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: hydrochlorothiazide / norvasc attending: chief complaint: presyncope major surgical or invasive procedure: picc line placement history of present illness: . 68 yo m with stage iii nonsmall cell lung cancer (adenocarcinoma) with metastatic disease to brain discovered in after focal seizure s/p cyberknife and hx of complete heart block s/p pacemaker who presents to the ed today after a presyncopal episode. . patient reports that he was walking out of cvs on th eday of admission and suddenly collapsed to the ground and was unable to get up. he denied any preceding symptoms such as chest pain, palpitations, sob, lightheadedness or dizziness. no focal weakness. denies any loc or head trauma. no reported confusion, bowel/bladder incontinence, tongue biting or witnessed shaking. found to be hypotensive to 88/44 by ems. denied any headaches, visual changes, muscle weakness or parasthesias. patient reports he was in his usual state of health prior to the fall. no recent infections, cough, uri sx or dysuria. no abdominal pain, brbpr or melena. . wife reported some concerns regarding her husband's health over the weekend. wife said he had "labored breathing" and appeared unsteady on his feet. he did not leave the house this weekend. she was planning on taking him to his primary care today. also with decreased po intake. mild confusion that has been present since starting chemo. . of note, patient reported isolated incident of tonic-clonic right arm shaking two weeks ago that lasted approximately 60 seconds. no loc. patient had similar right arm seizure like activity in for which he was hospitalized and found to have a new brain met. he has since been on a decadron taper that finished today and completed cyberknife. . in ed: 98 76p 110/42 20 95%ra; guaiac negative; given 2l ns and hydrocortisone 100mg for presumed adrenal insufficiency; cxr showed pna - started on cefepime and vancomycin; head ct showed improvement of vasogenic edema; abdominal ct showed stable aaa and no rp bleed . ros as per hpi, 10 pt ros otherwise negative past medical history: oncology history: diagnosis: 1. stage iii nonsmall cell lung cancer (adenocarcinoma) with a potential t4n0 tumor (stage iii, 7th tnm), egfr wild-type 2. metastatic disease to brain discovered in after focal seizure. current treatment: surveillance treatment: 1. status post chest radiotherapy to 6600 cgy completed on . 2. status post 2 cycles of cisplatin 50 mg/m2 d1, d8 and etoposide 50 mg/m2 d1-d5 of a 28 day cycle on and .he started concurrent chemoradiation therapy on . day 8 cisplatin was held during cycle 1 for aaa repair. day 8 cisplatin was held during cycle 2 for thrombocytopenia. 3. s/p cyberknife and decadron taper for brain mets past medical history: 1. hypertension. 2. hyperlipidemia. 3. complete heart block status post pacemaker. 4. arthroscopic knee surgery. 5. arthritis 6. coronary artery disease 7. rosacea 8. status post endovascular aortic aneurysm repair on 03/. social history: patient lives with wife, 6 children. retired engineer for telephone company. distant tobacco, no alcohol currently (had manhattens daily previously), no illicits. family history: no fhx of lung cancer. myocardial infarction in his father sustained at the age of 68. there is no history of premature coronary artery disease. no family history of malignancy. physical exam: admission physical exam: 98.5 106/68 68p 18 96%ra appearance: alert, nad eyes: eomi, perrl, anicteric ent: op clear s lesions, mmm, no jvd, neck supple cv: +s1, s2 -m/r/g, no peripheral edema, 2+ dp/pt bilaterally pulm: diminished at bases abd: soft, nt, nd, +bs msk: 5/5 strength throughout, no joint swelling, no cyanosis or clubbing neuro: cn 2-12 grossly intact, 5/5 strength, no pronator drift, normal finger-to-nose, downgoing babinski, 2+ reflexes ue/le, sensation grossly intact skin: no rashes psych: appropriate, pleasant heme: no cervical rectal: guaiac negative in ed pertinent results: 06:45pm ctropnt-<0.01 04:57pm lactate-1.4 04:45pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-2* ph-6.0 leuk-neg 01:33pm pt-13.0 ptt-26.0 inr(pt)-1.1 01:10pm glucose-159* urea n-21* creat-0.9 sodium-127* potassium-4.2 chloride-94* total co2-22 anion gap-15 01:10pm ctropnt-<0.01 01:10pm wbc-3.7*# rbc-3.09* hgb-10.0*# hct-28.4* mcv-92 mch-32.4* mchc-35.3* rdw-13.6 01:10pm neuts-93.4* lymphs-5.0* monos-1.2* eos-0.3 basos-0.1 . bcx: negative ucx: negative ekg: 63 v-paced, no change from . nchct: 1. no acute hemorrhage or mass effect. 