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: dyspnea major surgical or invasive procedure: thoracocentesis, pleuredesis, thoracoscopy history of present illness: pgy-1 accept note spoke with admitting moonlighter and confirmed relevant apsects of hpi and pmh with pt., as outlined in the excellent admit note. in brief, mr. is a 47yo with metastatic rcc who has failed sugen and most recently 1 month of sorafenib therapy that was discontinued increased left sided pain, constipation, general fatigue. he continued to feel worse, with increased dyspnea, first on exertion then at rest. over the last week, he has also developed increasing abdominal girth which he attributes to gas, and bilateral le edema, which he has never had before. ct in ed showed increased interval increase in size of metastatic lesions, r sided pleural effusion, and new ascites. he was tapped 2.5l of serosanguinous fluid, exudative by light's criteria, likely malignant. post-thoracentesis cxr still shows nearly complete white out of l lung field. currently, pt. states he feels much better than last night. he denies, cp, ha, confusion, nausea currently. did have some diarrhea o/n yesterday, likely kayexylate and po contrast. he does state he is thirsty. past medical history: metastatic rcc as noted in oncologic history cad s/p cabg htn hypercholesterolemia dvts social history: lives upstairs from mother, divorced with 3 children, girlfriend , + , no etoh family history: nc physical exam: afebrile o/n now t: 96.2 bp: 109/85 hr: 110, rr:20 02 sat 96% on 4l gen: tired, ill appearing man, breathing comfortably, no retractions, able to speak full sentences. heent: anicteric, perrla, eomi, mmm, op clear neck: supple, no cv:: tachycardic, occ. s3 vs. split s2, no murmurs, rubs chest: absent bs on l from posterior, dull to percussion to lung. wheezes, crackles at apex anteriorly. r side clear without wheezes, crackles abd:: soft, moderately distended, no focal ttp, though has some gneralized discomfort when palpated. + bs. able to faintly palpate mass vs. spleen in his mid/left abdomen. liver span wnl. ext: 2+ pitting edema to knees bilaterally, r>l edema, no calf tenderness. pertinent results: 04:30pm calcium-8.8 04:30pm lipase-37 04:30pm alt(sgpt)-188* ast(sgot)-90* alk phos-423* amylase-29 tot bili-0.3 04:30pm glucose-100 urea n-41* creat-1.1 sodium-120* potassium-6.3* chloride-94* total co2-20* anion gap-12 04:39pm hgb-13.2* calchct-40 04:39pm k+-5.8* 08:28pm pt-12.8 ptt-22.1 inr(pt)-1.1 08:28pm plt smr-low plt count-120* 08:28pm neuts-89* bands-4 lymphs-2* monos-2 eos-0 basos-0 atyps-0 metas-3* myelos-0 08:28pm wbc-7.4 rbc-3.99* hgb-12.2* hct-34.6* mcv-87 mch-30.5 mchc-35.2* rdw-19.2* 08:28pm lipase-37 08:28pm alt(sgpt)-186* ast(sgot)-95* amylase-28 tot bili-0.3 08:28pm glucose-87 urea n-37* creat-1.0 sodium-123* potassium-6.5* chloride-91* total co2-22 anion gap-17 08:29pm na+-122* k+-6.2* 03:56am blood wbc-7.5 rbc-2.97* hgb-9.0* hct-26.9* mcv-90 mch-30.2 mchc-33.4 rdw-19.4* plt ct-112* 04:00am blood fibrino-604* d-dimer-5305* 03:56am blood glucose-111* urean-76* creat-2.7* na-130* k-5.6* cl-100 hco3-17* angap-19 03:56am blood calcium-8.0* phos-5.6* mg-2.4 11:16am blood lactate-1.3 . ct torso: ct chest with iv contrast: there is a markedly enlarged left pleural effusion occupying the majority of the left hemithorax, causing shift of the mediastinum rightward. this limits detailed evaluation of mediastinal lymph nodes. the heart is normal in size. the great vessel are grossly unremarkable. there is compression of the distal left pulmonary arterial vasculature given large left pleural effusion. there is a large pericardial lymph node, increased in size compared to prior study, today measuring 21 mm in shortest axis, previously 8 mm. ct abdomen with contrast: the liver is unremarkable. the gallbladder is within normal limits. the pancreas appears stable. surrounding the pancreas are multiple metastatic lesions also encasing the celiac axis, sma and periportal regions which overall appears increased in size and extent compared to . there is no overt demonstration of vascular occlusion. patient is status post left nephrectomy. the left adrenal lesion previously seen today appears slightly larger in size and little more hypovascular, which could represent necrotic change of a metastatic lesion. the left retroperitoneal aggregate of soft tissue density consistent with metastatic mass is similar in size today, measuring 81 x 53 mm, previously 86 x 45 mm. the retroperitoneal lymphadenopathy extending along the course of nearly the entire aorta is also similar in size. there has been interval new development of a small-to-moderate amount of ascites. ct pelvis with iv contrast: the urinary bladder wall is slightly thickened, as demonstrated on prior studies. there are multiple inguinal and iliac enlarged lymph nodes, with similar appearance in size compared to . the rectum, sigmoid colon, prostate are unremarkable. bone windows: there are mixed sclerotic and lytic changes seen within the l4 vertebral body, similar in appearance compared to prior study, concerning for metastatic focus. there are no new suspicious lytic or sclerotic bony lesions. impression: 1. large dense left pleural effusion with significant rightward shift of the mediastinum. these findings were discussed with dr. at 10:00 p.m. on . 2. interval progression of metastatic disease manifested by a large left pleural effusion and new-onset ascites. 3. overall, slight interval increase in size of soft tissue metastatic lesions within the chest, abdomen, and pelvis. . bilateral le, no signs of dvt brief hospital course: patient is a 47 yo male who was initially admitted with worsening shortness of breath. he was first admitted to medical services and then after repeat thoracentesis and pleuradesis on with prolonged hypotension he was transferred to the icu. icu issues included hypotension, hyponatremia and thrombocytopenia as well as management of pleural effusions. hypotension was managed with fluid boluses, hyponatremia improved with saline. thrombocytopenia was thought secondary to splenic squestration as hit antibodies were negative. patient was maintained on a chest tube post procedure with continued output until it was self-discontinued. despite medical management, the patient continued to have dyspnea as well as poor liver and kidney function and worsening of mental status. given that the ct done on showed significant worsening of his metastatic disease and that the patient had failed multiple chemotherapeutic regimens, the decision was made to direct the care towards comfort after discussions with family and the patient. patient was being screened for hospice care and palliative care had been consulted. however, patient deceased in hospital on . medications on admission: sutent 50mg (off since ) zofran 8mg q8h oxycontin 60mg oxycodone 5mg q6hprn neurontin 400mg dilaudid 4mg q6h dexamethasone 4mg tid zestril 10mg zocor discharge medications: none discharge disposition: home with service discharge diagnosis: metastatic renal carcinoma discharge condition: deceased discharge instructions: deceased followup instructions: n/a procedure: insertion of intercostal catheter for drainage other pleural biopsy injection into thoracic cavity diagnoses: acute kidney failure, unspecified secondary malignant neoplasm of pleura malignant neoplasm of kidney, except pelvis other disorders of neurohypophysis 

Answer: The patient is high likely exposed to