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: no known allergies / adverse drug reactions attending: chief complaint: flank pain major surgical or invasive procedure: attempt at ir guided embolization history of present illness: 65yo male with h/o , hyperlipidemia presenting with left flank pain; ct with bilateral pulmonary emboli. . per report patient had been in usoh when developed acute onset left sided flank pain. pain described as a burning is non-radiating and localized to left flank. reports associated pleuritic component and difficulty breathing when pain severe. aggravating factors: sitting upright alleviated factors: lying flat, deep breaths pertinent +/-: no personal or family of dvt/clotting disorder, no long trips, no recent surgery, no fevers, weight loss, night sweats, no abdominal pain, no melena, no hematchezia, no h/o colonscopy . persistent pain prompted presentation to the ed. on arrival vs: 97.2 107 120/80 16 100% ra. ed labs notable for an elevated ddimer: 1381 ekg showed nsr 99 with no sign of r heart strain. . cta of chest/abd/pelvis obtained with prelim read concerning for bilateral pe's of basal segments with no sign of strain or pulmonary infarct. patient received dilaudid 0.5iv for pain control and was started on heparin per weight based protocal (wt 151): bolus 5500 and 1250 infusion to start. vitals on transfer afeb 110 118/78 20 98% on 2l nc. . on the floor, patient with persistent left flank pain, was initially . reports breathing is comfortable. the patient was started on heparin gtt in the ed. this was continued until heparin was discontinued on in the pm. on pm the patient was started on lovenox and coumadin in anticipation for discharge. however at 1530 the patient became hypotensive to the 70s. he was also pale and diaphoretic with tachycardia. the patient was triggered. he complained of abdominal pain and had tenderness so went emergently to ct scan which showed intra-abdominal hemorrhage. . ros: otherwise negative past medical history: disease dyslipidemia hypertension social history: married, lives with wife. involved in care occupation: retired; previously worked with animals and livestock; denies h/o pesticide exposure or factory work tobacco: denies etoh: denies drugs:denies family history: no history of clotting disorders no history malignancy physical exam: admission physical: vs: 99.2 132/96 97reg 16 99%2l gen: alert, oriented, portugeuse speaking male in nad heent: hypopigementation of left eyebrow; eomi, perrla, op clear without exudates, lesion, mmm neck: supple, no appreciable thyromegaly or nodules. cv: rrr, nl s1, s2 no m/r/g, no edema resp: shallow breaths, cta-b, decreased bs at left base abd: soft, mildly distented, non-tender, +bs, no palpable masses, no hsm ext: wwp, 2+ pulses, no calf swelling, asx, or tenderness, no palpable cords lymph: no cervical, supraclavicular, submandibular, axillary or inguinal lad. neuro: ii-xii intact, motor and sensation intact . discharge physical: vitals: 98.6 125/85 69 18 96%ra gen: alert, oriented, portugeuse speaking male in nad heent: hypopigementation of left eyebrow; eomi, perrla, op clear without exudates, lesion, mmm neck: supple, no appreciable thyromegaly or nodules. cv: rrr, nl s1, s2 no m/r/g, no edema resp: cta-b, decreased bs at bilateral bases abd: soft, mildly distented, non-tender, +bs, no palpable masses, no hsm ext: wwp, 2+ pulses, no calf swelling, asx, or tenderness, no palpable cords lymph: no cervical, supraclavicular, submandibular, axillary or inguinal lad. neuro: ii-xii intact, motor and sensation intact pertinent results: admission labs: cbc wbc-12.2*# rbc-5.56 hgb-15.7 hct-46.2 mcv-83 mch-28.2 mchc-33.9 rdw-14.0 plt ct-197 diff neuts-81.5* lymphs-12.0* monos-5.1 eos-0.8 baso-0.6 . pt-12.9 ptt-24.1 inr(pt)-1.1 . chem glucose-98 urean-15 creat-1.2 na-135 k-7.7* cl-102 hco3-24 angap-17 05:20am blood glucose-117* urean-18 creat-1.2 na-139 k-4.5 cl-100 hco3-27 angap-17 . blood tsh-2.4 . discharge labs: 05:50 wbc rbc hgb hct mcv mch mchc rdw plt ct 11.5* 4.00* 12.1* 34.4* 86 30.4 35.2* 14.5 232 . glucose urean creat na k cl hco3 angap 93 19 0.9 137 3.7 104 23 14 . alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 64* 37 80 1.2 . micro: 12:34 pm catheter tip-iv source: left subclavian. **final report ** wound culture (final ): no significant growth. . 4:35 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (final ): sparse growth commensal respiratory flora. . blood cx: ngtd . urine cx: ngtd . . studies: cta: impression: 1. bilateral segmental pulmonary emboli with small associated pleural effusions. there is no right heart strain or pulmonary infarct. 2. 1-cm cyst within the neck/body of the pancreas probably represents a side branch ipmn. . ctap: impression: 1. large right heterogeneously hyperdense subcapsular liver hematoma with active extravasation. possible extravasation from a posterior inferior right liver branch; unable to definitively identify vessel of origin. extracapsular extension of hemorrhage into the peritoneal cavity along the right paracolic gutter and adjacent to the spleen. large amount of hemorrhage within the dependent pelvis. 2. heterogeneous hypoenhancement of the liver adjacent to the subcapsular hematoma is likely related to mass effect. if clinical suspicision remains for an underlying subcapsular liver lesion, multiphasic ct would be useful to assess. 3. prostate enlargement. 4. enlarging left pleural effusion with worsening left lower lobe atelectasis and/or consolidation. . cxr: impression: 1. new left lower lobe atelectasis and possible left pleural effusion. 2. position of new left subclavian central venous catheter as described. 