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: tetanus / azithromycin attending: chief complaint: chest pain, hypotension major surgical or invasive procedure: none history of present illness: 77 yo male with history of coronary artery disease, pbh, recent prostate biopsy and recent dental work presented with substernal chest pain, with ed course complicated by hypotension. . chest pain began last night after eating an apple. worse with movement and with inspiration, radiates to his neck, associated with dyspnea and nausea, but no vomiting. no diaphoresis. the pain does not radiate to his back. he is unsure if this pain is same as his prior cardiac pain. his wife gave him simethicone- the pain persisted, and given his history, she gave him aspirin and sublingual nitroglycerin, without change in pain. he was then transferred to ed via ambulance. . of note, his pcp recently check his psa, which was elevated at 5.7. he saw dr. , who performed a turp about five years ago. the patient has recently had a prostate biopsy within the past two weeks, which showed localized prostate cancer. next management steps were to be discussed on . . he also reports having recent dental work in the past two weeks, and has an implanted piece of gold in his upper teeth. prior to dental work, he was pretreated with one dose of amoxicillin. . in the ed, initial vs were: 99.7 70 102/54 18 97% ra ekg - sinus rhythm at 65, normal intervals, twi in iii is old, other nsst changes unchanged from prior bedside echo no effusion rectal exam- no blood, non-tender prostate . patient was ready to be admitted to floor, and vitals were: 100.9 76/40 61 18 cvl placed, 3 liters total, cvp 8-9, and was started on noripenephrine to maintain map > 60. he received pip/tazo 4.5 grams x 1 anc vanc 1 gram x 1. uop 500 cc. . on arrival to the micu, patient reported chronic neck, back and leg pain. he reported some gassy pain, relieved with belching. . review of systems: (+) per hpi (-) denies recent fevers, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. he does endorse chroinc arthralgias related to arthritis. denies rashes or skin changes. past medical history: cad, status post previous cabg status post ptca/stent of distal lcx and mid lcx . recurrent atypical chest, with normal p-mibi in recent prostate biopsy, which showed prostate cancer -> subsequent pet ct did not show evidence of metastatic disease bph s/p turp about five years ago hypertension hyperlipidemia obesity complicated gallbladder surgery chronic back pain gout social history: patient lives in with his wife. originally from , . worked as a cabinet maker. smokes pipes of tobacco a day. glass of wine daily. family history: sister died from cva, father died at 54 from mi, brother with mi at 80 physical exam: vitals: t 97.8 hr 54 bp 115/51 95 % 2 liters n/c general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl. dentures in upper teeth, with gold piece in right upper teeth. neck: supple, jvp not elevated, no lad. right ij in place. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: bibasilar rales that clear with inspiration. no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, gait deferred. pertinent results: admission labs: 05:00am blood wbc-7.0 rbc-3.71* hgb-12.2* hct-36.0* mcv-97 mch-32.8* mchc-33.8 rdw-13.2 plt ct-194 05:00am blood neuts-52.7 lymphs-39.0 monos-4.5 eos-3.1 baso-0.7 05:00am blood pt-12.7 ptt-26.9 inr(pt)-1.1 05:00am blood glucose-93 urean-14 creat-0.8 na-136 k-4.2 cl-99 hco3-29 angap-12 05:00am blood alt-6 ast-16 ld(ldh)-126 alkphos-77 totbili-0.3 05:00am blood lipase-23 05:00am blood calcium-8.7 phos-3.7 mg-1.6 05:00am blood ctropnt-<0.01 05:59pm blood ctropnt-<0.01 05:31am blood lactate-0.6 07:20am urine color-yellow appear-clear sp -1.033 07:20am urine blood-mod nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-neg 07:20am urine rbc-4* wbc-<1 bacteri-none yeast-none epi-0 07:20am urine casthy-9* . discharge labs: 06:55am blood wbc-4.8 rbc-3.49* hgb-11.0* hct-33.4* mcv-96 mch-31.6 mchc-33.1 rdw-13.3 plt ct-209 06:53am blood glucose-85 urean-10 creat-0.6 na-137 k-3.8 cl-99 hco3-31 angap-11 07:30am blood cortsol-2.6 01:30pm blood cortsol-2.4 02:10pm blood cortsol-11.0 04:05pm blood cortsol-5.9 05:18pm blood