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: azithromycin / metformin attending: chief complaint: sob major surgical or invasive procedure: cvl placement midline access placement intubation thrombolysis of submassive pe egd and colonoscopy ivc filter placement history of present illness: 56 yo male with crohn's disease, diverticulosis s/p hemicolectomy times 2, type 2 diabetes, and obesity who initially presented to osh for shortness of breath of one week duration and found to have bilateraly submassive pes and intubated for respiratory failure. . transferred to on . echo showed rb strain. received tpa for thrombolysis and heparin gtt was started. vital signs were stable and was extubated on . after the heparin gtt was initiated, pt developed maroon stools mixed with brbpr, thought likely secondary to underlying crohn's disease. hcts were measured closely and fell from 40 on admission to 30 following heparin initiation. gi was consulted and pt underwent upper endoscopy which showed no active source of bleeding. steroids were increased from 20mg daily to 40mg daily and pt was continued on pentasa. . called out to the floor on with stable vital signs, but hct dropped from 30->26 requiring transfusion of 2 units prbcs. with bowel prep for colonoscopy planned for the next day, it was decided to readmit patient to icu for better monitoring of hcts and vital signs. patient was never hemodynamically unstable. in total, he has needed 4 units of prbcs. . in the icu, patient underwent colonoscopy, showing diffuse crohn's disease consistent with a flare but no intervention was warranted. ivc filter was placed on , should the patient require emergent cessation of anticoagulation secondary to large gi bleed. hcts and vitals signs stable during this admission. bridge to coumadin has been initiated. . upon reaching the floor, patient reports that he is feeling good. denies lightheadedness, weakness, shortness of breath, chest pain, acute change in abdominal pain. past medical history: type 2 diabetes obestiy crohn's disease, with history of gi bleed hypertension diverticulitis s/p partial colectomy x 2 s/p multiple herniorraphy's arthritis social history: patient is not married but lives with significant other (female) and lives in . he only drinks alcohol 2x year currently, but reports heavy alcohol use that stopped approximately 20 years ago. he denies tobacco use. he reports using cocaine with cessation approximately 25 years ago. he is a former mechanic. family history: no family history of blood clots, malignancy, or sudden cardiac death. no family history of crohn's disease. his mother passed away from pneumonia, but also had hypertension. physical exam: physical exam: () vs: t: 97.3 (97.5-98.6), hr 61 (61-76) bp 139/80 (133-139/80-90), 97% ra, rr: 18 gen: nad, comfortable. heent: perrla, eomi, mmm, oropharynx clear cv: distant heart sounds, rrr with nl s1, s2. no m/r/g. pulm: cta b with no w/r/r. abd: obese, midline scar and lateral scars on left and right with herniations visible. nontender, positive bowel sounds in all 4 quadrants. right femoral site has dressing from ivc placement - c/d/i. ext: ecchymosis noted on the arms bilaterally, no pedal edema, no calf tenderness, no palpable cord. neuro: a+ox3, 5/5 strength in all 4 extremities pertinent results: selected labs: 02:15pm blood wbc-16.7* rbc-4.72 hgb-13.2* hct-40.8 mcv-86 mch-27.9 mchc-32.3 rdw-15.1 plt ct-338 03:04am blood wbc-17.1* rbc-4.31* hgb-11.7* hct-37.3* mcv-87 mch-27.2 mchc-31.4 rdw-14.3 plt ct-267 03:14am blood wbc-10.8 rbc-3.67* hgb-10.2* hct-30.5* mcv-83 mch-28.0 mchc-33.6 rdw-15.1 plt ct-240 03:02am blood wbc-8.2 rbc-3.29* hgb-9.1* hct-27.6* mcv-84 mch-27.8 mchc-33.1 rdw-15.0 plt ct-261 08:09am blood wbc-7.2 rbc-3.21* hgb-9.0* hct-26.6* mcv-83 mch-28.0 mchc-33.7 rdw-14.9 plt ct-273 04:05am blood wbc-9.5 rbc-3.68* hgb-10.0* hct-30.3* mcv-82 mch-27.1 mchc-32.9 rdw-15.0 plt ct-309 04:52am blood wbc-9.0 rbc-3.62* hgb-10.2* hct-30.1* mcv-83 mch-28.1 mchc-33.7 rdw-14.6 plt ct-317 06:04am blood wbc-10.5 rbc-3.70* hgb-10.1* hct-30.9* mcv-84 mch-27.3 mchc-32.7 rdw-14.6 plt ct-362 07:10am blood wbc-14.1* rbc-4.27* hgb-11.4* hct-36.0* mcv-84 mch-26.6* mchc-31.5 rdw-15.3 plt ct-441* 07:00am blood wbc-14.1* rbc-4.17* hgb-11.3* hct-35.0* mcv-84 mch-27.1 mchc-32.3 rdw-15.4 plt ct-411 07:22am blood wbc-13.9* rbc-4.34* hgb-11.5* hct-37.1* mcv-86 mch-26.6* mchc-31.1 rdw-14.5 plt ct-416 06:47am blood wbc-13.6* rbc-4.29* hgb-11.5* hct-36.0* mcv-84 . 