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: history of present illness: patient is a 29-year-old female with a history of recurrent acute pancreatitis approximately once a month since undergoing laparoscopic cholecystectomy , who is presenting now with worsening right upper quadrant pain x4 days. the patient was previously seen by dr. and dr. in for similar symptoms. she has had multiple studies including ct and mrcp, which showed pancreatic dilatation in the past. an ercp was performed on , which demonstrated mild diffuse common bile duct dilatation and a sphincterotomy was performed without resolution of symptoms. the patient was referred for further workup including a small bowel follow-through, which was negative and a cftr study, which was negative. the patient was recently admitted to hospital for severe abdominal pain, nausea, vomiting, fevers, and chills. during that hospitalization, her amylase and lipase were not elevated. ct scan of the abdomen showed no pancreatic ductal dilatation. patient was started on pancreatic enzymes and given carafate. after discharge approximately three weeks ago, the patient has progressively gotten worse with symptoms much worse over the last three days after a large meal. she states that she is unable to tolerate p.o. and has subjective fevers, chills, nausea, vomiting, diarrhea, dizziness, and fatigue. her pain is characterized as a knife and sharp cramping and it is a up from her baseline of . she had bright red blood per rectum approximately four days ago. she has had a cough productive of greenish sputum for which she has been taking levaquin x1 week. past medical history: 1. history of dilated common bile duct status post sphincterotomy in , which did not improve her pain. 2. status post laparoscopic cholecystectomy in . 3. history of pancreatitis with multiple hospital admissions most recently one month at hospital, complicated by pancreatic ductal dilatation. 4. hypothyroidism. 5. anxiety. 6. fibromyalgia. 7. migraines. 8. asthma. 9. endometriosis diagnosed by exploratory laparotomy. 10. manic depression. 11. status post appendectomy. 12. status post right ovarian cystectomy. 13. status post knee surgery. 14. history of systolic dysfunction with an ef of 40-45% and echocardiogram performed at hospital in showing anteroseptal hypokinesis. allergies: latex which causes scars. sulfa and demerol, which causes hives. vicodin, codeine, percocet, and vancomycin. medications: 1. lithium 300 mg p.o. t.i.d. 2. wellbutrin 150 mg p.o. b.i.d. 3. ambien 10 mg p.o. q.h.s. 4. levaquin x1 week. 5. klonopin 0.5 mg p.o. prn. 6. fioricet prn. 7. ovcon 35 p.o. q.d. 8. synthroid 0.5 mg p.o. q.d. social history: the patient does not drink and quit smoking 10 years ago, but previously smoked two packs per day. she is currently on social security due to her disability and is married with one child. family history: she has uncles with diabetes, grandparents with cancer, father with cardiovascular accident at age 26, and mother and father with . physical exam: vital signs: 97.3, 91/63, 100, 16, and 98% on room air. in general, the patient is awake and alert in no apparent distress, lying in bed. heent exam: pupils are equal, round, and reactive to light. sclerae are anicteric. mucous membranes are moist. chest was clear to auscultation bilaterally. heart is regular rate and rhythm. abdominal examination is soft, mild right upper quadrant tenderness to palpation, mild right lower quadrant tenderness with palpation, no rebound, no guarding, and no hepatomegaly, and positive bowel sounds. rectal exam: small amount of reddish stool, which is guaiac positive, although the patient is also menstruating and it is difficult to separate whether the bleeding is coming from her stool or from menstruation. extremities: no lower extremity edema. laboratories on admission: show a white count of 14.6. her amylase is 60, lipase is 26. remainder of laboratories are within normal limits. hospital course: 1. right upper quadrant pain: the patient had been seen at clinic on the day of admission. they felt that her symptoms were possibly related to pancreatitis and was sent over to the ed for admission. however, on admission her amylase and lipase were within normal limits. from previous hospital records obtained from hospital, it is known that the patient has had prior episodes of pancreatitis, which have presented with elevated amylase and lipase. the patient has had multiple recurrent attacks of acute pancreatitis, although it is unclear whether the patient has such chronic pancreatitis that she has burned out her pancreas and that her amylase and lipase do not elevate even though she has pancreatitis. the patient underwent a right upper quadrant ultrasound to evaluate for biliary duct dilatation. it showed no intra or extrahepatic biliary ductal dilatation. there was mild prominence of the common bile duct with normal tapering. there was no stone or filling defect in the common bile duct. she had normal kidneys, normal spleen, and normal pancreas. given her recent history of cough, a chest x-ray was obtained to determine if she possibly had a right lower lobe pneumonia, which was producing this right upper quadrant pain. however, chest x-ray showed no evidence of pneumonia. in addition, she had been started on levofloxacin for possible pneumonia. there was also question raised of whether this was cholangitis, however, the patient was afebrile and there was no evidence for biliary duct dilatation on right upper quadrant ultrasound. a gi consult was obtained for assistance with deciphering the cause of her right upper quadrant pain. they recommended mrcp for further elucidation of the patient's biliary duct anatomy. mrcp showed no biliary duct dilation in the liver. her common bile duct