2. decreased area of vasogenic edema in left frontal vertex compared to . . a/p ct wo contrast: 1. stable size of aaa, measuring 6.8 x 6.4 cm (compared to 6.9 x 6.2 cm on ). 2. no retroperiotneal hematoma. . pa/lat cxr: bilateral upper lobe pneumonia. . ct chest without contrast: impression: 1. new severe alveolitis or other alveolar filling process primarily involving the upper lobes and therefore most likely connected to prior radiation therapy denoted by longstanding paramediastinal pulmonary fibrosis. the differential diagnosis includes delayed cryptogenic organizing pneumonia, drug-induced pneumonitis potentiated by prior radiation (given the appropriate clinical history of ongoing chemotherapy, unknown to me). diffuse pulmonary hemorrhage and widespread atypical pneumonia are alternative possibilities. 2. severe atherosclerosis, involving coronaries. . immunoflourescent test for pneumocystis jirovecii (carinii)(final ): negative for pneumocystis jirovecii (carinii). . : b-glucan fungitell (tm) assay for (1,3)-b-d-glucans results: >500 pg/ml* reference ranges negative: less than 60 pg/ml indeterminate: 60 - 79 pg/ml positive: greater than or equal to 80 pg/ml . legionella urinary antigen: negative for legionella serogroup 1 antigen. . immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii). . chest xray: impression: in addition to the biapical radiation changes, there is likely overlying atypical organism infection, possibly pcp, drug toxicity from chemotherapy that has now spread to the left mid, left lower, and right lower lung fields. . ultrasound l upper extremity: impression: no dvt in the left upper extremity. . ct of c, t and l spine: c spine impression: no evidence of metastatic disease. extensive degenerative disc disease of the cervical spine, as described above. t spine impression: 1. no evidence of spinal metastatic disease. 2. diffuse bilateral ground-glass opacities are partially imaged and are further characterized on ct exam of . small bilateral pleural effusions, right greater than left, appears slightly increased in size from prior. 3. calcified disk protrusion at t6-7 with likely cord compression. l spine impression: 1. no evidence of metastatic disease. no suspicious lytic or sclerotic lesion is seen within the bones. 2. stable appearance of the infrarenal abdominal aortic aneurysm. numerous sigmoid colon diverticula without associated inflammatory changes. brief hospital course: 1. hypoxic respiratory failure, progressive alveolar process: this is a 68 year old gentleman with chb s/p ppm and stage iv nsclc (adenoca) with a single brain metastasis s/p cyberknife one month ago and subsequent decadron taper terminating on the day of admission. he presented to the ed following a presyncopal episode during which he was found to be hypotensive by ems. this hypotension resolved without intervention prior to his arrival in the ed where he was given broad spectrum antibiotics (hcap coverage) for bilateral apical infiltrates and stress dose steroids for potential adrenal insufficiency. he was admitted to the general medical floor. a head ct with contrast demonstrated improvement of his vasogenic edema and abdominal ct demonstated a stable aaa. ct scan of the chest on the evening of admission demonstrated new severe alveolitis or other alveolar filling process primarily involving the upper lobes, but also with patchy involement in other lung fields. the differential diagnosis entertained included cop as a late term sequelae of the chest radiation he had received one year prior, atypical pcp with particular concern for pcp, less likely possiblities such as hypersensitivity pneumonitis, vasculitides, and pulmonary hemmorhage. he had no oxygen requirement on the day of admission despite pronounced findings on chest ct. he developed rapidly progressive hypoxemia. on hd2, he required 2l by nasal cannula to maintain o2 sats in the low 90s. in addition to the vancomycin and cefepime he had been receiving since admission, he was started on azithromycin and high dose iv bactrim with steroids (to empirically cover pcp and also potentially steroid-responsive inflammatory lung diseases such as cop). pulmonary was consulted regarding bronchoscopy, but this was cancelled given his worsening oxygen requirement which progressed despite