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: hypotension, fever to 101 major surgical or invasive procedure: femoral central line history of present illness: 78 yo man c pmh of chronic liver disease, hepatoma s/p x 2, copd, afib on coumadin, was in his usoh until am when he began having chills, rigors and was febrile at home to 101, per pt. he went to ed were he was found to be hypotensive bp in low 70 s. pt denies having: cough, sob, dysuria, urinary frequency, diarrhea, abdominal pain, n/v, night sweats, anorexia. last bm was yesterday. at : levaquin, 3 l ns, dopamine 5 mcg/min. pt arrived to ed c bp in near 120/48 hr 80-90s. dopamine drip was stopped. however pt was noticed to have refractory hypotension and started on levophed again. in the ed, he received iv vanco, levoflox, ffp and ns ivf at 100cc/hour. . his micu course: the pt was on vanc, levo, flagyl in the unit. panculture negative to date. cxr without infiltrates. abd u/s negative for cholecystitis. abdominal ct to r/o new liver abscess considering pt's pmh was negative. vancomycin was tapered off (received 4 days). iv levoflox and flagyl were continued. pt was also on steroids for bronchospasm, copd in micu, and received prednisone 60mg po qd in the unit, with bronchodilators. he is satting 99-100% on 2l nc (his baseline oxygen requirement). initially, his inr was supratherapeutic to 4.9, so coumadin was held initially. coumadin was restarted for goal inr . his foley was d/c'd and he continues to urinate well. he is tolerating a regular diet, taking all meds orally. past medical history: -afib for many years on coumadin -htn -copd -hepatocellular carcinoma and cirrhosis s/p surgery x 2, dx'd 2 years ago, folloed by dr. at . pt has hx of liver abscess s/p second . -prosthetic rigtht eye s/p hsv and subsequent enucleation -stent in pancreas for mass and h/o obstructive jaundice -sarcoidosis s/p lung biopsy on right -h/o right temporal infarct subtherapeutic inr, afib by mri, -h/o splenic infarct thought subtherapeutic inr, afib -last echo : ef 55%, mod-markedly dil atria b/l. dil rv with free wall hypokinesis, rv pressure overload, 1+mr, 4+tr, severe pulm artery htn, cardiologist at is dr. , dry weight 162 lbs. social history: the patient lives at home with wife, independent in adls, has 2 daughters, originally from but here since , smoked 2ppd x 20 years quit 40 yrs ago, no etoh, no drugs. former construction worker for gas co. family history: the patient is one of 11 children. 2 brothers and 1 sister with strokes, brothers at ages 38 and 50. one brother with cancer. no seizures run in family. physical exam: physical exam on admission: vitals: 99.7 hr 90-110 afib, 88-96/58-70, 18, 95% 2 lt gen: no acute distress, pleasant elderly man skin: no rash , jaundiced : nc/at, anicteric sclera, mmm neck: supple, no meningismus , + jvp chest: normal respiratory pattern, cta bilat anteriorly , decreased breath sounds in both bases cv: irregular irregular rate, no murmurs abd: soft, nontender, nondistended, +bs, liver edge not palpable , no ascites. extrem: no edema, 1+ dorsalis pedis pulses, 2+ radial pulses . phys exam on call out from micu: vitals: tm: 96.8 tc: 96.6 bp: 111/64 (99-120/49-69) p: 81 rr: 19-25 o2sat: 98-100% on 2l nc. 24 hour i/o 3090/1310 +1780. 8 hour i/o: 1250/2365 -1115. general: well appearing cm in nad. pleasant and cooperative. sitting upright in chair talking with daughter. : right eye is prosthetic, left eye perrl, left eye eomi. no nasal discharge. mm slightly dry, op clear. poor dentition. jvd mid neck. no cervical lad. lungs: ctab cv: irregularly irregular rhythm. s1 and s2 audible. abd: soft, nt, nd, positive bs, no ascites. no hsm. ext: no peripheral edema. no cyanosis/clubbing. ext warm and well perfused. 2+ dp pulses b/l. pertinent results: 08:00pm wbc-12.2*# rbc-2.92* hgb-10.3* hct-29.8* mcv-102* mch-35.1* mchc-34.5 rdw-16.8* 08:00pm neuts-73* bands-11* lymphs-11* monos-3 eos-1 basos-0 atyps-0 metas-1* myelos-0 08:00pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-1+ microcyt-normal polychrom-normal 08:00pm plt count-163 07:45pm lactate-1.3 08:00pm pt-43.3* ptt-39.9* inr(pt)-4.9* . : cxr impression: cardiomegaly with congestive heart failure.bibasilar atelectasis with small bilateral pleural effusions. . : abdominal ultrasound impression: no evidence of acute cholecystitis or cholelithiasis. patchy areas of increased echogenicity in the right lobe of the liver likely representing changes associated with prior rf ablation. . ct torso impression: 1. bilateral predominantly peripheral ground glass opacities, which are new from the prior study. the etiology is uncertain, but differential diagnosis includes includes infectious or inflammatory process, cryptogenic organizing pneumonia, eosinophilic or hypersensitivity pneumonia and pulmonary edema superimposed on severe emphysema. clinical correlation and follow up if indicated is recommended. 2. stable renal cysts. 3. stable appearance of the radiofrequency ablations site. no evidence of abdominal abscess or pseudocyst. 