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: reglan / seroquel attending: chief complaint: shortness of breath major surgical or invasive procedure: peritoneal dialysis history of present illness: 44 yo m w/ pmh of metastatic testicular germinoma, pckd on pd, b/l pe, presents with sob. pt was driving with his wife to for an appointment when he began to develop rapid shallow breathing and felt short of breath. the patient was unable to alleviate his shortness of breath and felt it was progressively getting worse over 45 minutes. he denied cp, dizziness, palpitations, loss of conscious. he drove into the garage where ems was called and he was taken to the ed. he reports altering his peritoneal dialysis protocol over the past couple days so that he was retaining fluid, rather than removing fluid. . in the ed he was satting 80% on nrb. he was put on bipap with satts improving to mid-90s. his cxr showed vol overload. pro bnp >70,000, wbc 12.9 wihtout bandemia, lactate 5.7, inr 3.4. he was given iv lasix and started on nitro drip. he was off bipap and was put on o2 by nc. his satts were 99%/6l. he also received iv ctx and iv levoflox x 1. past medical history: metastatic testicular ca, germinoma, s/p 40 rounds chemo, carboplatin and ifoosfamide. pckd on pd pe, bilateral, s/p peritoneal biopsy dm hypertension secondary hyperthyroidism renal transplant x2, , hyperlipidemia appendectomy s/p mvc social history: social history: quit smoking 5 yr back. smoked 1 ppd x 20 yrs, no alcohol x past 13 yrs, occa etoh before that, no drug use. family history: non-contributory physical exam: 96.2 100 138/99 22 100/5l nc gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, op without lesions neck: no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules. central line in place for administering chemo resp: bibasilar crackles cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly. pd cath in place ext: b/l 2+ edema, warm, good pulses skin: no rashes/no jaundice neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. no pass-pointing on finger to nose. pertinent results: wbc-12.9* rbc-3.26* hgb-10.8* hct-35.7* mcv-110* mch-33.1* mchc-30.3* rdw-18.4* plt ct-257 neuts-65.8 lymphs-28.2 monos-2.6 eos-2.5 baso-0.9 pt-32.7* ptt-31.5 inr(pt)-3.4* glucose-234* urean-36* creat-13.0* na-139 k-4.6 cl-98 hco3-25 angap-21* alt-12 ast-19 alkphos-57 amylase-39 totbili-0.3 12:35pm blood ctropnt-0.10*ck(cpk)-48 ck-mb-4 ctropnt-0.14* ck(cpk)-34* 04:24am blood ck-mb-4 ctropnt-0.12* ck(cpk)-30* 12:35pm blood albumin-3.2* calcium-9.4 phos-4.7* mg-2.2 06:25am blood probnp- >70,000 chest (portable ap) 12:43 pm findings: upright portable ap chest radiograph obtained. right ij central line is seen with its tip in the proximate location of the superior vena cava. the heart appears enlarged. low lung volume somewhat limit evaluation, as does patient motion. there is, however prominence of pulmonary vasculature, with indistinct pulmonary hila. findings are compatible with congestive heart failure. there may be right basilar atelectasis and small effusion. no pneumothorax. mediastinal contour is unremarkable. impression: right ij central line in acceptable position. cardiomegaly, congestive heart failure. echo: the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. there is moderate to severe global left ventricular hypokinesis (lvef = 25-30 %). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: borderline left ventricular cavity dilation with moderate to severe global hypokinesis c/w diffuse process (toxin, metabolic, cannot exclude multivessel cad). dilated thoracic aorta. brief hospital course: a/p: 44 yo m w/ pmh of metastatic testicular ca, pckd on pd, pe p/w pulm edema in the setting of volume overload from inappropriate . . #sob: the patient's cxr showed bilateral infiltrates. this was likely in the setting of improper peritoneal dialysis. he was initially in the icu on nitro gtt until his pd could be restarted. once his pd was restarted, greater than 3l fluid was removed in 24 hrs with marked improvement of his respiratory status. he was initally on bipap very shortly, and was then o2 by nc. prior to transfer to the floor, the patient was satting >95% on ra. the patient was given nebs, but did not require them prior to discharge any longer. he had bnp>70,000 even at the time of discharge. this could have been due to chf exacerbation vs volume overload from lack of pd. an echo showed an ef of 25-30%, though this could be depressed with massive volume overload from lack of pd. he should have a repeat echo as an outpt by his pcp once his volume status is back to his baseline. . # pckd: pt has h/o pckd and is on pd chronically. he had stopped doing his pd properly prior to coming to for his appt which probably led to his volume overload. the patient understands that he needs to keep up with his pd. during this hospitalization, the patient was followed by renal and he was restarted on his pd with a concentrated