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: no known allergies / adverse drug reactions attending: chief complaint: hypotension, low hct major surgical or invasive procedure: egd ir embolization history of present illness: this is a 66 yo male with h/o metastatic bladder ca to liver, lung on chemo who originally presented on from clinic with hypotension and hct of 17. pt was having episodes of syncope at home and some abdominal pain, went to his outpt oncologist's office for chemotherapy (c1d8 gemcitabine/cisplatin) where he was noted to have a bp of 75/56 and hct was 17 and thus pt was sent to the ed. in the , pt was given ivf, started on blood transfusions. ct abd showed pneumobilia cholecystoenteric fistula. pt was admitted to sicu for further management. though surgery was initially considered, it was determined that pt is not a surgical candidate. pt has remained hemodynamically stable, not requiring pressors. pt has been continuously transfused with goal hct>30. gi has been following who performed an egd which showed ulcers in stomach and duodenal bulb as well as a larger ulcerated region at the junction of duodenal bulb and second part of duodenum on the posterior wall of the duodenum with adherent clot, suggestive of possible tumor eroding the small bowel wall. per gi recs, pt was continued on ppi gtt and blood transfusions. since, pt continued to bleed, pt underwent an ir procedure today, where no active bleeding was seen and the gastroduodenal artery was embolized. pt continues to get supportive care with transfusions. currently, hct is 21.2 and getting 2u prbcs. . upon arrival to the micu, pt is comfortable in bed. endorses some mild pain in abdomen, but much better from admission. denies n/v. states he continues to have dark red stools. denies chest pain. denies dysuria. admits to occasional shortness of breath but denies fevers or cough. . ros: per hpi, endorses 20 lb weight loss in last 6 months. endorses syncopal episodes at home prior to admission. has. past medical history: oncologic history: - pt referred to dr for microscopic hematuria, found to have abnormal digital rectal exam with nodularity adjacent to the right prostate and the right seminal vesicle - cystoscopy showed normal bladder mucosa except for >2 cm calculus protruding from a diverticulum between the right urothelial orifice and bladder neck. - prostate biopsy showed invasive high-grade carcinoma involving the prostatic stroma and extraprostatic adipose tissue, one core showed prostatic adenocarcinoma, score 3+3. - cystoprostatectomy and ileal conduit.the final pathology examination showed invasive urothelial (transitional cell) carcinoma arising from the bladder diverticulum and extending into the perivesicular adipose tissue, prostate gland and right seminal vesicle. the tumor greatest dimension was 5.5 cm, high-grade, pt4a; two of the five regional lymph nodes were positive for metastasis (pn2), the margins were uninvolved by carcinoma, but there was extensive lymphovascular invasion and perineural invasion. a 3+3 adenocarcinoma of the prostate was identified, as well. other medical history: 1. nephrolithiasis 2. peripheral vascular disease 3. depression/anxiety social history: smoked 1/2-1 ppd for 50 years, quit recently. denies etoh (used to drink 2 drinks per day prior to bladder ca diagnosis) or drugs. family history: father died of colon cancer at age 60. mother with breast cancer at age s/p lumpectomy. one sister who died in her late 20s of ovarian cancer. physical exam: vs: temp: 96.8 bp: 118/63 hr: 94 rr: 22 o2sat 99% on ra gen: pale, weak, nad heent: perrl, eomi, pale conjunctivae, op clear