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: generalized swelling and respiratory discomfort major surgical or invasive procedure: intubation extubation history of present illness: cc: admitted to micu for hyponatremia, called out to the floor , back to micu for altered mental status, respiratory stress and fever . hpi please see the micu note for more details. briefly, mr. is a 69 yo man with hx of schizophrenia, copd, prostate ca on suppresive therapy since , cryptogenic cirrhosis, large ingunoscrotal hernia, and long-standing scrotal edema who presented from his group home with increased le and scrotal and was admitted to micu for hyponatremia on . hyponatremia improved with lasix diuresis and he was sent to the floor the next day . he was doing well for the next 2 days but then was found to minimally responsive, obtunded, febrile and hypoxic to the 70s (came back to low 90s on nrb) when he was receiving an infusion of albumin, so he was transfered back to the micu on for hypoxia and altered mental status. . on transfer to micu on , he was noted to be obtunded with thick secretions. his o2 requirement escalated to 100% nrb to maintain sats in the high 80s. abg at that point showed respiratory acidosis with hypercarbia and the decision was made to intubate him for hypoxic/hypercarbic respiratory failure. pt was successfully extubated on , and has been requiring 4-6 liters of o2 since. . sputum culture grew streptococcus pneumoniae on . pt was bronched on which revealed thick plugs throughout right airways with purulent drainage distally; bal and washings were sent but no microorg seen on gram stain or in culture. . currently, pt complains of some shortness of breath on 5 liters of oxygen. no chest pain or palpitations. no pain anywhere. he is complaining of increased lower extremity edema, and said his scrotal edema has been stable for many years. past medical history: - schizophrenia (followed by psychiatrist ) - prostate ca on lupron since - anemia of chronic disease with macrocytosis. - cryptogenic cirrhosis, followed by the liver center until recently, but he no longer wishes to see hepatology. it is thought to be probably secondary to prior alcohol abuse. appt w/ dr made for thurs - copd - obesity - prostate cancer - compression fracture status post vertebroplasty. - very large inguinoscrotal hernia, for which he has deferred surgery. (loops of bowel are in his scrotum) - pyruvate kinase deficiency - splenomegaly - status post cholecystectomy social history: lives at a group home for his schizophrenia () which has help daily, but not at night. ex-wife is still quite involved. smokes 1 ppd for "a long time". denies alcohol use, but past history of alcohol use is noted. denies other drugs. family history: he has 4 sisters that he does not keep in regular contact with. unsure of what his parents died from. physical exam: admission physical exam: vitals: t: 98.4 bp: 119/50 p: 96 r: 18 o2: 91% on 4l nc general: alert, oriented, no acute distress heent: sclera mildly icteric, mmm, oropharynx clear neck: supple, jvp 10 cm, no lad lungs: diminished breath sounds bilaterally, also with wheezes, but without rales or ronchi. cv: regular rate with frequent premature beats, no murmurs, rubs, gallops abdomen: soft, non-tender, obese, bowel sounds present, no rebound tenderness or guarding, no organomegaly noted. large umbilical hernia, easily reducible. gu: extensive scrotal swelling to the size of a basketball ext: warm, well perfused, 2+ dp pulses palpated through edema, 3+ edema to mid thigh and extensive scrotal edema as above. physical exam on transfer: vitals: t: 98.3 bp: 106/71 p: 85 r: 15 o2: 93 on 5l fm general: nad, fm in place, alert and oriented x3 heent: sclera mildly icteric, mmm neck: supple lungs: diminished breath sounds bilaterally, mild wheezing and crackles in the bases bilaterally cv: rrr, normal s1, s2, no murmurs, rubs, gallops abdomen: large umbilical hernia, easily reducible. normoactive bowel sounds. soft, non-tender, no rebound tenderness or guarding, no organomegaly noted. gu: extensive scrotal swelling. ext: wwp, 2+ edema to knee level with b/l lower extremity erythema. 