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: acute renal failure major surgical or invasive procedure: none history of present illness: 69 yr/o m who has received little previous medical care until one month ago when he was diagnosed on with liver mets indicative of diffuse metastatic disease - primary unknown. he had presented to his pcp with weight loss, jaundic, constipation, and anorexia of recent onset and pcp found and elevated tbili leading to u/s and ct which showed hepatic mets and biliary dilation. pt was referred to for ercp on which showed 1cm stricture of malignant appearance. a plastic biliary stent was placed (11cm by 10fr cotton- biliary stent) and obtained cytology was negative. pt was discharge home on 5 days of cipro. cr 0.9, tbili 32.8, alt 212, ast 198, and alk phos 868 at time of discharge. after this stent pt reported no improvement in his symptoms with persisting jaundice, constipation, and anorexia. pt returned for other ercp on as he was having increase in lfts. another stent was placed, this time a metal stent (no records in omr). old plastic stent sent for cytology and found to be negative for malignant cells. since pt with generalized weakness and jaundice. today he presented to hospital complaining of nausea. he was afebrile but appeared sob although pt states he does not feel sob. his bp showed systolics in the 70-80s and he was given an initial 60cc bolus followed by multiple 250cc boluses. lungs were clear and sating 99% on ra. at he was afebrile with elevated wbc, bun, and cr. a foley was placed but only drained 75 cc of urine. ct abd/pelvis showed narrowed stent. small ascites. he was given a dose of daptomycin and ertapenem at hospital before transfer. . on the floor, at presentation t 98.6 / bp 103/66 / hr 75 / rr 19 / sat 97% on ra. pt describes and confirms above report of history with some additions. . review of systems: (+) per hpi and the following: mild ha that started today. mild cough for the last 2-3 days productive of occasional clear sputum. pt also reports mild abdominal discomfort diffusely over the last few days along with continued abd pain as noted above. pt denied any melana or brbpr but also states that he is color blind and might not be able to note such a change in stool color. . (-) denies fever, chills, denies rhinorrhea or congestion. denies shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations. denies vomiting, diarrhea. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: none until recent liver troubles. never really went to a doctor until the last month. never has been hospitalized before and no previous surgeries. social history: married but does not live with wife (?estranged but still married). lives with son and daughter in law and wife has separate home. before last month was very active and worked as trophy maker. distant tob use for 10-15yrs in his 20s-30s. occasional pipe use since that time. current etoh is 2-3 beers/day after work - none in last few weeks. used higher amounts in the distant past >6 beers day most days. no ivdu/illicit drug use now or in the past. family history: father died of some heart disease in his 60-70s. mom is alive in her 90s. three siblings alive with no health problems. physical exam: t 98.6 / bp 103/66 / hr 75 / rr 19 / sat 97% on ra general: alert, oriented, no acute distress, obviously icteric skin heent: sclera icteric, slightly dry mm, oropharynx clear neck: supple, no jvd, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: soft hs, regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, mild tenderness, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place draining small amount of bronze urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: yellow throughout, reddish birthmark on r shoulder, some reddish discoloration under r elbow psych/neuro: limited work use, uses humor in conversation, appears to minimalize complaints, a&ox3, no asterixis, no focal deficits pertinent results: 05:09pm wbc-30.9*# rbc-2.29*# hgb-7.8*# hct-21.1*# mcv-92 mch-34.1* mchc-37.0* rdw-19.1* 05:09pm neuts-80* bands-2 lymphs-5* monos-10 eos-0 basos-0 atyps-0 metas-2* myelos-1* nuc rbcs-3* 05:09pm pt-18.2* ptt-43.0* inr(pt)-1.6* 05:00pm lactate-2.3* 05:09pm albumin-2.0* calcium-7.1* phosphate-8.0* magnesium-3.4* 05:09pm alt(sgpt)-235* ast(sgot)-494* ld(ldh)-1395* ck(cpk)-316 alk phos-852* tot bili-38.8* 05:09pm lipase-70* 05:09pm glucose-66* urea n-149* creat-7.2*# sodium-132* potassium-5.0 chloride-97 total co2-14* anion gap-26* cxr cardiac size is normal. the aorta is elongated. there are low lung volumes. opacities in the right perihilar and right lower lobe regions could be atelectasis but early infection cannot be totally excluded and followup is recommended. minimally atelectasis is in the left base. there is no pneumothorax or pleural effusion. ruq us impression: 1. markedly abnormal liver with multiple ill-defined masses throughout. markedly dilated intrahepatic ducts within the left lobe of the liver. moderate intrahepatic biliary dilatation in the right lobe of the liver. 