02:15pm blood glucose-265* urean-22* creat-1.4* na-139 k-5.6* cl-106 hco3-23 angap-16 06:47am blood glucose-145* urean-23* creat-1.2 na-135 k-4.1 cl-100 hco3-24 angap-15 . 02:15pm blood pt-12.8 ptt-27.8 inr(pt)-1.1 06:39am blood pt-13.6* ptt-82.7* inr(pt)-1.2* 05:27am blood pt-15.9* ptt-66.9* inr(pt)-1.4* 05:22am blood pt-17.2* ptt-62.5* inr(pt)-1.5* 05:55am blood pt-17.3* ptt-78.4* inr(pt)-1.6* 05:09pm blood pt-16.7* ptt-45.0* inr(pt)-1.5* 02:51am blood pt-17.3* ptt-101.6* inr(pt)-1.6* 09:10am blood pt-18.3* ptt-66.3* inr(pt)-1.7* 04:32pm blood pt-17.6* ptt-49.1* inr(pt)-1.6* 06:38am blood pt-17.0* ptt-58.4* inr(pt)-1.5* 10:00am blood pt-16.7* ptt-52.5* inr(pt)-1.5* 01:25am blood pt-24.4* ptt-58.3* inr(pt)-2.3* 04:25pm blood pt-23.9* ptt-43.7* inr(pt)-2.3* 07:00am blood plt ct-411 07:00am blood pt-23.4* ptt-83.9* inr(pt)-2.2* 07:10am blood pt-20.0* ptt-77.1* inr(pt)-1.8* 01:40am blood pt-18.4* ptt-71.9* inr(pt)-1.7* 07:00am blood calcium-9.6 phos-5.0* mg-2.1 07:10am blood calcium-9.6 phos-4.8* mg-2.1 06:38am blood calcium-9.6 phos-5.0* mg-2.1 06:47am blood pt-30.5* ptt-87.6* inr(pt)-3.0* 04:55pm blood pt-27.4* ptt-61.2* inr(pt)-2.7* . 02:15pm blood calcium-8.6 phos-6.1* mg-2.0 06:38am blood calcium-9.6 phos-5.0* mg-2.1 . upon reaching the floor on until discharge, patient's hematocrit remained between 30.4 and 37.3. . ecg (): tracing 1. sinus tachycardia. non-specific intraventricular conduction delay. non-specific st-t wave changes. no previous tracing available for comparison. . tte (): impression: rv strain c/w acute pulmonary embolism. . cta chest, abdomen, pelvis (): impression: 1. extensive bilateral pulmonary emboli involving the bilateral main pulmonary arteries with extension through to the lobar, segmental, lower lobe subsegmental branches bilaterally, as above. associated findings of right heart strain. 2. no evidence of acute aortic injury. 3. bilateral dependent atelectasis/aspiration. 4. small left-sided ventral abdominal hernia containing non-obstructed loop of small bowel. suggestion of right-sided spigelian hernia, incompletely assessed as right lateral aspect of the abdomen fully included. . ecg (): tracing 2. sinus tachycardia. non-specific t wave changes. low qrs voltage in the limb leads. compared to the previous tracing of the qrs voltage has decreased in the limb leads. st segment depression is less pronounced and the ventricular rate is slower. . ecg (): tracing 3. sinus rhythm. t wave inversions in leads v1-v3. cannot exclude ischemia. low qrs voltage in the limb leads. compared to the previous tracing of artifact is present. t wave inversions are less pronounced in lead v3 and the t waves are more upright and normal appearing in leads v4-v5. . cxr (): the et tube tip is 4.5 cm above the carina. the right internal jugular line tip is at the level of mid low svc. there is no change in the cardiomediastinal contour with the mediastinal widening being due to extensive mediastinal lipomatosis. bibasilar atelectasis have developed in the interim, new, but note is made that the lung bases cannot be entirely evaluated since they were not entirely included in the field of view. no evidence of pulmonary edema. no pneumothorax. . bilateral lower extremity vein ultrasound (): impression: 1. non-occlusive thrombosis of the right popliteal (deep) vein. non- visualization of right posterior tibial veins, can not exclude thrombosis within these veins. 