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: patient recorded as having no known allergies to drugs attending: chief complaint: left leg pain major surgical or invasive procedure: central venous catheter temporary dialysis catheter endotracheal intubation foley catheter arterial line history of present illness: 75 yo russian man h/o bladder cancer (s/p ureterostomy; recent admit for turbt), osteoarthritis, cad, dm-2 p/w acute onset of l posterior leg/buttock pain x 2 days. . pt has not been able to walk since onset of pain. denies similar episodes in past. no recent trauma. no numbness of extremity. no dysuria/hematuria. no chest pain/sob. no ha/dizziness. no back pain. no fevers, cough/cold, recent infection. past medical history: *bladder cancer diagnosed in s/p turb x4, bcg with r->l transureter-ureterostomy in c/b hemorrhagic cystitis; turbt done *cad s/p cabg in *chf, ef 32% *dmii *cri, baseline cr 1.6-1.7 *htn *severe burns with multiple skin grafts *atrial fibrillation, not on coumadin given significant hematuria *psoriasis * varicose veins social history: mr. was a former metal worker in the 's. he suffered severe third degree burns and survived. he is married and has 2 sons. was a former 1 pack per day smoker for over 40 years and stopped approximately 7 years ago. he drinks etoh rarely. family history: significant for colon ca. physical exam: vitals: t-96.5, p-66, bp-122/64, rr-16, o2-100% (ra) gen - obese man in mild distress secondary to pain eyes - eomi, perrla ent - dry mm cv - irreg/irreg, nl s1/s2, no murmurs. 3+ b/l le edema resp - comfortable, ctab gi - protruberant, soft, nt/nd, nl bs musculoskeletal - rle 5/5 strength; lle 4/5 strength. pain on palpation over lateral aspect of l hip and buttock. no spinal tenderness. neuro - +slr on l; negative slr on r. aaox3. fluent speech. skin - multiple skin grafts. warm psych - appropriate/pleasant lymph - no cervical lad gu - l urostomy tube in place pertinent results: admit labs: -------------- 04:40pm wbc-6.4 rbc-3.70* hgb-9.0* hct-28.2* mcv-76*# mch-24.3* mchc-31.8 rdw-17.8* 04:40pm neuts-82.9* lymphs-8.9* monos-7.0 eos-1.0 basos-0.2 04:40pm plt count-271 04:40pm glucose-120* urea n-90* creat-2.2* sodium-137 potassium-4.4 chloride-101 total co2-26 anion gap-14 . l-spine (ap & lat) 3:09 pm findings: there are five non-rib-bearing lumbar-type vertebrae. severe multilevel degenerative disc disease is evident, most notably at l3-l4 and l5-s1. extensive facet arthropathy is noted at the lumbosacral junction. grossly alignment is preserved. no suspicious osteolytic or blastic lesions are identified. the sacrum and sacroiliac joints are unremarkable. incidental note is made of an indwelling left-sided nephrostomy. impression: extensive multilevel degenerative disease with no suspicious osseous lesions evident. . unilat lower ext veins left 2:38 pm findings: grayscale, color doppler, doppler waveform evaluation were performed of the left lower extremity. the common femoral, superficial femoral, and popliteal veins were interrogated and demonstrated normal compressibility, color doppler signal, and doppler waveforms. impression: no evidence of deep venous thrombosis in the veins interrogated above. . femur (ap & lat) left and tib/fib 3:09 pm findings: mineralization is within normal limits. the hip, knee, and ankle joints are grossly appropriately aligned. mild degenerative changes are noted at the knee. the ankle mortise is congruent. the talar dome is intact. there is diffuse soft tissue swelling throughout the lower extremity particularly at the ankle and anterior to the proximal tibia. extensive vascular calcification is incidentally noted. impression: no underlying fracture. mild degenerative change in the knee. soft tissue swelling as above. . chest (single view) 3:09 pm findings: lung volumes are further diminished. there is no consolidation. there is mild central vascular congestion, although no overt edema is seen. again noted are prominent pulmonary arteries. there is tortuous aorta. the cardiac silhouette size remains enlarged but stable. there is pleural thickening along the lateral aspects of both hemithoraces. no pleural effusion or pneumothorax is evident. median sternotomy wires are stably aligned. impression: no acute pulmonary process. . ecg () - a-fib@56, lad, rbbb, q's ii/iii/avf. (no significant change vs. previous) . . mri l-spine: impression: 1. no evidence of bony metastasis or acute compression fracture. 2. mild-to-moderate spinal stenosis at l3-4 level. 