resp: ctab with good air movement throughout cv: rrr, no m/r/g abd: soft, mild diffuse ttp in abdomen ext: no c/c/e neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits. pertinent results: 05:47am blood hct-22.5* 02:00am blood wbc-4.3 rbc-2.85*# hgb-8.9*# hct-24.4* mcv-86 mch-31.1 mchc-36.3* rdw-14.9 plt ct-96* 10:14pm blood hct-26.7*# 05:06pm blood hct-20.9* 02:10pm blood hct-26.3* 09:27am blood wbc-4.8 rbc-4.15*# hgb-12.2*# hct-34.0*# mcv-82 mch-29.3 mchc-35.8* rdw-14.7 plt ct-109* 03:41am blood wbc-5.1 rbc-2.61* hgb-7.7*# hct-21.3* mcv-82 mch-29.7 mchc-36.3* rdw-14.0 plt ct-80* 08:39pm blood hct-21.2* 03:53pm blood hct-22.4* plt ct-145*# 08:26am blood hct-22.8* plt ct-70* 01:45am blood wbc-10.0 rbc-3.38*# hgb-10.3*# hct-28.5* mcv-84 mch-30.6 mchc-36.3* rdw-14.3 plt ct-63* 11:01pm blood hct-29.6*# 07:15pm blood hct-22.3* 01:44pm blood hct-21.4* 07:23am blood hct-28.3* 03:59am blood hct-28.9*# 10:45pm blood wbc-11.5* rbc-2.65* hgb-7.9* hct-22.0* mcv-83 mch-29.9 mchc-36.1* rdw-15.2 plt ct-108* 06:15pm blood wbc-8.8 rbc-2.68*# hgb-8.0*# hct-22.5*# mcv-84 mch-29.7 mchc-35.5* rdw-14.7 plt ct-105* 12:25pm blood wbc-8.9 rbc-1.98* hgb-5.9* hct-17.1* mcv-86 mch-29.8 mchc-34.5 rdw-14.4 plt ct-124* 10:46am blood wbc-10.4# rbc-2.30*# hgb-6.6*# hct-20.6*# mcv-90 mch-28.7 mchc-32.1 rdw-14.1 plt ct-154# 09:27am blood pt-15.1* ptt-24.5 inr(pt)-1.3* 03:41am blood pt-19.9* ptt-27.1 inr(pt)-1.8* 01:45am blood pt-15.0* ptt-22.7 inr(pt)-1.3* 03:59am blood pt-13.7* ptt-23.5 inr(pt)-1.2* 12:25pm blood pt-13.4 ptt-19.6* inr(pt)-1.1 03:59am blood fibrino-515* 02:00am blood glucose-623* urean-63* creat-1.6* na-134 k-3.9 cl-110* hco3-16* angap-12 03:41am blood glucose-212* urean-72* creat-1.7* na-148* k-4.5 cl-120* hco3-19* angap-14 01:45am blood glucose-114* urean-66* creat-1.3* na-146* k-4.2 cl-116* hco3-21* angap-13 03:59am blood glucose-112* urean-59* creat-1.3* na-140 k-3.3 cl-108 hco3-22 angap-13 10:46am blood urean-65* creat-1.6* na-130* k-4.1 cl-91* hco3-29 angap-14 03:41am blood alt-14 ast-18 ld(ldh)-153 alkphos-28* totbili-0.5 10:46am blood alt-30 ast-26 ld(ldh)-128 alkphos-79 totbili-0.4 dirbili-0.2 indbili-0.2 02:00am blood calcium-5.5* phos-3.8 mg-1.6 03:41am blood calcium-6.1* phos-4.8* mg-2.0 01:45am blood calcium-7.0* phos-4.5 mg-2.4 03:59am blood calcium-7.0* phos-3.6 mg-1.9 10:46am blood albumin-2.7* mg-2.1 10:46am blood hapto-357* 06:27pm blood lactate-1.0 12:44pm blood lactate-2.4* micro: mrsa screen mrsa screen-final inpatient blood culture blood culture, routine-pending imaging/studies: cxr: impression: relatively stable examination. the patient has diffuse nodules presumably from metastatic disease. conceivably, there could be early consolidation of the right lower lung; however, the increased opacity is felt more likely due to differences in technique, inspiratory effort, and resultant ronchovascular crowding. ct head: impression: no acute intracranial process. ct abd/pelvis: impression: 1. likely fistulous communication between the first portion of the duodenum and the gallbladder which may be from ulceration or inflammation of previously seen duodenal diverticulum. high-density material within the gallbladder lumen likely represents clot/blood. 2. bilateral moderate-to-severe hydronephrosis, left worse than right. the right hydronephrosis is new since , although the cause of the new-onset hydronephrosis not appreciated on this study. 3. multiple pulmonary metastases as described on prior studies. 4. multiple intramuscular metastases as described above. 