily suggestions. the patient will follow up with after discharge. we also made an appointment to for her to have an ophthalmologic exam. . # renal insufficiency: the patient exhibited significant proteinuria on urinalysis with a pr/cr ratio of 11.3. her creatinine remained elevated around 1.8-2 and her outside hospital records did not provide a reliable baseline. we renal, who suggested sending labs to rule out secondary causes of hypertension (renal u/s was negative for renal artery stenosis, plasma renin and aldosterone levels were normal, serum cortisol suppressed after dexamethasone), as well as cryoglobulins (negative), spep/upep (negative), and complement levels (normal). they performed a kidney biopsy, which revealed diabetic nephropathy. we have set her up with a follow up renal appointment after discharge. . # anemia: the patient's normocytic anemia is likely secondary to her renal disease. her hematocrit remained stable throughout her hospital stay. evaluation for hemolysis was negative. she will need to follow up with her primary care physician for continued evaluation and monitoring. . # prophylaxis: the patient was maintained on sc heparin for dvt prophylaxis until she received the kidney biopsy, and was switched to pneumoboots. medications on admission: insulin clobetasol metoprolol lisinopril elavil ultram lyrica nortryptiline coreg discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 2. metoclopramide 10 mg tablet sig: one (1) tablet po tid (3 times a day): please take 30 minutes prior to eating. disp:*90 tablet(s)* refills:*2* 3. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*60 capsule(s)* refills:*0* 6. dilaudid 2 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain for 2 weeks. disp:*84 tablet(s)* refills:*0* 7. sucralfate 100 mg/ml suspension sig: ten (10) ml po qid (4 times a day): please take 10 ml by mouth one hour before meals, and at bedtime. please do not take with other medications. . disp:*1200 ml(s)* refills:*2* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 9. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch transdermal once a week: please place every saturday. disp:*5 patches* refills:*0* 10. insulin glargine 100 unit/ml solution sig: seven (7) units subcutaneous once a day: in am. disp:*1 bottle* refills:*2* 11. insulin lispro 100 unit/ml solution sig: as directed subcutaneous four times a day: please take as prescribed. please check your blood sugar before meals and before bedtime. please take the number of units corresponding to the insulin sliding scale that you were provided. disp:*1 bottle* refills:*2* 12. ativan 0.5 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea: please place under tongue as needed for nausea. disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: autonomic hypereflexia gastroesophageal reflux disease gastroparesis diabetes mellitus, insulin-dependent chronic kidney disease secondary to diabetic nephropathy psoriasis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were recently admitted to for evaluation of your chest pain, which is accompanied by nausea and vomiting, and increased blood pressure and heart rate. we have ran many tests and many specialists, but are unable to fully understand why you have these episodes. we suspect it is the result of your nerves reacting too strongly to different stimuli. during your hospital stay we obtained a gastric emptying study, which showed that you have gastroparesis, meaning that your stomach does not move its contents down at a normal rate. this is due to your diabetes and causes nausea, vomiting, and pain. it may then lead to your body reacting to the pain, nausea, and vomiting with increased heart rate and blood pressure. we have given you a medication called reglan to take 30 minutes prior to meals to help with the gastroparesis. we have also started you on medications to control your blood pressure and heart rate. importantly, during your stay we determined that your chest pain was not from a blood clot in an artery of your lung, or a heart attack. gastroenterology doctors and ulcers in your esophagus, stomach, and part of your intestine, for which you were started on medications. cardiology doctors were also and saw on an echocardiogram that your heart is not pumping as strong as it should be. you underwent cardiac catheterization and they saw no blockages in your coronary arteries. we also the kidney doctors, who performed a biopsy of your kidney, which told us that your kidney problems are the result of your diabetes. the diabetes doctors were and us daily recommendations on how to best control your diabetes. throughout the hospital course we controlled your blood pressure, heart rate, nausea and pain with both intravenous and oral medications. you are doing well on oral medications now. you will need to follow up with a primary care doctor, and many specialists, for continued evaluation of your symptoms. we have made you appointments to follow up with these services: gastroenterology cardiology renal (kidney) neurology primary care physician please stop taking all the medications you were taking prior to coming to the hospital. you were provided prescriptions for all of your new medications. please take them as prescribed. followup instructions: primary care physician . () great family alliance center at 13:45 pm department: gastroenterology when: wednesday at 10:40 am with: , md building: ra (/ complex) campus: east best parking: main garage department: west clinic when: wednesday at 12:00 pm with: , m.d. building: de building ( complex) campus: west best parking: garage department: cardiac services when: monday at 11:00 am with: dr. building: sc clinical ctr campus: east best parking: garage department: digestive disease center when: thursday at 12:00 pm with: , md building: building (/ complex) campus: east best parking: main garage name: , t. md location: diabetes center/ ophthalmology address: one place, , phone: appointment: , , 4pm department: neurology when: thursday at 3:30 pm with: drs. & building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified coronary arteriography using two catheters angiocardiography of left heart structures left heart cardiac catheterization closed [percutaneous] [needle] biopsy of kidney esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: other primary cardiomyopathies nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere esophageal reflux congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified long-term (current) use of insulin chronic systolic heart failure chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction other psoriasis diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with renal manifestations, type i [juvenile type], uncontrolled gastroparesis ulcer of esophagus with bleeding unspecified disorder of autonomic nervous system 

Answer: The patient is high likely exposed to