empiric treatments. he was transferred to the medical icu on as he began to require a non-rebreather to maintain sats in the low 90s. on admission to icu, it was noted that pneumonitis hypersensitivity panel, and anca were negative. sputum was negative for pcp x 2. however, b-glucan was grossly elevated to >500, galactomannam was elevated at 0.5, and ldh was elevated up to 754, suspicion was high for pcp pneumonia and patient was started on bactrim ds and steroids. he improved greatly over several days, weaned down to 5l nc, at which time he was transferred back to the floor. he completed a 7 day course of broad spectrum antibiotics (vancomycin, cefepime and azithromycin) to cover for hcap. the patient's oxygenation steadily improved on bactrim and prednisone although he continues to require supplement o2 ( 5 lits ) per nasal cannula.as below, pt developed transaminitis and pan-cytopenia while on bactrim. cbc, lfts and chem 10 will need to be followed closely at the outside faciliy and pt will also be followed by the clinic. his hospitalization was also notable for: 2. concern for adrenal insufficiency which prompted ed physicians to give stress dose steroids. his am cortisol over 24 hours after stress dose steroids were stopped was 20, making this very unlikely.pt is being d/c on prednisone ( as part of treatment for pcp ) and will need a slow taper after completion of treatment dose. . 3. hyponatremia: his serum sodium dropped as low as 125 but pt remained asymptomatic. likely causes included some element of siadh secondary to lung inflammation/nsclc and this was likely exacerbated by mild hypovolemia as his sodium did increase with normal saline. treated with high sodium diet, mild fluid restriction and intermittant ivf as required by his volume status.pt being d/c with low dose of oral supplemental salt. . 4. pancytopenia: on admission, his thrombocytopenia and leukopenia improved without intervention and was attributed to acute illness. however, his anemia recurred mostly likley from myelosuppression due to high dose bactrim and he required 2 units prbcs on and . iron studies, b12 and folate did not show deficiencies and work up did not support hemolysis.on d/c plts are trending down and levels need to be followed closely as an outpt. . 5. nsclc/ code status: initially the patient was listed as dnr/dni, but given his progressive oxygen requirement from a potentially reversible/treatable process and his relatively good response thus far from an oncologic point-of-view, this was discussed with the patient and his wife on by the hospitalist caring for him and he was switched to full code. the patient's son was also present for this conversation. . 6. lower extremity weakness: patient complained of progressively worsening weakness. non contrast head ct showed no worsening of his brain mets. a ct spine (patient's pace maker is not compatible with mri) showed no mets in the spinal cord but did reveal cord impingement due to djd at t6. the patient was seen in consultation with neuro oncology who felt that this radiologic finding was not causing clinical symptoms, had been documented on prior studies and was stable. differential diagnosis included neuromuscular process, paraneoplastic process, and deconditioning given prolonged hospitalization. tsh and cpk levels were wnl.symptoms did improve spontaneously and likely cause is deconditioning due to prolonged hospital stay including icu admission. pt will need pt. . 7. hyperkalemia: likely due to high dose bactrim. in the acute circumstance the patient received kayexalate on two occasions. long term the issue was managed by decreasing the patient's carvedilol dose, adding low torsemide every other day with or without iv hydration depending on the patient's volume status.pt being d/c on a low k diet and electroltyes will need to be monitored as an outpt. . 8. transaminitis with elevated alkaline phos and normal bilirubin: the patient was assymptomatic and these laboratory changes were thought most likely due to drug effect. hepatitis serologies pending on d/c. the patient's statin was discontinued and his keppra was changed to zonisamide. high dose bactrim may also be contributing and dose reduced after dsicussion with the id service . . 9. stage iii nsclc / brain mets: repeat head ct with contrast showing no new lesions, edema decreased. pt will continue f/u with primary oncologist. . 