2. no evidence of deep venous thrombosis in the left lower extremity. . ecg (): sinus tachycardia. possible left atrial abnormality. there is one ventricular premature contraction. non-specific inferior st-t wave changes. compared to the previous tracing of there is no significant change. brief hospital course: 56 yo with dmii, htn, crohn's disease on steroids, diverticulosis s/p colectomy x 2, who was admitted to the micu on for respiratory failure requiring intubation secondary to submassive pe. . # pulmonary embolism. patient presented to and found to have submassive clot burden on cta with significant hypoxia (pao2 only 130 in spite of 100% oxygen). he required intubation for respiratory failure and also had evidence of right heart strain from bedside echo. he was lysed with tpa and extubated afteward. he was begun on heparin gtt. shortly after the initiation of heparin, pt developed maroon stools with brbpr and required transfusion of 4 u prbc. hematocrits were measured closely and fell from 40 on admission to 30 following heparin initiation. gi was consulted and pt underwent upper endoscopy which showed no active source of bleeding. steroids were increased from 20mg daily to 40mg daily and pt was continued on pentasa. patient was called out to the floor on , but given persistence of maroon stools with brbpr, patient returned to the micu the following morning for bowel prep for anticipated colonoscopy with close monitoring of vitals and hematocrit. he underwent colonoscopy and was found to have evidence of active crohns disease, though no active bleeding was identified. his hematocrit stabilized but because he had a clot in his lower extremities in combination with concerns regarding his ability to tolerate anticoauglation in the short term, an ivc filter was placed on . patient was called out to floor on with a stable hematocrit greater than 30. vital signs remained stable without any requirement for supplemental oxygen. . on the floor, heparin gtt was continued with bridge to therapeutic inr with coumadin. hematocrits were monitored closely and remained stable. the option to be discharged home on lovenox therapy was presented to the patient on several occasions but given the gravity of his presentation and his underlying anxiety, pt preferred to remain hospitalized until his inr was therapeutic. patient never developed hypoxia and never complained of shortness of breath on the floor. patient's inr slowly elevated over the course of this admission, reaching therapeutic inr (2.2) on . in order to reach this inr, coumadin doses were increased as tolerated, with daily doses between 5-15 mg daily depending on the inr. on , patient reported that central line was accidentally removed during showering, and occlusive dressing was placed. patient was given midline access and was without anticoagulation for approximately 3-4 hours. patient was bridged for 48 hours upon reaching therapeutic inr. the duration of his anticoagulation therapy remains unclear, but patient has been instructed to follow up with his primary care physician, . , for further guidance. he will likely need anticoagulation for at least 3 months, with repeat lenis to determine if clot burden is still present. if clots are present, he will need to continue anticoagulation. if clots are absent, stopping of anticoagulation may be considered. however, if his underlying crohn's disease is the etiology of his increased susceptibility to hypercoagulability, patient may require life-long anticoagulation with coordinated care between his pcp and gastroenterologist. in regards to patient's ivc filter, it was not removed during this admission due to persistent clot burden and the necessity to continue heparin gtt. he will follow up with interventional radiology at and will have it removed within the next year, as per ir. . # acute blood blood loss anemia: likely secondary to underlying crohn's disease with flare in the setting of anticoagulation. patient developed maroon stools with brbpr in response to initiation of heparin gtt, with concurrent drop in hematocrit from 40 on admission to 26 on . patient was transfused with 4 units prbc in the micu. egd showed no acute bleeding but colonoscopy showed diffuse crohn's disease. hematocrit was measured frequently, stabilized around 30 on and remained at