cortsol-22.5* . pending labs: acth, free cortisol, renin, aldosterone from . microbiology: blood cultures 11/4 and : no growth (final) urine culture : no growth (final) catheter tip culture : no growth (final) influenza dfa : negative . imaging: cta chest : the thyroid gland is unremarkable. there is no axillary or mediastinal lymphadenopathy by ct size criteria. the heart and greater vessels are unremarkable. there is mild coronary artery calcifications. no pericardial effusions are present. the pulmonary arteries are patent down to the subsegmental level. the lungs show minimal bibasilar atelectasis and a small focus of scarring in the left upper lobe, unchanged since . a 2 mm and 4 mm nodule in the right upper lobe is unchanged since the previous examination. no other nodules, effusions or consolidations are present. the patient is status post a coronary artery bypass grafting. although this examination was not intended for subdiaphragmatic evaluation, the partially imaged abdomen shows a granuloma in the right lobe of the liver and a calcified right adrenal nodule, unchanged. the patient is status post cholecystectomy. osseous structures: the visible osseous structures show no suspicious lytic or blastic lesions or fractures. there is mild scoliosis of the thoracic spine. impression: no acute intrathoracic process. . ct abd/pelvis : 1. no acute intra-abdominal process. 2. diverticulosis, but no diverticulitis. 3. atherosclerotic disease of the coronary arteries and intra-abdominal aorta. 4. scoliosis and degenerative changes of the lumbar spine. . tte : the left atrium is mildly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. mild aortic regurgitation. pulmonary artery hypertension. dilated ascending aorta. compared with the report of the prior study (images unavailable for review) of , the ascending aorta is slightly larger and mild pa systolic hypertension is now identified. the other findings are similar. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. . cxr : in comparison with the study of , the cardiac silhouette is less prominent and the pulmonary vascularity is substantially improved. mild atelectatic changes are seen at the bases. brief hospital course: mr. is a 77 yo m with a hx of cad s/p cabg, htn, hl, recent diagnosis of prostate cancer who presented to the micu with chest pain and hypotension. . # hypotension: initially, the patient's hypotension in the setting of low grade fevers was concerning for a septic etiology. however, he only required pressors transiently, and his blood pressure improved significantly with fluid resuscitation. he was started on unasyn, as possible sources of infection were thought to be gu and oropharyngeal (patient had recent prostate biopsy and dental work). unasyn was stopped when infectious workup remained unrevealing. he was ruled out for an mi and a pe. after transfer to the medicine floor, the patient's bp remained low but stable. a morning cortisol was low, as was a cortisol stimulation test, raising concern for adrenal insufficiency. the endocrinology service was consulted, and performed another cortisol stimulation test; several portions of this test were pending at discharge, and the patient planned to follow up in endocrine clinic in several weeks. he was started on hydrocortisone 15 mg in the am and 5 mg in the pm for presumed partial adrenal insufficiency, with a plan for endocrine to taper steroids after the patient is seen in clinic. . # fevers: during his stay in the micu, the patient had low grade fevers. however, no sources of infection were found. workup included urine culture, blood cultures, influenza dfa, ct abdomen and pelvis and cta chest. additionally, the patient underwent tte to evaluate for culture negative endocarditis, and no vegetations were seen. his fevers resolved several days after admission, and he had been afebrile > 72 hours at the time of discharge. . # chest pain: the patient initially presented with chest pain, which persisted throughout his hospitalization. he was ruled out for pe, and cardiac enzymes were negative. he did have subtle ecg changes when he was hypotensive on admission, and he might benefit from repeat stress testing with imaging as an outpatient. . # anemia - the patient