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: flomax / shellfish derived / fish product derivatives / zolpidem / ativan attending: chief complaint: altered mental status major surgical or invasive procedure: history of present illness: mr. is a 69 y.o. spanish-speaking male with multiple myeloma, esrd on hd, history of right pica cva, htn who presents with worsened mental status per his family members. apparently he was doing fine 1 day prior to admission. of note he received chemotherapy (cytoxan) on and his blood counts are decreasing. he is overall a poor historian despite use of a spanish interpreter on the phone. . he did make it to today on his own, but was slightly confused there and sent home from hd by taxi. his son then brought him to because he "wasn't acting right." initial vs in the ed: t 97.3, bp 173/76, hr 104, 87%ra, up to 100% 3l nc. emperically given vanco/ceftriaxone for possible infection. he does not complain of respiratory symptoms (cough, sob). his temperature subsequently went up to 100.6 in the ed. ct head negative for acute process. cxr negative. cta chest pursued given his h/o pe (although inr 6.0), and revealed rul consolidation consistent with pneumonia. azithromycin also given to cover atypical organisms. blood cultures drawn prior to antibiotics. in addition his serum calcium was 12.2 (has h/o hypercalcemia of malignancy) and he was given 500cc bolus of normal saline only given his h/o failure on hd. troponin elevated at his baseline given his esrd. . while in ed, his sbp rose into the 200s when he was aggitated waiting for ct scan and other tests. this was not treated given concern for possibility he may decline clinically and become septic. the sbp come down to 180 spontaneously after the studies. . ros: denies chest pain, sob, cough, chills, abdominal pain, n/v. does admit to "total body pain" which on further characterization seems to be muscle pain, predominately in the legs and head. he admits to chronic leg pain at baseline. past medical history: iga multiple myeloma s/p 11 cycles velcade/dex -- received first dose cytoxan on for disease progression on velcade esrd to mm - tu/th/sa r pica cva - ataxic @ baseline paf pe mild-mod ar mod mr tr c. diff strep pneumo pna pcp pna htn hyperlipidemia diverticulosis h. pylori gastritis anemia of b12/fe-deficiencies, ckd anxiety and depression social history: formerly worked at and . married, 3 children. son is hcp. wife has ca. 20 pack-year smoking hx. drinks etoh socially. family history: mother and father died of lung ca. physical exam: vs: t 99.4, bp 194/97, hr 106, rr 18, 95%3l neck: supple lungs: scattered rhonchi and wheezes, l>r heart: tachy, regular, late systolic murmur, best at apex abd: soft, nd/nt ext: le edema, r>l (chronic per patient) neuro: answers questions appropriately, no focal deficit pertinent results: admission labs: 07:02pm wbc-3.0* rbc-2.58* hgb-8.8* hct-26.8* mcv-104* mch-33.9* mchc-32.6 rdw-17.7* 07:02pm neuts-82.9* lymphs-10.8* monos-3.1 eos-2.8 basos-0.3 07:02pm plt count-141* 07:02pm pt-53.7* ptt-60.3* inr(pt)-6.0* 07:02pm glucose-98 urea n-12 creat-4.1*# sodium-137 potassium-4.1 chloride-94* total co2-28 anion gap-19 07:02pm calcium-12.2* phosphate-4.1 magnesium-2.0 . portable chest x-ray: no acute process . cta chest : 1. right upper lobe consolidation, likely infectious. 2. no pe or acute aortic process. 3. emphysema. 4. interval resolution of bilateral pleural effusions and left lower lobe pneumonia. . ct head (non-contrast) : impression: no acute intracranial process. . ecg: sinus tachycardia @ 104. 1mm downsloping st depressions v4-v6 (new) brief hospital course: mr. is a 69 y.o. man with multiple myeloma and esrd on who presented with altered mental status and was found to have a right upper lobe pneumonia and hypercalcemia. . # rul pneumonia. the patient was found to have a right upper lobe pneumonia on ct scan. he was treated with vancomycin, zosyn, and azithromycin for hospital acquired pna. he was hypoxic on admission. his o2 requirement worsened in the setting of volume overload. pt had rigors and low grade temps on hd2. blood and sputum cultures were negative. a bronchoscopy was performed on and the bal was negative. he was discharged breathing comfortably on room air. . # hypercalcemia/ altered mental status: the patient's altered mental status likely due to a combination of his infection (pneumonia) and metabolic derangements (hypercalcemia). the patient's hypercalcemia was thought to be secondary to his multiple myeloma. he has been on weekly pamidronate. he was treated with pamidronate, calcitionin, decadron, and to decrease his calcium level. . # right back pain: the patient developed excruciating right back pain during this admission. multiple imaging modalities were negative for any pathological fractures, but there was a question of left sided ilio-psoas bursitis which did not correlate with his clinical presentation. his pain was managed with dilaudid throughout his admission. he was transitioned to oral dilaudid prior to discharge. . # end-stage disease: the patient is on hd with esrd secondary to his multiple myeloma. the team was consulted and the patient was treated with hd during this hospitalization. the patient is basically anuric so his hypercalcemia and volume status was dependent on hd. the patient