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: percocet / serax attending: chief complaint: weakness major surgical or invasive procedure: none history of present illness: 76 yof w/ complex pmhx including cad s/p cabg, esrd on hd, dm, nephrogenic systemic fibrosis, sarcoidosis w/ pulmonary involvement, copd on home o2 at night, diastolic chf, paf on coumadin who presented to - this am for generalized weakness. patient awoke this am feeling generalized weakness. prior to this she had been in her usual state of health. she went to dialysis yesterday and may have had a lot of volume taken off but is unsure. following hd, she felt fine. this am she awoke with generalized weakness. she also noted mild sob. her fsbg was normal. she denied and fever, chills, cough, chest pain, or any other complaints. she checked her bp at home and it was low so went to hospital. at -, she was found to be tachycardic to the 120s in af and hypotensive w/ sbp in 90s. she received iv lopressor which dropped her sbp to 80s. she received 1l of ns at - without significant improvement in her bp so she was transferred to for further management. . in ed, t 96.6, bp 102/59, hr 119, rr 15, o2 80% ra->100% on 3lnc. found to be hypoglycemic to 39 and received 1 amp of d50. she received 10 mg of iv dilt which dropped her sbps to 70s and hrs to 70s, then 50s. she received an additional 2l ns with sbps to 80s-90s. she received a bedside u/s which showed no pericardial effusion but a large ra. there was some concern that her noninvasive bp measurements were inaccurate given her nephrogenic systemic sclerosis and an a line placement was attempted without success. during attempted placement, patient became transiently bradycardic to the 30-40s and was unresponsive for 3-5 seconds but awoke w/ improved hr. except for transient presyncope, patient continued to mentate throughout ed admission. she noted that her breathing felt better than this am. cardiac enzymes were checked and cks were flat. trop mildly elevated but unchanged from baseline and from level at . . upon arrival to micu, patient feeling well. notes she is feeling back to normal self except that she is ready for sleep. no longer notes generalized weakness. denies fever, chills, chest pain, abdominal pain. she notes her breathing has improved over the course of the day. past medical history: # cad s/p cabg () # esrd on hd (qmwf; due to renal artery stenosis) # dm ii: since age 47 with triopathy # nephrogenic systemic fibrosis (wheelchair bound) # hypercholesterolemia # h/o hypotension after dialysis (pretreated w/ midodrine) # sarcoidosis with pulmonary involvement: followed by dr. # copd (fev1 61% on home o2 at night) # hypothyroidism # renal artery stenosis s/p bilateral stents () # diastolic chf (ef>55%) # atrial fibrillation, paroxysmal, on coumadin # pvd s/p left fem- , s/p right fem- , s/p angioplasty and stent # breast cancer s/p left mastectomy # h/o mesenteric ischemia s/p sma bypass # gastritis # s/p cholecystectomy # chronic anemia esrd (baseline hct 28-30) # : lt sc angioplasty for necrotic l thumb # carpal tunnel syndrome bilaterally, with positive electromyogram # s/p acute tubular necrosis secondary to dye nephropathy social history: lives w/ husband in . she is dependent with her adls. in wheelchair at home. has vna and husband to care for her. tobacco: 25 50 pack year smoking history, quit . no etoh. family history: one sister had lung cancer, one brother had lung cancer and leukemia, five of the patient's six siblings have diabetes. father died of myocardial infarction at age 66. there is a strong family history of hypertension. physical exam: t: 96.3 bp: 97/43 hr: 47 rr: 13 o2 99% 3lnc gen: pleasant, brething comfortably, nad heent: r eye post surgical. l eye reactive. no icterus. dry mms. op clear. neck: supple, no lad, no jvd. cv: irreg irreg. distant heart sounds. no appreciable murmurs. firm mobile mass over xyphoid process, nontender to palpation lungs: ctab. r tunneled hd line cdi abd: nabs. thin, firm, nt, nd. midline surgical incision ext: wwp. no edema. erythematous skin changes on b /o increased warmth. healed incisions over medial : sclerotic skin on arms and legs neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. symmetric strength. pertinent results: cardiomediastinal silhouette is unchanged. there are bilateral small pleural effusions, which are chronic. the cardiomegaly has improved. increased interstitial markings are due to combination of edema and underlying known pulmonary sarcoidosis, there is no focal consolidation. tip of one dual chamber right supraclavicular central venous line projects over the lower svc and superior cavoatrial junction. there is no pneumothorax. impression: mild interstitial edema, improved. chronic increased pulmonary markings consistent with known sarcoidosis 09:50pm blood wbc-6.0 rbc-3.77* hgb-12.1 hct-37.0 mcv-98 mch-32.2* mchc-32.8 rdw-15.6* plt ct-301 05:11am blood wbc-7.6 rbc-3.25* hgb-10.3* hct-32.2* mcv-99* mch-31.6 mchc-31.9 rdw-15.9* plt ct-308 09:50pm blood pt-28.2* ptt-49.7* inr(pt)-2.8* 05:11am blood pt-30.5* ptt-50.1* inr(pt)-3.1* 09:50pm blood glucose-69* urean-37* creat-3.9* na-137 k-4.8 cl-98 hco3-29 angap-15 05:11am blood glucose-65* urean-37* creat-4.0* na-137 k-4.8 cl-102 hco3-23 angap-17 09:50pm blood ck-mb-notdone ctropnt-0.13* 05:11am blood ck-mb-notdone ctropnt-0.14* 05:11am blood calcium-8.5 phos-4.6* mg-2.9* 01:57am blood lactate-1.7 brief