2+ dp and pt pulses palpated through edema pertinent results: chemistries: 11:30am glucose-108* urea n-9 creat-0.7 sodium-118* potassium-4.6 chloride-82* total co2-31 anion gap-10 05:46pm glucose-107* urea n-9 creat-0.8 sodium-122* potassium-4.3 chloride-86* total co2-31 anion gap-9 11:10pm sodium-120* 11:30am albumin-3.7 11:30am probnp-2207* 11:30am lipase-20 11:30am alt(sgpt)-18 ast(sgot)-30 alk phos-79 tot bili-3.5* 11:31am lactate-0.9 05:46pm cortisol-13.3 05:46pm tsh-0.89 hematology: 11:30am wbc-7.7 rbc-3.32* hgb-11.4* hct-33.4* mcv-101* mch-34.4* mchc-34.3 rdw-17.3* 11:30am neuts-86.4* lymphs-8.1* monos-4.7 eos-0.4 basos-0.3 11:30am plt count-247 05:46pm pt-13.5* ptt-28.0 inr(pt)-1.2* urine studies: 01:25pm urine hours-random urea n-355 creat-67 sodium-15 chloride-24 01:25pm urine osmolal-282 01:25pm urine color-amber appear-clear sp -1.010 01:25pm urine blood-sm nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-4* ph-6.5 leuk-neg ct abd/pelv: impression: 1. no hyperenhancing hepatic mass. 2. findings consistent with cirrhosis and portal hypertension, as described above. 3. stable left adrenal nodule, likely a fat-containing adrenal nodule. 4. stable diffuse right adrenal thickening, likely related to hyperplasia. cxr: impression: moderate new right sided pleural effusion and diffuse middle and lower lobe consolidation is most likely due a developing pneumonia secondary to aspiration with a diagnosis of assymetrical edema less likely brief hospital course: 69 yo man with hx of schizophrenia, copd, prostate ca, and cryptogenic cirrhosis presents with anasarca and profound scrotal edema. . pneumonia: patient was febrile with tachycardia and hypoxia on prompting transfer to the micu. patient with new infiltrates on cxr c/w pneumonia. he required intubation for hypoxic hypercarbic respiratory failure. he was started on vanc/zosyn/levo, and showed extensive mucous plugging which was cleared out with resolution of atelectasis and mediastinal shift. he was extubated after 2 days and quickly weaned to 4 l nc. evaluated by speech and swallow who recommended continuing po diet of thin liquids (single sips), regular solids, whole pills with puree, and strict aspiration precautions. vanc was discontinued on due to concern for leukopenia and as mrsa screen negative. he completed an 8-day course of cefepime for hospital acquired v. aspiration pneumonia on . . lower extremity edema: likely related to liver cirrhosis. bnp elevated at 2207 but no evidence of pulmonary edema. echocardiogram showed moderate pulmonary systolic hypertension which could be an etiology of right sided failure. he has known cryptogenic cirrhosis (unclear etiology) which could lead to elevated portal pressures. dopper ultrasound without evidence of portal/splenic venous thrombosis. lower extremity ultrasounds negative for dvt. tsh and cortisol are within normal limits. albumin is also within normal limits. fena of 0.1% in the setting of total body volume overload favors cardiac or liver etiology. ct abd without hepatoma. micu had held further diuresis, this was changed to 40mg po lasix daily and 100mg spironolactone daily on the floors for goal negative 0.5 to 1 liter daily. strict i's and o's were measured and daily weights were followed. he diuresed well, leg edema markedly improved upon discharge. his weights trended as follows: 90.2kg--> 89kg--> 88.2kg - aldactone 50 mg daily given evidence of cirrhosis . hyponatremia: hypervolemic as above. urine na of 15 and fena of 0.1% on presentation suggesting cirrhosis as etiology. psychiatric medications also can cause hyponatremia including risperdal. this started to resolve with lasix diuresis and fluid restriction. on the floor, we monitored strict i's and o's and conducted free h2o restrict to 1.5 l. scrotal edema: patient with knowed inguinoscrotal hernia for which he has refused surgery in the past. there are loops of bowel herniating into his scrotum. rn and aides at group home, edema is much worse over past several days. hx of prostate ca on lupron therapy. scrotal u/s with large free fluid. urology placed foley catheter without difficulty. foley was d/c on and pt was voiding well on his own. ***would readdress inguinal hernia repair when acute issues stable; has refused in past . leukopenic: slowly declining wbc count thought to antibiotics. vanc discontinued. has a macrocytic anemia but b12 and folate levels were checked on discharge which were wnl. . schizophrenia: currently appears appropriate although slightly tangential during interview. - received risperdol consta dose on (q2 week dosing) - continue ativan hs . will need risperdal consta on (sees for psych) copd: severe by pfts in with fev1 33% and fvc 51% of predicted - continue spiriva and advair discus - albuterol nebs prn **would recommend getting outpatient pft's to assess changes in pulmonary function and home oxygen requirement. **would strongly encourage smoking cessation especially given home o2. . s/p vertebral fracture: currently without pain. - continue vit d/calcium - fosamax dosing unknown gets