5. extensive diverticulosis. mesenteric angiogram with embolization of gda gi bleed study: impression: bleeding in the region of duodenum, presumably in the gda territory. mesenteric angiogram brief hospital course: this is a 66 yo male with h/o metastatic bladder ca to liver, lung on chemo who originally presented on from clinic with hypotension and hct of 17, has been in sicu getting blood transfusions, then transferred to micu for further management as pt is not a surgical candidate. . # goals of care: on admission, pt was full code. pt was deemed not a surgical candidate by surgery. pt was dnr/dni at time of transfer to the micu. ir performed ir embolizations with no success in stabilizing the bleeding. as the pt continued to bleed, it was then decided by him and his family that he would be cmo. sw and palliative care teans were involved. pt was started on a morphine gtt for comfort and the pt passed in early hours of . . # anemia: pt not a surgical candidate. continued to require blood transfusions. pt was s/p ir embolization of the gastroduodenal artery on . however, continued to require transfusions and shows active bleeding. pt was continued on ppi gtt. per ir recs, pt underwent a tagged rbc scan which showed active bleeding in gda territory and pt underwent ir embolization again on . however, as pt continud to bleed, pt and his family decided to change his goals of care to comfort measures only. nsaids and asa were held. . # metastatic bladder cancer/cholecystoenteric fistula: pt was maintained on unasyn to cover any possible gi infections. pain was controlled with dilaudid prn. pt's outpt oncologist dr. was following closely. sw and palliative care were consulted to help pt and his family with end of life issues. . # pvd: home asa and statin were held. . # depression/anxiety: home citalopram was held. ativan prn was used for anxiety. . pt was initially npo at mn for possible interventions then allowed to eat when became cmo. pt was on pneumoboots for dvt ppx. medications on admission: aprepitant - 125 mg (1)-80 mg (1)-80 mg (1) capsule, dose pack - 1 capsule(s) by mouth daily the day of chemotherapy and the following 2 days citalopram - 10 mg tablet - 1 tablet(s) by mouth daily dexamethasone - 4 mg tablet - 1 tablet(s) by mouth every twelve (12) hours x 2 days after chemotherapy lorazepam - 0.5 mg tablet - tablet(s) by mouth daily as needed for anxiety or nausea lovastatin - 20 mg tablet - 1 tablet(s) by mouth once a day ondansetron - 8 mg tablet, rapid dissolve - 1 tablet(s) by mouth twice daily x2 days after chemo and as needed afterward prochlorperazine maleate - 10 mg tablet - 1 tablet(s) by mouth every six (6) hours as needed for nausea aspirin - 81 mg tablet - 1 tablet(s) by mouth once a day docusate sodium - 100 mg capsule - 1 capsule(s) by mouth twice a day as needed for constipation take this while taking narcotic pain medication, stop if you develop diarrhea polyethylene glycol 3350 - (prescribed by other provider) - dosage uncertain discharge medications: n/a discharge disposition: expired discharge diagnosis: metastatic prostate ca discharge condition: n/a discharge instructions: n/a followup instructions: n/a procedure: other endoscopy of small intestine arteriography of other intra-abdominal arteries transcatheter embolization for gastric or duodenal bleeding diagnoses: malignant neoplasm of liver, secondary acute posthemorrhagic anemia acute kidney failure, unspecified dysthymic disorder hypotension, unspecified personal history of malignant neoplasm of bladder chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction secondary malignant neoplasm of lung chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction hydronephrosis fistula of gallbladder 

Answer: The patient is high likely exposed to