3. no evidence of post-insertion pneumothorax. . tee: conclusions due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is no pericardial effusion. impression: extremely limited study. globally-preserved biventricular systolic function. aerated saline contrasted study was performed at rest, but its results are uninterpretable. if clinical question regarding valvular disease or possible intracardiac shunting persists, would recommend a transesophageal study. compared with the report of the prior study (images unavailable for review) of , biventricular function still appears normal overall. . cxr : findings: as compared to the previous radiograph, the patient has been intubated. the tip of the tube projects 8 cm above the carina, the tube should be advanced by approximately 2 to 3 cm. the venous introduction sheath over the left subclavian vein is in constant position. there is no evidence of complications, notably no pneumothorax. in the interval, the patient has received a nasogastric tube. the course of the tube is unremarkable. no evidence of pulmonary edema, the cardiac silhouette is unchanged. unchanged right retrocardiac atelectasis. newly appeared mild volume loss in the middle lobe, repeat radiograph should be performed to exclude early pneumonia. tip of an inferior vena cava filter is included on the image. . cxr: there is slight interval improvement of preexisting interstitial pulmonary edema. there is no change in bilateral, left most likely more than right, pleural effusions and bibasilar areas of consolidation. there is no pneumothorax. brief hospital course: mr is a 65yo male with history of disease presenting with left sided chest/flank pain found to have bilateral pulmonary emboli with hospital course complicated by spontaneous intra-hepatic hematoma requiring massive transfusion protocal activation and micu transfer . # intra-abdominal hemorrhage: likely secondary to anticoagulation. interesting admission ct abdomen without obvious hepatic anatomic abnl. ct scan demonstrates intrahepatic hematoma with extravasation. pt taken to ir, and no active extravasation discovered, nothing embolized. pt received 4 units prbc's initially with massive transfusion protocol, in addition to 1 unit of platelets. pt received add'l 2 units prbc's on day 1 of micu stay for hypotension attributed to hemorrhage. transplant surgery followed, but recommended conservative management. serial hcts were checked. calcium was repleted. bleed stabilized without intervention. . # bilateral pulmonary emboli: etiology of emboli unclear. inherited hypercoagulable states vs malignancy. he has not had age appropriate screening, primarily c-scope and psa. no evidence of rhs on ecg. leni??????s not done prior to hemorrhage as discussed above. ir placed ivc filter as anti-coagulation contraindicated. outpatient issues: -- will likely need outpatient malignancy work-up with c-scope and psa and possible thyroid us/work-up; of note no lab data suggestive of mm therefore spep, upep . # hypoxic respiratory distress: likely multifactorial given pe??????s, volume overloaded in setting of transfusions, and possible flash pulmonary edema given likely diastolic dysfunction, vs. intrabdominal distension. trali also a possibility given recent transfusions, though relatively quick timing make this unlikely and cxr not supportive. pt was weaned to pressure support and on patient was successfully extubated. on the medical floor patient with signs of volume overload and intermittent diuresised with 20mg iv lasix with good response. on discharge patient saturating well on ra and with ambulation . # fever: ddx includes pe, vs. infectious source. on admission to icu, cultures were sent. pt grew out gpc??????s in sputum. cxr suggestive of infiltrate vs. fluid. pt was started on vancomycin though due to low clinical suspicion for infection vancomycin stopped. patient afebrile for >48hr on the floor with downtrending wbc. . # transaminitis: likely decreased perfusion in setting of hypotension vs. inflammation associated with intrahepatic bleed. lft??????s were trended daily and normalized prior to discharge. simvastatin was held in the micu and decision made to hold at time of discharge. . # history of disease. previously followed by endocrine at . per patient not receiving any treatment. denies symptoms or hyper/hypothyroid at this time. . # dyslipidemia: held simvastatin 10mg qhs given transaminitis. medications on admission: advil simvastatin 10mg qhs lisinoril 10mg qd discharge medications: 1. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. discharge disposition: home discharge diagnosis: primary: bilateral pulmonary emboli spontanous hepatic hematoma . secondary: hypertension dyslipidemia 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 taking care of you. . you were admitted to due to treatment and evaluation of left flank and were found to have clot in the blood vessels supplying your lungs. it is unclear what triggered the formation of the clots however your primary care doctor will continue to explore for potential causative factors. to prevent propogation of clot you were started on anticoagulation: lovenox and coumadin. unfortunately shortly after starting these medications you experienced a spontaneous bleed in your liver. this bleed transfer to the icu. there you received multiple blood transfusions with stabilization of your blood counts. the interventional radiologists attempted to find the source of bleed but could not identify it. it was decided that you could no longer take anticougulation safely so an ivc (inferior vena cava) filter was placed to prevention new pulmonary emboli. . of note while hospitalized you labs demonstrated inflammation of your liver. simvastatin, a cholersterol lowering medication, can also irritate the liver so the decision was made to hold this medication until your liver functions return to normal. . at time of discharge you were without pain and oxygenating well without need for supplemental oxygen. . changes to your medications discontinue simvastatin until seen by primary care doctor and liver function test rechecked. take over the counter stool softners and laxatives as needed to faciliate regular bowel movements. . again it was pleasure taking care of you. please contact us with any questions or concerns followup instructions: please call pcp . at uphams corner to schedule a follow-up appt within the next week. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube interruption of the vena cava arterial catheterization arteriography of other intra-abdominal arteries angiocardiography of venae cavae diagnoses: unspecified essential hypertension other and unspecified hyperlipidemia acute respiratory failure anticoagulants causing adverse effects in therapeutic use other pulmonary embolism and infarction cyst and pseudocyst of pancreas other specified disorders of liver transfusion associated circulatory overload 

Answer: The patient is high likely exposed to