was 8 mm, which was dilated, but yet normal for someone who has undergone cholecystectomy. she had small bilateral pleural effusions. further hospital records from hospital were also obtained. a ct scan obtained at hospital on showed prominence of part of the pancreatic tail without acute changes. the appearance was stable. there was diffuse fatty change of the liver. gi felt that this prominence of the pancreatic tail was normal and did not represent pancreatitis. the gi fellow called dr. , who had previously been involved in the patient's ercp. he stated given a completely normal mrcp, there was no indication for sphincterotomy. in addition, she had previously received a sphincterotomy, which should not lead to resolution of her abdominal pain. there was no indication for ercp. a gastric emptying study was obtained to determine if there was any evidence for gastroparesis, however, gastric emptying was normal. given thus far extensive negative workup, gi consult recommended further outpatient management. the patient should follow up with dr. from the clinic or dr. for outpatient secretin test. they recommended advancing her diet to low fat low residue as tolerated. the patient should be started on viokase with meals, when she is taking good p.o. she should also be restarted on her pancreatic enzymes (lipram three tablets p.o. with meals) when the patient is taking better p.o. she should also be on ranitidine 150 mg p.o. b.i.d., which will help increase the ph in order to activate her pancreatic enzymes. 2. anemia: the patient was admitted with a hematocrit of 42. she was noted to have started menstruation, and there was a question of whether her positive guaiac stools were due to menstruation or actual blood in her stool. a repeat hematocrit was checked, which was found to be 29 down from 42. the patient then also became hypotensive with a systolic blood pressure in the 60s. she was given a liter of fluid and transfused 2 units of packed red blood cells. her blood pressure improved, although still running in the high 80s to low 90s. her hematocrit remained stable throughout the remainder of the hospitalization at 32-34. the patient was restarted back on her oral contraceptives. gi consult felt that her stools were not guaiac positive and that the blood was coming all from menstruation. 3. shortness of breath: given her drop in systolic blood pressure down to the 60s, the patient was given a liter of normal saline. she was also continued on maintenance fluid given her npo status as well as borderline blood pressure. however, on the morning of , the patient desaturated down to 70% on room air. she was noted to have very shallow breathing. the patient also complained of shortness of breath at that time. she was placed on a nonrebreather, which improved her o2 saturation. however, abg on nonrebreather showed a ph of 7.36, pco2 of 42, a po2 of 61, and a bicarb of 25. there was concern that the patient might have had a pe given her multiple risk factors including a mother, who had a blood clot in her leg in her 40's, the patient currently taking oral contraceptives, immobility, and lack of heparin subq due to concern for possible bleed. it was also noted that the patient had received approximately 5 liters of fluid, and had a prior history of systolic dysfunction with an ef of 40-45% on an echocardiogram from an outside hospital. the patient was sent to the micu for management. she was continued on nonrebreather, but did not require any intubation. the patient was given 60 mg of lasix iv to which she diuresed approximately 2 liters. chest cta was negative for pe, but did show bilateral lower lobe patchy opacities. the patient did not have any fevers to suggest pneumonia and was not started empirically on antibiotics especially considering that the patient recently completed a one week course of levofloxacin by her pcp for bronchitis. the patient continued to be diuresed and eventually was able to get back on room air. a lower extremity noninvasive showed no dvt. an echocardiogram was ordered, but unfortunately, had not been performed at the time of this dictation. the patient was transferred back to the for further management. 4. id: the patient had been started on a week long course of levofloxacin for possible bronchitis. throat culture obtained from the pcp's office was growing moraxella catarrhalis. chest cta obtained to rule out pe showed infiltrates, which was thought to possibly represent focal areas of consolidation. the patient had low-grade fevers, but a normal white blood count. given the low likelihood of pneumonia, the patient was not treated with any antibiotics and remained afebrile throughout the remainder of the hospitalization. 5. hypothyroidism: the patient was continued on a regular home dose of synthroid. tsh was within normal limits. 6. psych: the patient was continued on a regular home dose of wellbutrin as well as lithium. she was also given klonopin prn. 7. migraines: the patient has a history of chronic migraines, and was taking fioricet with increased frequency at home. given the risk for addiction to fioricet, the patient was taken off fioricet during the hospitalization to give her a break. she was treated with tylenol and toradol prn for her pain. the remainder of the hospital course as well as discharge diagnoses and medications will be dictated at a later time. , m.d. dictated by: medquist36 procedure: transfusion of packed cells diagnoses: anemia, unspecified unspecified acquired hypothyroidism asthma, unspecified type, unspecified pulmonary congestion and hypostasis chronic pancreatitis migraine, unspecified, without mention of intractable migraine without mention of status migrainosus abdominal pain, right upper quadrant 

Answer: The patient is high likely exposed to