3. moderate-to-severe left foraminal and mild to moderate right foraminal narrowing at l5-s1 level with disc and facet degenerative changes. .. .. mri hips: findings: the ilia are not completely imaged in coronal stir or axial sequences. there is abnormal bone marrow signal within the left iliac , extending to the articular surface at the left sacroiliac joint and to the medial acetabular wall and roof. the marrow signal within the sacrum is within normal limits, so is in the right ilium except for a small focus of t1 low signal and t2 high signal in the medial acetabulum, which likely represents a subchondral cyst. the heterogeneous marrow signal within the proximal femoral shafts likely represents hematopoietic marrow. the bone marrow signal within the visualized vertebrae is unremarkable except for mild endplate changes. there is increased t2 signal within the adductor and obturator internus muscles, left greater than right, and within left gluteus medius and minimus muscles. the urinary bladder is contracted, and shows nodular thickening, which is concordant with the patient's history of bladder carcinoma. there is also dilatation of the visualized distal ureters bilaterally. there are multiple shotty and mildly enlarged perirectal and retroperitoneal lymph nodes, the largest measuring 11 mm in the right iliac chain. impression: 1. abnormal left ilium, which likely represents a non-displaced fracture; however, metastatic disease cannot be excluded. atypical radiation changes are much less likely. edema within the adductor and gluteus muscles as described above. ilia are not completely imaged. we will be happy to complete the mri of the pelvis at no additional charge; however, followup ct would be better to assess for fracture. 2. findings in the bladder are concordant with the patient's history of bladder carcinoma. there is distal bilateral hydroureters. 3. multiple shotty and mildly enlarged lymph nodes, the largest measuring 11 mm in the right iliac region. specimen submitted: left iliac bone lesion. procedure date tissue received report date diagnosed by dr. . brown/tcc previous biopsies: bladder tumor. bladder cancer. bladder tumor (1). lt/rt distal ureter (and more) diagnosis: left iliac bone lesion: metastatic urothelial carcinoma. ct head w/o contrast 5:33 am ct head w/o contrast reason: assess for cva/bleed medical condition: 75 year old man with h/o afib and metastastic bladder ca, p/w lethargy and acute change ms reason for this examination: assess for cva/bleed contraindications for iv contrast: none. head ct without contrast indication: a 75-year-old man with history of atrial fibrillation, metastatic bladder carcinoma, presenting with lethargy and acute mental status change. assess for hemorrhage, cva. comparison: not available. findings: there is no acute intracranial hemorrhage, edema, shift of normally midline structures or hydrocephalus. there is no evidence of major vascular territorial infarction. surrounding soft tissues and osseous structures are unremarkable. minimal mucosal thickening is noted in the right maxillary sinus. the rest of the paranasal sinuses and mastoid air cells are well aerated. the ventricles, sulci and extra-axial spaces are prominent, consistent with age-related involutional change. there are periventricular white matter hypodensities, mild, consistent with chronic microvascular ischemic changes. impression: no acute intracranial hemorrhage. no ct evidence of major vascular territorial infarction, but mri remains most sensitive for evaluation of acute ischemia. renal u.s. port 9:15 am renal u.s. port reason: re-evaluate for hydronephrosis medical condition: 75 year old man with acute on chronic renal failure and nephrostomy tube in place reason for this examination: re-evaluate for hydronephrosis indication: acute and chronic renal failure, nephrostomy tube in place. renal ultrasound: comparison with nephrostogram and renal ultrasound, . this study is limited by patient inability to position and bowel gas. the left kidney measures 11.7 cm, with a nephrostomy tube faintly visible. there is no hydronephrosis. the right kidney is not well identified due to habitus and inability to position. the bladder is collapsed around the foley. impression: no hydronephrosis. echo:the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. there is mild to moderate regional left ventricular systolic dysfunction with severe hypokinesis of the inferior and inferolateral wall. the remaining segments contract well (lvef = 35 %). right ventricular chamber size is normal with mild free wall hypokinesis. 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. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , mild mitral regurgitation is not seen on the current study. urine culture (final ): yeast. >100,000 organisms/ml.. brief hospital course: 75 yo man h/o bladder ca (s/p multiple turbts & s/p urostomy tube), cad s/p cabg, oa presents with severe pain of left buttock, radiation into hamstring found to have metastatic bladder cancer in the bone, lung, and liver. patient had a complicated medical admission resulting in transfer to the medical icu after mental status change post ir guided bone biopsy. after progressive deterioration including multi-system organ failure requiring triple pressor therapy, mechanical ventilation, and cvvhd, goals of care were changed to comfort measures only and the patient quickly died minutes after removal of care from respiratory failure. outlined by problem is his hospital course: #hypotension: multiorgan system failure. initial concern for septic shock v. possible cardiogenic. other possible etiologies hemorrhagic, obstructive unlikely. cardiac ezymes cycled and unrevealing. patient not responsive to trial of dobutamine. echo shows lvef>35% concern for