10. history of seizures: secondary to brain mets.as above, dc'd keppra, started zonisamide due to elevated lft's. . 10. htn: held home meds on admission. decreased carvedilol (coreg) 12.5 mg --> 3.125 to allow every other day torsemide to manage hyperkalemia. bp remained stable on this dose after discontinuation of torsemide but may need to titrated back up. . 11. gerd: continued omeprazole. . 12. hld: given his transaminitis, discontinued simvastatin. . 13. acute delerium at night: managed with haldol 0.5-1 mg qhs with marked improvement though not complete resolution. he remained oriented during the day. . 14. left upper extremity edema: etiology unclear. ultrasound negative. emergency contact: (wife) (h), (c). medications on admission: carvedilol 25mg dexamethasone taper - finished today, taper started with 4mg daily levetiracetam 1000mg lisinopril 10mg daily prilosec 20mg simvastatin 20mg daily asa 81mg daily mvi discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 6. haloperidol 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for confusion. 7. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). 8. zonisamide 100 mg capsule sig: one (1) capsule po daily (daily). 9. prednisone 20 mg tablet sig: two (2) tablet po qam (once a day (in the morning)) for 1 days. 10. prednisone 20 mg tablet sig: one (1) tablet po qam (once a day (in the morning)) for 8 days: will need taper after - to discuss with primary oncologist. 11. insulin lispro 100 unit/ml solution sig: two (2) units subcutaneous asdir (as directed): per sliding scale. 12. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: 2.5 tablets po every six (6) hours for 11 days. 13. sodium chloride 1 gram tablet sig: one (1) tablet po qod (). discharge disposition: extended care facility: discharge diagnosis: pcp (pneumoncystis) pneumonia lung cancer with brain metastases elevated liver function tests hyperkalemia (high potassium) hypoxemia (low oxygen) hyponatremia (low sodium) diffuse weakness degenerative joint disease left arm swelling delerium at night high blood pressure high cholesterol heart burn pan-cytopenia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted with shortness of breath from pcp (pneumoncystis) pneumonia that required intensive care unit monitoring for your oxygen levels. you are being treated with 3 weeks of bactrim antibiotics with prednisone steroid medication and you have been steadily improving. you have continued to need oxygen, but this is expected to improve over time. your strength has been improving and tests did not reveal a cause for weakness.you liver function tests have been elevated so your statin has been stopped and your anti seizure medication has been changed.your potassium has been high probably from the bactrim antibiotic you need for your pneumonia. this has been treated with a water pill (toresamide), iv fluids, and decreasing your carvedilol blood pressure medication.you have received 2 blood transfusions for anemia with good response. you have had confusion at night time that has been treated with haldol at bedtime. pending results: hepatitis serologies followup instructions: f/u blood pressure-carvedilol may need to be titrated up. f/u cbc and chem 10 in 2 days and then at least twice a week. results to be faxed to dr , fax # ## pt will be contact for f/u with the clinic , if you do not hear from them please contact to set a f/u in days. department: physical therapy when: monday at 2:00 pm with: , pt building: (, ma) campus: off campus best parking: free parking on site department: hematology/oncology when: thursday at 11:00 am with: , md, phd building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: thursday at 11:30 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: hyperpotassemia esophageal reflux pure hypercholesterolemia unspecified essential hypertension hyposmolality and/or hyponatremia hypotension, unspecified secondary malignant neoplasm of brain and spinal cord malignant neoplasm of bronchus and lung, unspecified pneumocystosis cerebral edema osteoarthrosis, unspecified whether generalized or localized, site unspecified cardiac pacemaker in situ hypoxemia abdominal aneurysm without mention of rupture encephalopathy, unspecified other malaise and fatigue other alteration of consciousness swelling of limb displacement of thoracic intervertebral disc without myelopathy other pancytopenia heartburn 

Answer: The patient is high likely exposed to