dialysate. he will need to continue that regimen for more days after discharge, and he will f/u with clinic the afternoon of his discharge to get the supplies he needs. he has an outpatient nephrologist in that he follows regularly with. . # cad: the patient has no past h/o cad. he presented with trop of 0.1 with sr cr of 13. ekg showed diffuse twi. no st changes. he had no prior available to compare. he was chest pain free during this hospitaliziation. a discussion of ace and asa was done with the patient. he will bring these up with his pcp since he is on neither of these medications with a h/o diabetes and a low ef. . # htn/tachycardia: he will continue his outpatient metoprolol dose. . # dm: the pt had h/o dm. at home he is on actos and amaryl. he was on iss during this hospitalization, but was restarted on his home medications at discharge. . # testicular cancer: the patient was in for a df cancer appt which he did not make given that he was unable to breathe and presented to ed. he has had many rounds of chemotherapy in the past. he will need to f/u with his oncologist for further followup. medications on admission: actos 15mg po qd dulcolax 100mg capsule po qd iron 325 mg po qd phoslo 1334 po tid famotidine 40mg po qd sensipar 60mg po qd glimepride 2mg po qd metoprolol 25mg po bid prednisone 5mg po qd alprazolam .5mg po hs:prn nasonex 50mcg suspension 2 sprays each nostril qd coumadin 3.5mg po qd procrit 24,000 units injection, qmwf. discharge medications: 1. actos 15 mg tablet sig: one (1) tablet po once a day. 2. dulcolax stool softener 100 mg capsule sig: one (1) capsule po once a day. 3. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 4. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 5. famotidine 40 mg tablet sig: one (1) tablet po once a day. 6. sensipar 60 mg tablet sig: one (1) tablet po once a day. 7. glimepiride 2 mg tablet sig: one (1) tablet po once a day. 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po twice a day. 9. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 10. alprazolam 0.25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for insomnia. 11. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily): each nostril. 12. warfarin 1 mg tablet sig: 3.5 tablets po qd (). 13. procrit 20,000 unit/ml solution sig: () units injection qmon/wed/fri. 14. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. cyanocobalamin 50 mcg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 16. peritoneal dialysis please go to your clinic for dialysis as scheduled. continue using 4.25 dextrose dialysate for more days and followup with your clinic 17. echocardiogram outpatient repeat echocardiogram- discuss with your pcp 18. outpatient lab work repeat cbc by your pcp discharge disposition: home discharge diagnosis: primary diagnosis: volume overload secondary to renal disease polycystic kidney disease on peritoneal dialysis secondary diagnoses: hypertension diabetes testicular cancer/germinoma history of bilateral pulmonary embolisms hyperlipidemia discharge condition: stable, good o2 sats on room air, ambulating without difficulty discharge instructions: you were admitted for difficulty breathing. you were found to have lots of excessive fluids. this was likely due to improper peritoneal dialysis. you were initally in the icu, and once your dialysis was restarted, your breathing improved quickly. you also had an echocardiogram (ultrasound of the heart) which showed some decreased functioning of your heart. you should have discussions with your pcp regarding repeating that test now that most of the fluid is off. . please take all medications as prescribed. please keep all of your scheduled appointments. please continue with your peritnoeal dialysis as instructed. you will need another days of 4.25 dextrose dialysate pd to help remove some more fluid. after discharge, please go to your clinic to ensure you get the proper supplies. . if you develop any of the following concerning symptoms, please call your pcp or go to the ed: chest pains, shortness of breath, nausea, vomiting, fevers, or chills. followup instructions: please call your pcp . tray to schedule an appointment within the next week. please discuss with him about repeating an echocardiogram, possibly a stress test, and whether starting an aspirin or ace-inhibitor is appropriate. , multispecialty grp, , ct . please call your oncologist to schedule an appointment and to repeat your cbc (cell counts) procedure: peritoneal dialysis diagnoses: end stage renal disease obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of anticoagulants personal history of venous thrombosis and embolism secondary hyperparathyroidism (of renal origin) mechanical complication due to peritoneal dialysis catheter acute systolic heart failure other malignant neoplasm without specification of site complications of transplanted kidney malignant neoplasm of other and unspecified testis 

Answer: The patient is high likely exposed to