urosepsis vs question new aspiration pna (may have aspirated while intubated for ir procedure). empiric treatment for aspiration pneumonia and candiduria initiated. culture data was unrevealing. repeat ruq us was negative for cholelithiasis. patient was continued on neosynephrine, levophed, and vasopressin and patient received course of stress dose steroids. . # respiratory failure: patient requiring intubation in setting of altered mental status and hypotension for adequate airway management and management of acidosis. altered mental status improved on . patient not hyperventilating to compensate for metabolic acidosis appropriately. patient verified that he wanted to be intubated on via interpretor, given multi-system organ failure and multiple pressor requirement, will keep intubated and sedated. . # anion gap acidosis: uremia, lactic acidosis, attempted correct w/ cvvhd, vent settings. . #altered mental status: initially in setting of hypotension, likely toxic metabolic due to sepsis. ct of the head is without acute hemorrhage or stroke (although mr is more sensitive). differential included narcotics vs. sepsis vs. hypercarbia v hyperkalemia. abg 7.24/66/66. however, did not wake up with narcan. pco2 down s/p cpap then intubation. ms improved on , pt responding appropriately, following commands. . # candiduria: persistent yeast in urine, with no other culture data to support infectious etiology of hypotension. treated with caspofungin as per id. nerphostomy tube chnaged at ir on . # elevated lfts/ruq pain: shock liver vs. metastatic disease in liver. . #acute on ckd: likely prerenal due to hypotension; concern for atn s/p multiple insults. no muddy brown casts seen in sediment on initial examination. renal us on did not show any evidence of hydro. nephrostomy tube replaced on by ir, intitially put out well, now uop has dropped off. initiated on cvvhd on am of after roj temporary dialysis line placed. cvvhd discontinued when goals of care changed. . # bladder cancer s/p multiple turbt w/ urostomy tube: #1, pathologic fracture, metastasis as above. urostomy changed by interventional radiology in the setting of candiduria. . # left buttock pain, ilium fracture, history of bladder cancer: mri l-spine and hip done on admission demonstrated ? fracture of left ilium, concern for pathologic fracture. patient denied trauma before admit. ct scan performed for better definition of lesion, concern for pathologic fracture. patient non weight bearing, pain management, see by orthopoedics but ortho/onc, rad/onc unavailable. on , ct scan reviewed, ortho/onc and rad/onc consulted. pt underwent ct guided biopsy of the bone lesion on which showed metastatic bladder cancer. in staging, bone scan had no further lesions, ct torso showed lesions in liver and nodules in lung. oncology prognosis was less than 6 months. . #urinary tract infection: pt passes urine only through left nephrostomy tube. right ureter is divert to left ureter. started on cipro on . urine culture returned klebsiella and enterococcus (though only low grade). pt was treated to cover klebsiella only with ciprofloxacin. . #cad s/p cabg . antihypertensives held in setting of hypotension. aspirin was not given as patient had a history of hematuria. . #chf, systolic , 30% (): systolic dysfunction on repeat echo, lvef 35%. . #htn - held meds in setting of hypotension. . # atrial fibrillation: patient not anti-coagulated because of severe hematuria in the past. beta blocker with good rate control. while in the icu, patient anticoagulated with a heparin gtt. . # fen: tube feeds provided while npo. . # prophylaxis: heparin gtt, bowel regimen. . # access: aline, lij, rij dialysis cath . # code: changed to full on when patient intubated and lined, dnr as of and changed to comfort measures only on . medications on admission: percocet 1-2 tabs q4h prn pain lasix 120mg daily losartan 50mg daily toprol xl 50mg daily neurontin 300mg asa 81 nph 15u qam humalog sliding scale discharge medications: none discharge disposition: expired discharge diagnosis: metastatic bladder cancer multisytem organ failure respiratory failure acute renal failure shock liver candiduria discharge condition: deceased discharge instructions: none followup instructions: none procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis non-invasive mechanical ventilation transfusion of packed cells biopsy of bone, other bones replacement of nephrostomy tube diagnoses: hyperpotassemia anemia in chronic kidney disease end stage renal disease malignant neoplasm of liver, secondary acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension acute and subacute necrosis of liver unspecified septicemia severe sepsis candidiasis of other urogenital sites atrial fibrillation aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled secondary malignant neoplasm of lung metabolic encephalopathy acute on chronic systolic heart failure secondary malignant neoplasm of bone and bone marrow pathologic fracture of other specified site other artificial opening of urinary tract status malignant neoplasm of other specified sites of bladder 

Answer: The patient is high likely exposed to