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: quinolones attending: chief complaint: seizure major surgical or invasive procedure: 1. arterial line placed 2. bronchoscopy history of present illness: 63 yo m h/o hld, bph, etoh abuse, has had dry cough for several months. seen by ent at and dx with atrophic rhinitis. saw pcp who ordered chest xray. cxr suggestive of rml pna and possible post obstructive pna. patient was scheduled to have repeat imaging following the weekend however wife was concerned and brought him to ed for evaluation. repeat cxr today showed persistant rml opacity, c/f underlying mass. ct scan showed 3.6 cm in lungs and liver and osseus mets. in the ed, initial vs were: t98.8 p85 bp179/89 r18 o2 sat100%. patient was given ctx and levo for post obstructive pna. seen by in ed who informed patient and wife of possible cancer dx. patient was admitted to floor where he complained of rue pain before having a minute tonic/clonic seizure witness by his wife. a code blue was called. he did not recieve ativan or other anti-epiletics. his seizure resolved spontaneously. he was intubated for airway protection and taken for emergent head ct. . per report from his wife his pressure has been creeping up all day to the 160's sytolic. no reports of ha, dizzyness or other focal neurologic disorders. no nausea or vommiting. past medical history: right kidney cysts nephrolithiasis social history: - tobacco: former smoker - alcohol: history of etoh use. no recent use - illicits: unknown family history: his twin brother died of a coronary occlusion and his older brother died at age 38 of aids. his father died of coronary disease at age 58 and mother of breast cancer at age 84. physical exam: admission: initial icu admission physical exam: intubated, sedated. bp 116/66 hr 93 rr 18 99% o2 sat on psv 10/5 fio2 0.5 lungs clear anteriorly cv rrr distinct s1 and s2 abdomen soft, nontender extremities warm neuro exam not noted discharge physical exam vss lungs clear cv rrr no pronator drift ataxic gait mental status close to baseline. pertinent results: admission labs: 06:55pm glucose-94 urea n-22* creat-0.9 sodium-140 potassium-4.1 chloride-103 total co2-26 anion gap-15 06:55pm wbc-9.4 rbc-4.51* hgb-13.1* hct-37.7* mcv-84 mch-29.1 mchc-34.9 rdw-13.0 06:55pm neuts-62.0 lymphs-20.1 monos-8.6 eos-8.3* basos-0.9 06:55pm plt count-197 . discharge labs: 12:56pm wbc-19.2* rbc-4.71 hgb-13.8* hct-40.1 mcv-85 mch-29.3 mchc-34.4 rdw-13.3 plt ct-175 12:56pm plt ct-175 12:56pm glucose-145* urean-27* creat-1.1 na-139 k-3.9 cl-103 hco3-25 angap-15 12:56pm alt-44* ast-19 alkphos-154* totbili-0.5 . studies: . cxr : impression: persistent right middle lobe opacities. although the patient has not undergone interval treatment for pneumonia, per discussion with the referring physician, . , there is concern for underlying mass lesion. recommend ct for further evaluation. . ct chest : impression: 1. obstructing right middle lobe mass, with post-obstructive pneumonia and ipsilateral bronchovascular spread. 2. innumerable hepatic and osseous metastases. 3. suspicious 1.2-cm soft tissue nodule in the right upper renal pole. this constellation of findings is highly suggestive of stage iv metastatic lung cancer. . ctap : impression: 1. obstructing right middle lobe mass, with post-obstructive pneumonia and ipsilateral bronchovascular spread. 2. innumerable hepatic and osseous metastases. 3. suspicious 1.2-cm soft tissue nodule in the right upper renal pole. . mri : impression: findings are consistent with multiple brain metastases in the supra- and infratentorial region. mild surrounding edema seen. no midline shift or hydrocephalus. . bone scan : multiple increased areas of uptake in the spine, left shoulder, ribs and pelvis consistent with metastatic disease. . pathology: liver biopsy : needle biopsy of liver: hepatic parenchyma only. no metastatic carcinoma seen. liver biopsy : needle biopsy of liver: metastatic adenocarcinoma. tumor cells stain strongly and diffusely for ck7 and ttf1, very focally for ck20, and do not stain for ck5/6. the findings are consistent with a tumor of lung origin. also : fna, and touch prep of core, liver: positive for malignant cells, consistent with carcinoma. note: this is a non-small ccell carcinoma. the site of origin cannot be determined based on cytomorphology. see core biopsy s11- for further discussion. . eegs: : this is an abnormal continuous eeg due to the presence of a burst suppression pattern where the bursts consist of a mixed alpha/beta frequency activity seen with an anterior predominance. this pattern is suggestive of a spindle coma which may be secondary to medication effects (most commonly benzodiazepines, barbiturates, or tricyclics). alternatively, if seen after diffuse hypoxic injury, it portends an extremely poor prognosis. there were no focal abnormalities or epileptiform features seen. . :this is an abnormal continuous eeg due to the presence of prolonged periods of generalized, mixed theta and delta frequency slowing interrupted by occasional