2. common bile duct stent seen and appears similar in configuration to the recent ercp of , with an area of focal narrowing in the upper aspect of the stent. 3. small amount of ascites, mainly over the right lobe of the liver and also small amount seen within the left upper quadrant. 4. normal-appearing kidneys bilaterally with no evidence of hydronephrosis. mri abdomen w/o contrast 1. multifocal intrahepatic duct diatation with proximal dominant strictures due to innumerable hepatic lesions in segments 2 and . 2. severe pancreatitis. 3. asymmetric thickening of right lateral wall of distal esophagus with upper esophageal dilatation. brief hospital course: mr. is a 69 year-old gentleman with limited past medical history who was recently diagnosed with metastatic cancer to the liver from unknown primary and now s/p to ercps with 2 stent placements in the last 10 days presenting with elevated bili, hypotension, and acute renal failure. #. liver metastases from unknown primary: causing acute liver failure with jaundice/icterus, encephalopathy, ascites, coagulopathy, poor liver synthetic function. the thickening of the esophagus seen on mri may represent a possible primary, but patient's family declined further workup. given the extent of his disease, including end-organ failure and lack of treatment options, the patient's family elected to make him comfort measures only. he denied pain throughout admission, but was encephalopathic. at first he was treated with lactulose for encephalopathy, but after discussions with the family, all meds were stopped except for medications for comfort/pain relief. he was discharged to family hospice home. #. acute renal failure: renal service was consulted; the exact etiology of his acute kidney injury was unclear. possibly atn related to meds or contrast, pre-renal state vs hepatorenal syndrome. ct at hospital showed no evidence of hydronephrosis or obstructive process. his renal function continued to decline but he did not require dialysis; his family decided that even if it was indicated, he would not undergo hemodialysis. he was made cmo, and nephrotoxic agents were held but no futher intervention was taken. at the time of discharge he was anuric. #. hypotension: bps low at and dipping down to systolics of 80-90s on presentation to . likely some element from anemia (see below) but might have also been related to hypovolemia due to poor po intake over last two weeks or secondary to sepsis with a very elevated wbc. he was responsive to initial fluid boluses but remained hypotensive at discharge to hospice. # anemia: without obvious source of bleeding. he was initially transfused and workup pursued, but when he was made cmo, he received no further interventions. #. leukocytosis: etiologies that were considered include cholangitis, uti (in the setting of arf, though urine culture was negative), pneumonia (though cxr was unconvincing). arrived from on daptomycin and ertapenem, and he was switched to vanc and unasyn. these were discontinued when his goals of care were changed. medications on admission: none discharge medications: 1. morphine sulfate 2-4 mg iv q2h:prn dyscomfort sob 2. lorazepam 0.5-2 mg iv q4h:prn agitation discharge disposition: extended care facility: family hospice house discharge diagnosis: metastatic cancer to liver, unknown primary acute liver failure acute renal failure discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were transferred from another hospital for worsening kidney function. you also had worsening liver function and you had test that showed large amount of tumor in your liver compressing your liver drainage system. it is unclear what the primary tumor is that caused the metastasis. since we cannot offer curative or even palliative therapy for your disease, you and your family have elected for comfort measures only status. you are being discharged to hospice. . we have made the following changes to your medications: -stop all prior medications -start morphine and lorazepam as needed for pain/discomfort followup instructions: you will be seen by healthcare professionals at the hospice center. procedure: endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct diagnoses: anemia, unspecified malignant neoplasm of liver, secondary acute kidney failure with lesion of tubular necrosis acute and subacute necrosis of liver unspecified septicemia severe sepsis other ascites hepatic encephalopathy hypovolemia cholangitis obstruction of bile duct other malignant neoplasm without specification of site leukocytosis, unspecified malignant neoplasm of other specified part of esophagus congenital factor xi deficiency 

Answer: The patient is high likely exposed to