it monthly . cryptogenic cirrhosis: previously followed at the liver center. likely thought to be due to etoh abuse in past. followed by liver team. - pt refusing liver f/u and screening egd at this time; cont to readdress - have scheduled appointment w/ dr in liver clinic for 11:45 am on thursday . . fen: no ivf, replete electrolytes, regular diet with fluid restriction 1.5 l . prophylaxis: subutaneous heparin access: picc code: dnr but okay to re-intubate (discussed with patient and with hcp). followed by sw and palliative care. communication: patient, and hcp (h) (c), program rn medications on admission: mvi folate 1 mg daily thiamine 100 mg daily cogentin 1 mg hs vit d 400 mg caco3 500 mg senna prn spiriva 1 cap daily fosamax 70 mg qweek ativan 1 mg hs lupron q 3 months risperdol consta q2weeks (unknown when his last dose was) discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 2. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain/fever. 3. risperidone microspheres 37.5 mg/2 ml syringe sig: one (1) syringe intramuscular q2w (fr). 4. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 8. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 9. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). 10. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 11. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: disk with devices inhalation (2 times a day). 12. cogentin 1 mg/ml solution sig: one (1) injection at bedtime. disp:*30 * refills:*2* 13. folic acid 1 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 14. vitamin d 400 unit tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 15. calcium 500 500 mg (1,250 mg) tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 16. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. disp:*60 tablet(s)* refills:*2* 17. fosamax 70 mg tablet sig: one (1) tablet po once a week. disp:*5 tablet(s)* refills:*2* 18. ativan 1 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 19. lupron depot 7.5 mg syringe sig: one (1) intramuscular q3months. disp:*1 * refills:*2* 20. risperdal consta intramuscular 21. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours). discharge disposition: extended care facility: center discharge diagnosis: primary: anasarca, pneumonia, respiratory distress secondary: cryptogenic cirrhosis,schizophrenia, prostate cancer, pyruvate kinase deficiency discharge condition: stable he will need a less than 30 day stay at the skilled nursing facility discharge instructions: you were admitted to the hospital on with generalized body swelling. because your sodium got very low on you were transfered to the intesive care unit (icu). this improved with water pills (diuretics) so you went back to the floor the same day. you did well over the next 2 days, however you spiked a fever and your oxygen was low on . because of this you went back to the icu and had to have a breathing tube because you had a bacterial infection in your lungs that made it hard for you to breathe. you got antibiotics, did well and the tube came out on . you were monitored in the intesive care unit did well, and went back to the medicine floor on where you were stable. you had one episode of low oxygen on the night of . you continued to do well on the general medical floors, where we diuresed you (gave you water pills) to help decrease the swelling in your legs. you did very well with the diuresis so we discharged you to a skilled nursing facility on . please return to the hospital if you have any of the following symptoms: crushing chest pain, severe shortness of breath, fevers/chills, intractable nausea and/or vomiting, and blood in your stool or urine. . your medications have changed as follows: 1. furosemide (lasix) 40mg po once daily 2. spironolactone 100mg po once daily our diuresis plan is as follows: daily spironolactone and lasix (hold if sbp <100) for a goal of -0.5 to -1 l daily. strict i's and o's and daily weights. followup instructions: - f/u in liver clinic w/ dr. on thursday at 11:45 am please call them if you need to cancel or reschedule ( -will need risperdal consta im on fri dose unknown) procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified anemia of other chronic disease cirrhosis of liver without mention of alcohol hyposmolality and/or hyponatremia portal hypertension chronic airway obstruction, not elsewhere classified pulmonary collapse acute respiratory failure malignant neoplasm of prostate edema schizophrenic disorders, residual type, chronic edema of male genital organs other hemolytic anemias due to enzyme deficiency 

Answer: The patient is high likely exposed to