periods of alpha frequency activity with an anterior predominance. this pattern is suggestive of a moderate to severe diffuse encephalopathy commonly seen with medication effect, metabolic disturbance, or infection. compared to the previous tracing, the periods of mixed theta and delta slowing are more prolonged and frequent possibly consistent with a lightening of sedation effect. there are no focal abnormalities or epileptiform features seen. . : this is an abnormal 24-hour video eeg due to the slow and disorganized background of hz with bursts of generalized delta frequency slowing, indicative of a moderate encephalopathy. again seen were periods of generalized mixed alpha and beta frequency activity, which were far less prolonged and noticeable than the previous day's recording. these findings represent an improvement in the background compared to the previous day's recording. however, rare generalized sharp and slow wave discharges were seen and indicate generalized cortical irritability. no clear electrographic seizures were seen. . : this is an abnormal eeg telemetry due to the presence of a disorganized, mixed alpha and theta frequency background, alternating with periods of hz frontally predominant generalized detla slowing. this pattern is indicative of a moderate encephalopathy, commonly seen with medication effect, metabolic disturbance, or infection. in addition, the frequent periods of generalized rhythmic delta activity with embedded sharp waves are suggestive of a diffuse cortical irritability, these were less prominent than the previous day's recording. there were no definite electrographic seizures seen. . micro: bcx: negative bal: 12:21 pm bronchoalveolar lavage gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. respiratory culture (final ): no growth, <1000 cfu/ml. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. . sputum : gram stain (final ): pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs, chains, and clusters. 1+ (<1 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): sparse growth commensal respiratory flora. . pending tests: acid fast culture (preliminary): pending dilantin level brief hospital course: hospital course: mr. is a 63 yo man with prior history of etoh abuse and smoking, transferred from icu after admission to the medical service with pneumonia, and found to have a post obstructive pneumonia with a lung mass. ct also showed liver and osseous metastases. course complicated by a seizure on the floor, for which he was intubated for airway protection and transferred to the micu. brain mri showed brain metastases. he was loaded with phenytoin, as well as keppra and decadron. his course was also notable for an acute delirium, subsequently resolved. while hospitalized, he was seen by neurology, neuro-oncology, radiation oncology, and medical oncology. he was started on brain xrt and will follow up with oncology for chemotherapy initiation and discussion of further steps after discharge. . hospital course by problem: . # metastatic lung cancer: pt had mets suggested by ctap to liver & bone, and mets in brain by mri. liver biopsy was performed twice, with the second biopsy revealing metastatic lung cancer. bone scan revealed multiple areas of ossesous metastatic disease, including ribs, left shoulder, bilateral pelvis and spine. oncology was consulted and he will follow up with them as an outpatient (appt still pending) to discuss chemotherapy after his brain radiation is completed. neuro-oncology was involved by neuro and he will have repeat mri and neurology follow up in 1 month. . # seizure with brain metastases: he had a seizure shortly after presentation, and was seen by neurology. it was attributed to metastatic disease and lowered seizure threshhold due to florquinolone usage. he was treated with aed's, and neurology was consulted. pt had ct head demonstrating vasogenic edema. mri brain showed brain metastases. he appeared to be seizing on keppra on hod#1. keppra was increased; he was loaded with dilantin & started on decadron for edema. an eeg was placed and showed high cortical irritability but no further seizures. pt was weaned off propofol and maintained on antiepileptics. after discharge from the icu, he had no further seizure activity. he was seen by radiation oncology and underwent whole brain radiation starting on without complications. he will have a total of 10 treatments. given prolonged decadron treatment, he was started on a ppi, bactrim tiw, calcium and vitamin d. he was discharged on keppra 1500 mg po bid . # acute respiratory distress: intubated for airway protection in setting of seizures. vent was kept overnight given need to ensure adequate antiepileptic coverage prior to discontinuation of propofol. pt was extubated on without complication. . # post obstructive pneumonia: as suggested by ct. pt with recent reported fevers, but only low grade temps in micu. he was placed on vanc/zosyn for coverage. he was treated for 8 days, with no fevers. cultures were negative. . # acute delirium. while in the icu, he