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: none history of present illness: this is a 71 with history of perianal mucinous adenocarcinoma currently receiving radiation therapy with concurrent 5-fu for 3 days (2-26-2/28) who presented to his radiation appointment today with shortness of breath and was referred to the ed out of concern for pe. the patient reports gradually worsening sob since friday with sob now occuring at rest. he denies any assoicated chest pain, n/v palpitations, pnd, orthopnea, pedal edema or calf pain. he denies any recent cough, nasal congestion, sore throat. he denies any recent fevers but does report +chills x 4 days. patient reports no other symptoms aside from his sob. . in the ed: temp 98.4, bp 97/70, hr 103, rr 20, 100% 3lnc. labs notable for k 6.3. ekg with peaked t waves. he was given kayexalate 30gm po x 1, insulin 10u iv x 1 and d50 1 amp iv x 1. given ckd, cta was not performed. lenis were done and were negative. v/q scan was ordered but not performed prior to patient leaving the ed. patient was admitted to the medical floor for further management. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations. denies cough, nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. denies rashes or skin breakdown. no numbness/tingling in extremities. no feelings of depression or anxiety. all other review of systems negative. past medical history: past oncologic history: perianal mucinous adenocarcinoma currently receiving radiation therapy, s/p concurrent 5-fu for 3 days (2-26-2/28) . other past medical history: ckd iv- s/p transplant with course c/b membranous gn and possible acute rejection due to med non-compliance esrd s/p renal transplant secondary to htn, glomerulonephritis in hypertension hyperlipidemia genital hsv-2 (penile) in s/p acyclovir gout gi bleed secondary to gastric ulcer in recent enterococcal bacteremia treated with social history: denies tobacco, etoh or illicit drug use. from , married but separated from his wife, lives with his son. family history: mother has . brother has diabetes and gout. there is no family history of any renal failure, diabetes, or any coronary artery disease. physical exam: gen: nad, tachpneic but answering question in complete sentences, no accessory muscle use vs: temp 95.3, bp 144/70, hr 106, rr 24 100% 2lnc heent: ncat, eomi, perrla, op clear, mmm cv: +s1/s2, ii/vi sem heard best in lusb, no r/g pulm: ctab, no wheezes crackles or ronchi abd: +bs, nt/nd limbs: no c/c/e, + 2 distal pulses skin: no rashes . on discharge vitals: 98.4 119/62 72 18 100%ra pain: denies access: picc, rue gen: nad heent: o/p clear, mmm cv: rrr, no m resp: ctab, no crackles or wheezing abd; soft, nontender, +bs ext; no edema neuro: a&ox3, nonfocal, mild baseline tremor skin: improving swelling and bruising of rue, lue old fistula w/o thrill psych: appropriate pertinent results: wbc 3.8 (baseline)-->1.6 with 63%n hgb 11 (baseline)--> stable (s/p 1u prbc) plt 174->102 (b/l wnl) inr 1.3 chem: k 6.2->4.7 bicarb 8->32 after bicarb drip-->19 off gtt bun/creat 38/2.5 (baseline creat 3s) tacro 5.6 albumin 4.3 ast/alt 77/206-->54/158, alkphos and t.bili wnl . ua negative blood cx x2 ntd . . . . imaging/results: cxr: r base calcified granuloma, old . le dopplers : no dvt b/l le brief hospital course: 71year old male with h/o esrd htn vs chronic gn, s/p kidney transplant in , in found to have membranous gn (unclear or recurrent) in the background of acute cellular rejection with new baseline cr 3's, pud, recently diagnosed anal adenocarcinoma currenlty receiving radiation therapy with concurrent 5-fu for 3 days (2-26-2/28) who presented to his radiation appointment on and reported progressive shortness of breath x4days. he denied any assoicated chest pain, palpitations, pnd, orthopnea, pedal edema or calf pain. he denies any recent cough, nasal congestion, sore throat. no obvious bleeding. . initially admitted to onc service. concern was for pe and pt awaiting v/q scan. on labs, noted to have bicarb of 8, nongap met acidosis, so resp distress likely tachypnea from compensation. so v/q scan defered, lenis negative. access was difficult so pt t/f to micu given severe acidosis. in micu on , bicarb gtt x12hours with correction of acidosis (bicarb 8->32) as well as resp distress. taken off bicarb gtt on prior to transfer to floor. seen by renal who felt that the metabolic acidosis and hyperk is rta iv on top of ckd iv. he was followed over next two days off gtt just on home nabicarb 1300mg tid. his bicarb slowly downtrended from 32 to 19. his previous baseline bicarb was around 20s so it is unclear why he dropped so much this time and whether this will reccur. only new med from last admission was acyclovir for genital herpes, but there are no reports of this causing metabolic acidosis so renal felt okay to resume on d/c so pt could complete course. renal reccommended increasing nabicarb to 3tabs tid. they will follow up bicarb levels. pt did very well ever since his bicarb was initially corrected with drip. other issues: also had severe hyper k to 6.2 with peaked twaves on admission, which improved with kayexalate, insulin/d50. bactrim resumed, k was stable. ace-i not resumed. for access issues rue midline placed on and was d/c'd prior to d/c. was noted to have r arm swelling but no dvt noted by ir at time of midline placement, and this was improving at time of discharge. he continued to get his xrt per schedule while here. he developed pancytopenia, with lowest wbc 1.6 (63%n) and hgb . we gave him 1u prbc while here. however, we did not give him neupogen but the oncology service was notified of dropping counts. his plt count was around 100s. he was discharged in good condition with onc/transplant f/u on and pcp f/u on . he has home vna for pt and nursing but he is fairly independent. . see progress note below for details: . 