had to undergo hd daily in order to manage his hypercalcemia. . # pancytopenia: the patient was supported with blood transfusions during this hospitalization. he was transfused to keep his hematocrit greater than 25. he also receives epogen at . . # atrial fibrillation: the patient has been anticoagulated for paroxsymal atrial fibrillation. he was in sinus rhythm on admission. the patient was supratherapeutic on admission. his inr was 6.0. he was reversed with vitamin k and anticoagulation was held as patient was thought to be at high risk of bleeding given his likely uremic platelets. of note, the patient had a history of pe in , but completed a 6 month treatment course with warfarin and repeat cta was negative for residual clot. it was decided that the risks of anticoagulation outweigh the benefits at this point and it was discontinued. . # hypertension: the patient's antihypertensive medications were initially held due concern that he might be developing sepsis physiology; however, he developed htn with sbp 200. his metoprolol was restarted and he was treated with hydralazine iv prn. . # st depressions: the patient was noted to have st depressions on ekg most likely secondary to demand ischemia. he did not have any symptoms of chest pain or pressure. his troponin was elevated in the setting of failure and missed , but his ck was flat. . # multiple myeloma: the patient has end stage multiple myeloma. his was treated with cytoxan on in an effort to help control his disease and hypercalcemia. he was started on rituxan as an inpatient and will follow-up with dr. (oncology) for further treatment. orthopedic oncology was consulted and it was determined that no intervention for his back pain would be indicated at this time. medications on admission: albuterol inhaler - 1-2 puffs q4-6h prn allopurinol - 100 mg every other day b complex-vitamin c-folic acid caps] - 1 mg capsule daily calcitonin 200 unit/dose aerosol, spray - epogen - 10,000 unit/ml daily fexofenadine 60 mg daily folic acid - 1 mg daily lactulose - 10 gram/15 ml solution - one tsp po daily prn constipation metoprolol 100mg tid midodrine 2.5 mg po 20 minutes prior to the end of pantoprazole - 40 mg po daily sevelamer - 1600 mg tid with meals trazodone 50mg po qhs bactrim 400mg-80mg, 1 tab daily warfarin 4mg daily acetaminophen prn b12 1000mcg po daily benadryl 25mg iv during hd ferrous sulfate 325 mg (65 mg iron) po daily discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. epoetin alfa 10,000 unit/ml solution sig: one (1) injection injection asdir (as directed): given at hd. 3. metoprolol tartrate 100 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 4. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). disp:*15 tablet(s)* refills:*2* 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. cyanocobalamin 100 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. fexofenadine 60 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. capsule(s) 12. renagel 800 mg tablet sig: two (2) tablet po three times a day. disp:*180 tablet(s)* refills:*2* 13. 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* 14. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 * refills:*0* 15. dilaudid 2 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain. tablet(s) discharge disposition: extended care facility: of discharge diagnosis: right upper lobe and aspiration pneumonia, hypercalcemia of malignancy secondary diagnoses: - esrd on tuesday/thursday/saturday - depression/anxiety - multiple myeloma - history of pulmonary embolus - hyperlipidemia - diverticulosis - h. pylori gastritis - paroxysmal atrial fibrillation discharge condition: stable, afebrile, no oxygen requirement, ambulatory discharge instructions: you were admitted to hospital with confusion, increased calcium levels, and a right upper lobe pneumonia. your confusion was caused by the combination of your pneumonia and increased calcium levels. your high calcium was treated with , pamidronate, calcitonin, and dexamethasone. you also completed a course of antibiotics for your pneumonia. please follow-up with your outpatient with dr. and for . please seek medical care if you experience any concerning symptoms including , chills, night sweats, pain not responsive to medication, difficulty breathing, or chest pain. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: please follow-up with all of your outpatient listed below: 1. provider: , schedule unit date/time: 12:00 2. provider: , md phone: date/time: 11:30 provider: , : date/time: 11:30 md procedure: hemodialysis closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified end stage renal disease other pulmonary insufficiency, not elsewhere classified atrial fibrillation depressive disorder, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia anxiety state, unspecified pneumonitis due to inhalation of food or vomitus multiple myeloma, without mention of having achieved remission personal history of venous thrombosis and embolism personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hypoxemia backache, unspecified other pulmonary embolism and infarction diverticulosis of colon (without mention of hemorrhage) hypercalcemia neoplasm related pain (acute) (chronic) other specified gastritis, without mention of hemorrhage 

Answer: The patient is high likely exposed to