developed an acute delirium after extubation. he slowly cleared and returned to his baseline. the cause was likely multifactorial with infection, steroids, and icu-related. . # lactic acidosis: most likley etiology is to seizure. as above, possibly also related to lung source; however lactate quickly came down once aeds started and treated with ivf's. pt was ruled-out for mi with serial cardiac enzymes. lactic acidosis resolved. . # steroid induced hyperglycemia: he was started on iss as on decadron, and then transitioned to po glipizide, with glucometer monitoring. he will have vna teaching regarding glucose testing in the next 2 days. . outstanding tests at discharge: dilantin level pending afb culture pending . transitional issues: 1. oncology follow up: he will need oncology follow up in the next 2 weeks after completing radiation. 2. home services: he will have home pt as well as home nursing services. medications on admission: lipitor 10mg flomax discharge medications: 1. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). disp:*30 tablet(s)* refills:*1* 2. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 3. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 4. dexamethasone 4 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*0* 5. phenytoin 50 mg tablet, chewable sig: two (2) tablet, chewable po tid (3 times a day). disp:*180 tablet, chewable(s)* refills:*1* 6. levetiracetam 750 mg tablet sig: two (2) tablet po twice a day. disp:*120 tablet(s)* refills:*1* 7. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 8. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 9. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever, pain. 10. glipizide 5 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*1* 11. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*1* 12. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. disp:*30 tablet(s)* refills:*0* 13. glucometer check sugar twice daily, first thing in the morning and then before dinner. dispense #1 no refills. 14. lancets use as directed to test sugar. dispense: 1 month's supply 1 refill 15. test strips use as directed, twice daily. dispense #100 1 refill discharge disposition: home with service facility: vna discharge diagnosis: seizure post obstructive pneumonia metastatic lung cancer acute delirium gait instability discharge condition: ataxic gait, some slowed responses, requires walker for ambulation discharge instructions: you were admitted with a cough, and then subsequently had a seizure. the evaluation that we did found metastatic cancer originating in your lungs, and also in your bones, liver and brain. you started on radiation therapy for your brain metastases, and will follow up with the oncologists in the next few weeks to discuss chemotherapy. as your gait remains unsteady, you should have someone within you whenever possible, and use a walker to walk with. . your sugar is high due to the steroids. you should check your sugar twice a day and keep track. the visiting nurses will teach you how to use the glucometer machine. do not worry about it until tomorrow. . new medications: start decadron 4 mg po every 6 hours (brain swelling) start keppra 1500 mg twice daily (seizures) start phenytoin 100 mg three times daily (seizures) start sulfameth/trimethoprim ds 1 tab 3x/week (mo,we,fr) (infection reduction) start calcium carbonate 500 mg po/ng tid (bones) start vitamin d 800 unit po/ng daily (bones) start prilosec 20 mg po daily (ulcer prevention) start trazodone 50 mg po qhs (sleep) start glyburide 2.5 mg po twice daily. (high sugars) start tylenol 500 mg 1-2 tabs, up to 4 tablets per day, for pain followup instructions: radiation therapy - monday, 9am . department: internal medicine when: monday at 9:45 am with: , md building: lm campus: west best parking: garage location: -division of hematology/oncology address: , 9, , phone: we are working on a follow up appointment with hematology/omcology within 1 week. you will be called at home with the appointment. if you have not heard from the office within 2 days or have any questions, please call the number above. department: radiology when: monday at 1:55 pm with: radiology mri building: campus: east best parking: garage department: neurology when: monday at 3:30 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver arterial catheterization closed [endoscopic] biopsy of bronchus other radiotherapeutic procedure diagnoses: pneumonia, organism unspecified acidosis anemia, unspecified malignant neoplasm of liver, secondary adrenal cortical steroids causing adverse effects in therapeutic use other pulmonary insufficiency, not elsewhere classified other convulsions hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia secondary malignant neoplasm of brain and spinal cord cerebral edema delirium due to conditions classified elsewhere secondary malignant neoplasm of bone and bone marrow malignant neoplasm of middle lobe, bronchus or lung other abnormal glucose nonspecific low blood pressure reading 

Answer: The patient is high likely exposed to