or above this level throughout this admission. on , hct was noted to be 37.2. active type and screen was maintained. patient continued to have brbpr/maroon stools until , which may have been due to the passing of clots. all other vital signs remained stable and patient did not experience any signs of hypotension or anemia. . # crohns. diagnosed in but patient reported chronic symptoms for many years. prior to admission, patient was on 20mg po prednisone taper for prior crohn's flare. as above, following administration of tpa lysis and heparin gtt for pe, patient developed brbpr and maroon stools. in the micu, an egd showed no upper gi bleeding and a colonoscopy showed an active crohn's flare with no intervenable bleeding areas. gi followed patient during this admission and increased po steroid dose to 40mg po in the micu. he was continued on mesalamine 500mg po bid. on , patient reported that his stools were brown, formed, without blood. on , gi was re-consulted and his prednisone was tapered down. he will be discharged on 30mg po daily with a goal taper of 5mg per week. remained hemodynamically stable and asx. patient will follow up with his gastroenterologist, dr. , for further management as an outpatient. . # type 2 diabetes: with the administration of increased steroids, it was suspected that blood sugars would run higher. it was difficult to control dinner and evening sugars, which spiked in the 300's. during this admission, patient was continued on hiss with long acting glargine. the scale was continually uptitrated with goals of containing sugars under 300. patient will be discharged on his home insulin regimen, which he reports was effective in controlling his sugars. the tapering of steroids will help with better sugar control. . # htn. patient's outpatient medication for hypertension included lisinopril. in the micu and in the setting of his lower gi bleeding, this medication was held. after several days of continued stabilized of the hematocrits and vital signs, lisinopril was restarted. blood pressures remained stable following re-initiation of this medication. . # acute renal failure. patient was noted to have a creatinine of 1.4 on presentation. likely secondary to decreased volume status in the setting of lower gi bleeding. creatinine improved in response to fluids and remained stable over the course of this admission. . # disposition: there were several obstacles to the discharge of this patient. patient is from and transportation was an initial problem. was originally agreeable to discharge on lovenox therapy, provided that his significant other could pick him up from the hospital. primary team and social work contact pt's significant other, who reported that she was not ready to have patient back home. she initially reported that the weekend traffic at was too overwhelming for her to travel. upon further conversation, she revealed that in the last year, patient had become increasingly angry and had become more threatening (though not physically). patient believed that he was not medically stable, was anxious, and demanded to stay on heparin gtt until he was therapeutic. denied several offers to leave on lovenox therapy. . patient if full code. hcp is long-time girlfriend, (. medications on admission: medications at home: (as per initial note) lisinopril 10 mg daily humalog iss lantus 30 qhs nph 30 qam tramadol 50 mg po daily pentasa 500 mg . medications on transfer: pantoprazole 40 mg po q24h warfarin 5 mg po daily hydrocortisone acetate ointment 1% 1 appl pr daily heparin iv sliding scale insulin sc (per insulin flowsheet) mesalamine 500 mg po bid prednisone 40 mg po daily cepacol (menthol) 1 loz po prn morphine sulfate 1-2 mg iv q4h:prn pain acetaminophen 325-650 mg po q6h:prn docusate sodium (liquid) 100 mg po bid senna 1 tab po bid:prn bisacodyl 10 mg po/pr daily:prn discharge medications: 1. mesalamine 250 mg capsule, sustained release sig: two (2) capsule, sustained release po bid (2 times a day). disp:*120 capsule, sustained release(s)* refills:*2* 2. insulin glargine 100 unit/ml solution sig: fifteen (15) units subcutaneous at bedtime: please continue to take your humalog sliding scale as prior to hospitalization. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 5. prednisone 10 mg tablet sig: three (3) tablet po once a day. disp:*90 tablet(s)* refills:*0* 6. tramadol 50 mg tablet sig: two (2) tablet po bid (2 times a day) as needed for pain. 7. warfarin 2.5 mg tablet sig: three (3) tablet po once daily at 4 pm: please follow up with your pcp as scheduled to check your inr, with goal inr of . disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: submassive pulmonary embolus acute blood loss anemia from lower gi bleed crohns disease type 2 diabetes hypertension arthritis discharge condition: stable, hematocrit 30-33, stools brown and formed. discharge instructions: you initially went to an outside hospital with difficulty breathing. after getting transferred to , we found that you had a large blood clot in your lung. we treated your with medication to dissolve your clot and this caused you to have lower gi bleeding. we then put a filter in your ivc, put you on blood thinners, and your bleeding has improved. your vital signs and hematocrit continue to remain stable. you were given coumadin to thin your blood and now your inr levels are therapeutic. your stools are no longer bloody or maroon in color. . we made the following changes to your medications: -added coumadin 7.5mg by mouth daily. your dose of this medication may vary. your primary care doctor, dr. , tell you whether to increase or decrease this medication to keep your inr between 2 and 3 -added prednisone 30mg by mouth daily. you should continue to take this medication until you follow up with your gi doctor. -added pantoprozole 40mg by mouth daily. you can speak with your gi doctor about when to stop this medication. . please follow up with your gi doctor and your pcp as below. you will need to have your blood levels monitored closely over the next few weeks. . if you have any abdominal pain, fevers, chills, increase in your bloody bowel movements, please contact your primary care physician or visit the emergency room. followup instructions: gi doctor: dr. . thursday at 4pm. . please talk to your doctor about starting bactrim for prophylaxis if you will require long term steroids. please follow up with him regarding the tapering of your steroid doses. . primary care doctor: dr. , check inr wednesday at 12:00pm. . please go to the clinic on wednesday morning to have your labs drawn. the clinic will call you in the afternoon and tell you if you need to adjust your coumadin dose. your primary care physician will order you a repeat ultrasound at 3 months after discharge to see if you still have a blood clot in your leg. if this ultrasound is negative, you may consider stopping anticoagulation and schedule to remove your ivc filter. you can call the interventional radiology department at to remove your ivc filter within 1 year. phone: . you may ask your primary care physician to set you up with a hematologist to determine if you are at risk for any future clots. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other endoscopy of small intestine insertion of endotracheal tube interruption of the vena cava injection or infusion of thrombolytic agent arterial catheterization insertion of other (naso-)gastric tube colonoscopy diagnoses: hyperpotassemia abnormal coagulation profile adrenal cortical steroids causing adverse effects in therapeutic use acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified anxiety state, unspecified acute respiratory failure blood in stool obesity, unspecified other pulmonary embolism and infarction diverticulosis of colon (without mention of hemorrhage) leukocytosis, unspecified acute venous embolism and thrombosis of deep vessels of distal lower extremity fibrinolysis-affecting drugs causing adverse effects in therapeutic use arthropathy, unspecified, site unspecified regional enteritis of large intestine chronic kidney disease, stage i 

Answer: The patient is high likely exposed to