had a hct drop from 36 to 31; this was felt to be multifactorial from dilution after fluid resuscitation, phlebotomy and ongoing hematuria related to prostate cancer and recent prostate biopsy. . # hypoxia - after fluid resuscitation the patient had a small oxygen requirement. cxr showed interstitial edema and he received several doses of oral furosemide with good urine output. at discharge, his oxygen requirement had resolved and his ambulatory o2 saturation was in the mid-90s. . # prostate ca - patient reported a recent diagnosis of prostate cancer, with a plan to follow-up with dr. as an outpatient. . # htn - anti hypertensives were initially held secondary to the patient's hypotension, but low dose metoprolol was restarted on discharge. . # cad - patient was continued on asa. metoprolol initially held, but restarted on discharge. . # spinal stenosis: continued on home oxycontin and prn oxycodone. medications on admission: allopurinol - 300 mg tablet daily fluoxetine - 20 mg capsule daily metoprolol succinate 25 mg daily nitroglycerin - 2.5 mg capsule, extended release - 1 capsule(s) by mouth every 12 hours nitroglycerin - 0.4 mg tablet, sublingual - 1 tablet(s) sublingually every 5 minutes up to 3 tablets for chest pain oxazepam 10 mg capsule - 2 capsule(s) by mouth at bedtime oxycodone - 5 mg tablet - q 4-6 hours prn pain oxycodone - 10 mg pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth daily in the morning and 1 at night primidone - 50 mg tablet daily simvastatin - 40 mg daily sucralfate 2 grams by mouth qam and hs ursodiol - 300 mg capsule - two capsule(s) valsartan 40 mg tablet daily aspirin 325 mg tablet daily cholecalciferol (vitamin d3) 2,000 unit tablet daily omega-3 fatty acids-fish oil discharge medications: 1. allopurinol 100 mg tablet sig: three (3) tablet po daily (daily). 2. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 3. oxazepam 10 mg capsule sig: one (1) capsule po hs (at bedtime). 4. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 5. oxycodone 10 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po q12h (every 12 hours). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. primidone 50 mg tablet sig: one (1) tablet po hs (at bedtime). 8. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 9. sucralfate 1 gram tablet sig: two (2) tablet po twice a day. 10. toprol xl 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 11. hydrocortisone 5 mg tablet sig: three (3) tablet po qam (once a day (in the morning)). disp:*90 tablet(s)* refills:*2* 12. hydrocortisone 5 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). disp:*30 tablet(s)* refills:*2* 13. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 14. cholecalciferol (vitamin d3) 1,000 unit tablet sig: two (2) tablet po daily (daily). discharge disposition: home with service facility: vna discharge diagnosis: partial adrenal insufficiency hypotension acute pulmonary edema discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , you were admitted to the hospital with low blood pressure and chest discomfort. your blood pressure medications were held, you were given iv fluids and your blood pressure improved. you were seen by endocrinology while in the hospital, and they think that you may have a partial deficiency in cortisol. you have an appointment to see endocrinology in clinic to discuss whether you will need any treatment for this condition. . we made the following changes to your home medications: stop nitroglycerin stop ursodiol stop valsartan start hydrocortisone, 15 mg in the morning and 5 mg in the pm around 2pm followup instructions: department: medical group when: monday at 2:00 pm with: dr. building: (, ma) campus: off campus best parking: on street parking department: medical specialties-endocrinology when: monday at 4:20 pm with: dr. & zhiheng building: sc clinical ctr campus: east best parking: garage md procedure: central venous catheter placement with guidance diagnoses: anemia, unspecified unspecified essential hypertension coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia malignant neoplasm of prostate examination of participant in clinical trial acute edema of lung, unspecified other adrenal hypofunction 

Answer: The patient is high likely exposed to