hospital course: 76 yof w/ cad s/p cabg, esrd on hd, dm, nephrogenic systemic fibrosis, sarcoidosis w/ pulmonary involvement, copd on home o2 at night, diastolic chf, paf on coumadin who presented with weakness and was found to be tachycardic and mildly hypotensive following recent hd, now admitted to the micu for persistent hypotension in the setting of nodal medications. . # hypotension: patient has a h/o hypotension following hd and typically receives midodrine. likely secondary to volume depletion initially from hd and then medication induced metoprolol and diltiazem. now volume repleted. also question of whether noninvasive measurements are accurate given her h/o nephrogenci systemic sclerosis. upon arrival to the micu, patient's sbps were in the 90s but was mentating clearly. no further interventions were made and she remained stable. her hrs remained in the 50s. the following mornings, hrs had increased as had blood pressure. there was no evidence of infection. blood cultures were sent but had no growth at the time of discharge and patient was afebrile without leukocytosis throughout. her metoprolol was held and was not restarted at the time of discharge due to bradycardia. . # weakness: presumably secondary to hypotension. fsbg was normal. neuro exam nonfocal throughout hospitalization. her weakness had resolved upon arrival to the icu and she had no further complaints. . # afib: paroxysmal. on coumadin. inr currently 2.8. following metoprolol and diltiazem in eds, hr dropped to 50s and as low as the 30s. all nodal agents were held and the following morning she was in normal sinus rhythm. her metoprolol was not restarted at discharge due to bradycardia but her coumadin was continued throughout. . # esrd on hd qmwf. last hd the day prior to admission. likely contributing to hypotension. she was dialyzed the following day per her regular schedule and was discharged following dialysis. she received midodrine prior to dialysis and her sevelamer was continued throughout. . # cad s/p cabg . anatomy unknown. some potentially ischemic ecg changes but asymptomatic and cardiac enzymes negative. low likelihood of acs. she was continued on asa. beta blocker held as above. . # dm ii: she was continued on her lantus and iss . # hypothyroidism: cont levothyroxine . # hypercholesterolemia: cont zocor . # chronic anemia: esrd. baseline hct 28-30. current hct 37 suggesting dehydration but unlikely to be bleeding. hct remained at baseline during admission. . # fen: renal, diabetic diet . # ppx: ppi. hold heparin given therapeutic inr. . # access: r hickman. piv . # code: dnr/dni medications on admission: zocor 20 mg daily nexium 40 mg once a day metoprolol tartrate 12.5 mg lactulose(10) ml po daily docusate sodium 100 mg aspirin 81 mg daily sevelamer 800 mg tid w/meals levothyroxine 300 mcg alternating with 200 mcg qod midodrine 5 mg qmwf w/ hd insulin lispro sliding scale coumadin 2 mg at bedtime. lantus (10) units subcutaneous qam. discharge medications: 1. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 2. esomeprazole magnesium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. sevelamer 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 7. levothyroxine 100 mcg tablet sig: 2-3 tablets po daily (daily): alternate taking 200 mcg and 300 mcg daily. 8. midodrine 5 mg tablet sig: one (1) tablet po prior to hemodialysis. 9. warfarin 2 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 10. insulin glargine 100 unit/ml solution sig: ten (10) units subcutaneous qam. 11. insulin lispro 100 unit/ml solution sig: as directed units subcutaneous qachs: per your normal sliding scale. discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: post-dialysis hypotension; atrial fibrillation . secondary diagnoses: chronic kidney disease v nephrogenic systemic fibrosis pulmonary sarcoidosis copd hypertension hypothyroidism coronary artery disease type 2 diabetes mellitus discharge condition: stable discharge instructions: you were admitted to the hospital with a rapid heart rate, a slightly low blood pressure, and weakness. it appears that all of these symptoms may have been due to you having recently received dialysis. no evidence of infection was found while you were here, and all of you symptoms resolved without any intervention. . no changes were made to your medications. you should continue to emidodrine prior to your dialysis sessions. you should also discuss with your primary care doctor possibly holding off on taking your lopressor on the mornings that you have dialysis. . if you experience any high fevers, chest pain, difficulty breathing, loss of consciousness, or other concerning symptoms, then you need to seek medical attention. followup instructions: provider: , md phone: date/time: 1:15 provider: , md phone: date/time: 1:15 provider: breathing tests phone: date/time: 12:00 procedure: hemodialysis diagnoses: anemia in chronic kidney disease end stage renal disease congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation aortocoronary bypass status personal history of malignant neoplasm of breast sarcoidosis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease atherosclerosis of renal artery long-term (current) use of anticoagulants kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure chronic diastolic heart failure hypotension of hemodialysis lung involvement in other diseases classified elsewhere 

Answer: The patient is high likely exposed to