4. peripheral high attenuation area transiently seen ?perfusion anomaly, as described. . culture data: blood cx x 4 neg blood cx x 4 neg urine cx no growth : ua neg nitr, neg leuks, 0-2 wbc, rbc, rare bact, 0-2 epi. . brief hospital course: 78 yo man with chronic liver disease, hepatoma s/p x 2, h/o liver abscess, copd, atrial fibrillation on coumadin admitted for fever and hypotension, thought to be septic secondary to unclear etiology-- cxr negative for infiltrate but with bilateral pleural effusions (effusions too small for a diagnostic thoracentesis), urinalysis negative, urine cx negative, blood cx x 4 negative. pt covered empirically x 4 days on vanco/levo/flagyl, d/c vanco , and continued levo/flagyl to complete 7 day course given history of liver abscess in past. . 1. hypotension, fever on admission thought to be septic-picture: with no clear source. however low bp, documented fever at osh, and hx of chills makes infection likely. pt started on levofloxacin + vanc in ed and on levophed trough peripheral iv. on vanc, levo, flagyl in the micu. panculture negative to date. cxr without infiltrates. abd u/s negative for cholecystitis. ct torso showing ground glass opacities in lungs inflamm vs. infectious, bilateral effusions too small to tap. no intraabd abscess. - plan to continue levo/flagyl for 2 more days to complete 7 day course given h/o liver abscess in past. . 2. cardiovascular: a. coronaries: no signs of ischemia on ekg, enzymes negative. aspirin was held and his beta blocker was continued. b. pump: no signs of ischemia on ekg or enzymes. getting 20mg iv lasix for diuresis, transitioned to 40mg po lasix on transfer to medical floor. of note, he usually gets 80mg po qd of lasix at home. last echo was showing ef 55%, severe pulm a htn, dil atria b/l, dilated right ventricle with pressure overload. on discharge, he is monitor his daily weight and call his pcp if his weight increases by 3 lbs or more, as this may indicate heart failure. c. rhythm: atrial fibrillation. he is to continue his beta blocker, atenolol, for rate control, and coumadin for anticoagulation. goal inr . the pt is at goal inr with 1mg coumadin po qday. . 3. copd: started prednisone 60mg qday for total of 5 days, which was completed during this hospitalization. he is to continue bronchodilators. pt satting well on 2l nc, his baseline oxygen requirement. he was satting well ambulating with physical therapy. . 4. gi: pt with hx of liver disease, hepatocellular carcinoma status post . lfts are elevated, afp high, however stable and trending downward. no abd pain, nausea, vomiting, diarrhea, constipation. no intraabdominal abscess was seen on ct abdomen. stable appearance of radiofrequency ablations site on ct abdomen. . 5. htn: pt's blood pressure has remained stable, he has not required pressors in over 48 hours, no fluids needed for past 24 hours. taking well po. restarted beta blocker and his with tight hold parameters. . 6. code: pt is full code. medications on admission: 1. aspirin 81 mg tablet 2. albuterol-ipratropium 103-18 mcg/actuation aerosol 3. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: 4. atenolol 25 mg tablet sig 5. losartan potassium 25 mg tablet sig: one (1) tablet po daily (daily). 6. warfarin sodium 1 mg tablet sig: one (1) tablet po once a day. 7. lt4 25 ug qd 8. lasix 20 qd discharge medications: 1. levothyroxine 25 mcg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*3* 2. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 days. disp:*2 tablet(s)* refills:*0* 4. warfarin 1 mg tablet sig: one (1) tablet po daily (daily): you will need to see dr. for refills and to monitor your inr lab values/adjust dose. . disp:*30 tablet(s)* refills:*0* 5. losartan 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. furosemide 40 mg tablet sig: two (2) tablet po daily (daily): you will need to follow up with dr. for refills, and to check your electrolytes. disp:*60 tablet(s)* refills:*0* 7. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 2 days. disp:*6 tablet(s)* refills:*0* 8. albuterol 90 mcg/actuation aerosol sig: two (2) puffs inhalation every 4-6 hours as needed for wheezing. disp:*1 mdi* refills:*2* 9. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). disp:*1 mdi* refills:*2* discharge disposition: home with service facility: home health care discharge diagnosis: 1. hypotension 2. atrial fibrillation 3. hypertension 4. chronic obstructive pulmonary disease 5. hepatocellular carcinoma 6. history of right temporal infarct 7. history of splenic infarct 8. history of sarcoidosis status post lung biopsy on the right 9. history of prosthetic right eye discharge condition: stable, good discharge instructions: if you experience fever, chills, chest pain, shortness of breath, abdominal pain, nausea, vomiting, please report to the emergency room immediately. please take all of your medications as prescribed. please follow up with your physician. information below. followup instructions: you have an appointment with dr. , 11:00am, , . please call her office at if you need to reschedule your appointment. procedure: venous catheterization, not elsewhere classified diagnoses: unspecified essential hypertension unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation septic shock malignant neoplasm of liver, primary 

Answer: The patient is high likely exposed to