71year old male with h/o esrd htn vs chronic gn, s/p kidney transplant in , in found to have membranous gn (unclear or recurrent) in the background of acute cellular rejection with new baseline cr 3's, pud, recently diagnosed anal adenocarcinoma currenlty receiving radiation therapy with concurrent 5-fu for 3 days (2-26-2/28) who presented to his radiation appointment on and reported progressive shortness of breath x4days. found to have severe metabolic acidosis, which has been corrected, with improvement in his symptoms. short icu stay for access issues. . severe nongap metabolic acidosis: possbile type iv rta/hypoaldo on top of ckd. unclear why he had acute drop given his baseline bicarb is 20s while on nabicarb tabs. bicarb 8->32 with bicarb gtt with improvement in symptoms of sob-->19 today -continue to monitor bicarb trend off gtt -increase nabicarb 650mg to 3tabs tid -only new med since last admission is acyclovir. pt has new lft elevation as well as acidosis. however, renal does not feel this is the cause and are okay with resuming acyclovir to complete course -f/u renal/transplant on -okay with them to cont tacro/bactrim . pancytopenia: likely 5-fu. wbc 1.6, anc barely 1000 -follow closely -may need neutropenic precautions if anc<1000, have notified onc of this . anemia: current drop hct bm suppression from chemo. no obvious bleeding. s/p 1u prbc , hgb stable today (all counts dropping) -fe supp -epo mwf . dyspnea: no hypoxia. likley hypervent as compensation for ma. has chronic mild dyspnea, stable, good o2 sats. -defer v/q scan. le dopplers neg. . ckd iv s/p renal transplant: baseline creat 3s chronic gn vs allograft nephropathy -cont tacro (follow levels) and mmf at home doses -have set up appt with dr. on -bactrim ss . hsv-2 genital infection: -recently started on acyclovir on , completed on 6/14days before admission -renal okay with resuming this and completing course. . hyperk: may be part of rta/hypoaldo. improved with medical management. -cont holding ace-i. bactrim okay per renal. . rue swelling: started 2days ago. went to ir for picc this am and they did not mention thrombus (wouldnt have placed line if this was the case). -improving . htn: -lopressor, norvasc at home doses . bph: tamsulosin 0.8mg qd . perianal mucionus adenoca s/p chemo with 5fu/xrt: no acute issues, monitor pancytopenia -getting xrt per schedule -cont megestrol -cont zofran -has f/u with dr. on . pud: ppi and sucralafate. gib . current anemia likely chemo. . dispo/code: full code. wife . medications on admission: tamsulosin 0.8 mg po hs tacrolimus 2 mg po twice a day. mmf 500mg metoprolol tartrate 25 mg po once ferrous sulfate 300 mg po bid megestrol 400 mg/10 ml (625) ml po daily pantoprazole 40 mg po q12h sucralfate 1 gram po qid sodium bicarbonate 1300 mg po three times a day. amlodipine 10 mg po once a day. sulfamethoxazole-trimethoprim 400-80 mg po daily epoetin alfa 4,000 unit/ml one (1) ml injection qmowefr zofran odt 8 mg po every eight (8) hours as needed for nausea. compazine 10 mg po every six (6) hours as needed for nausea. discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain/fever. 2. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po hs (at bedtime). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 4. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 5. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 6. ondansetron 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po bid (2 times a day). 11. megace oral 400 mg/10 ml (40 mg/ml) suspension sig: 625mg po once a day: resume your previous dose. 12. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 13. ferrous gluconate 325 mg tablet sig: one (1) tablet po twice a day: resume your previus dose. 14. sodium bicarbonate 650 mg tablet sig: three (3) tablet po three times a day: higher dose. 15. tacrolimus 1 mg capsule sig: two (2) capsule po q12h (every 12 hours). 16. acyclovir 800 mg tablet sig: one (1) tablet po three times a day for 7 days: complete your previous 14day course. discharge disposition: home with service facility: homecare discharge diagnosis: severe nongap metabolic acidosis leading to resp distress/sob from compensation ckd iv after renal transplant, stable hyperkalemia, resolved genital herpes infection anemia, s/p 1u prbc anal adenoca s/p 5fu, undergoing xrt discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: you were admitted with respiratory distress/shortness of breath. this was due to your blood being very acidic. this is caused by your kidney failure. we gave you some medicine to fix this and your symptoms improved. you will go home on a higher dose of your sodium bicarb tablets,take 3tabs three times a day instead of two. you will have follow up with nephrology to follow these levels. . also while here, you continued to get your radiation therapy. . also, your anemia level was low again and we gave you a unit of blood as reccommended by your oncologist. . your medications are otherwise kept the same. your acyclovir was held while you were here. please complete the remaining 8 or so days of therapy for your herpes infection. followup instructions: department: transplant when: monday at 2:40 pm with: , md building: lm campus: west best parking: garage name: , l. when: tuesday, , 2:40pm location: address: , , phone: department: hematology/oncology when: monday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: monday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: monday at 12:00 pm with: , rn building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified other radiotherapeutic procedure diagnoses: acidosis hyperpotassemia chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified other and unspecified hyperlipidemia antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use kidney replaced by transplant genital herpes, unspecified other specified aplastic anemias malignant neoplasm of anus, unspecified site mineralocorticoid deficiency 

Answer: The patient is high likely exposed to