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: history of present illness: the patient is a 77-year-old gentleman with renal cell carcinoma originally diagnosed in . the patient had bilateral partial nephrectomies at that time for chromophobe oocytic component tumor (grade ii to iii) with 4.5 cm skin size with capillary penetration but negative margins. cancer was quiescent until two months ago when metastases were noted in the patient's lungs. the patient presents with progressive dyspnea on exertion over the past two weeks and an oxygen saturation in the 80s on the day of admission at his oncologist's office. prior oxygen saturation in had been 99%. as noted, a chest x-ray in showed hilar lymphadenopathy and a bronchoscopy with biopsy showed metastatic renal cell carcinoma. the patient denies fevers, chills, nausea, vomiting, chest pain, and palpitations. the patient has had a chronic cough for months which has been intermittently productive of yellow and green sputum. the patient has complained of anorexia over the past several weeks. the patient notes orthopnea requiring him to sleep on two pillows, but no paroxysmal nocturnal dyspnea. the patient went to his oncologist on for an appointment and had low oxygen saturations to 83% and was sent to the emergency department. in the emergency department, the patient responded to 3 liters of oxygen with oxygen saturations coming up to 92% but had an increasing oxygen requirement. the patient was seen by the primary medicine team at 4 a.m. and was short of breath on 100% nonrebreather but was mentating well. an arterial blood gas at that time revealed ph was 7.56, pco2 was 38, and po2 was 38. the patient was transferred to the medical intensive care unit for further evaluation. the chest x-ray on admission was consistent with congestive heart failure with small bilateral pleural effusions. the patient's last dialysis had been on . past medical history: 1. renal cell carcinoma diagnosed in with bilateral partial nephrectomies; chromophobe oocytic component tumor (grade ii to iii); 4.5 cm; capillary penetration; and negative margins. the patient has been on dialysis since . 2. paroxysmal atrial fibrillation. 3. hypertension. 4. coronary artery disease with a myocardial infarction in and a normal echocardiogram in . 5. seizure disorder (however the patient is no longer on dilantin). 6. history of transient ischemic attacks. 7. vascular dementia. 8. gout. 9. history of gastrointestinal bleed resulting in a hemicolectomy. 10. psoriasis. 11. type 2 diabetes. medications on admission: (medications on admission were as follows) 1. celexa 20 mg p.o. once per day. 2. digoxin 0.125 mg p.o. once per day. 3. metoprolol 75 mg p.o. once per day. 4. isosorbide mononitrate 90 mg p.o. once per day. 5. zantac 150 mg p.o. once per day. 6. zestril 20 mg p.o. once per day. 7. clarinex 5 mg p.o. once per day. 8. ticlid 250 mg p.o. once per day. 9. renagel 21 mg p.o. twice per day. 10. phos-lo 3 p.o. three times per day. 11. nephrocaps one tablet p.o. once per day. allergies: allergy to aspirin (which causes bleeding) and to penicillin (which causes a rash). social history: the patient was a building wrecker for about 20 to 30 years beginning in the and then a salesman. the patient does not have a smoking history. family history: family history was noncontributory. physical examination on presentation: physical examination on admission revealed temperature was 96.3, heart rate was 76, blood pressure was 190/80, the respiratory rate was 21, and the oxygen saturation was 80% to 92% on a 100% nonrebreather mask. in general, the patient was in no acute distress. alert and oriented times three. head, eyes, ears, nose, and throat examination revealed pupils were equal, round, and reactive to light. extraocular movements were intact. the neck was supple with no jugular venous distention. pulmonary examination revealed the patient's lungs were clear to auscultation bilaterally/anteriorly. cardiovascular examination revealed a regular rate and rhythm. no murmurs appreciated. the abdomen was soft, nontender, and nondistended with positive bowel sounds. extremity examination revealed no edema. dorsalis pedis pulses were 2+ bilaterally. neurologic examination revealed no gross deficits. skin examination revealed multiple psoriatic plaques on the scalp. pertinent laboratory values on presentation: laboratories on admission revealed white blood cell count was 8, hematocrit was 38, and platelets were 280. sodium was 139, potassium was 3.9, chloride was 92, bicarbonate was increased at 35, blood urea nitrogen was 34, creatinine was 7.2, and blood glucose was 111. arterial blood gas initially revealed ph was 7.56, pco2 was 38, and po2 was 38. arterial blood gas then improved to a ph of 7.42, pco2 of 43, and po2 of 62; this was on 100% nonrebreather mask. pertinent radiology/imaging: a chest x-ray from showed bulky lymphadenopathy with diffuse reticular nodular pattern and bilateral pleural effusions; consistent with congestive heart failure and metastatic disease. electrocardiogram was compared with with a rate of 75, normal sinus, left axis deviation, and normal intervals. left ventricular hypertrophy with a flipped t wave in leads v4, v5, and iii (which were new). just noting a computed tomography scan from , prior to admission, showed extensive mediastinal adenopathy with a node as large as 3.3 cm x 2.9 cm (which has increased in size). also, small bilateral pleural effusions. also with new nodular densities and an increased size of metastases in the left lobe with one nodule measuring 12 mm in diameter. hospital course by issue/system: 1. hypoxia issues: the patient was admitted with hypoxia with an oxygen requirement, but his saturations improved on 100% nonrebreather mask to the 90s. he was breathing comfortably. it seemed that the patient encountered sputum that he could not clear. his saturations dropped, but when he coughed his saturations would improve. of note, the patient came to the intensive care unit on a nitroglycerin drip and had been taking isosorbide mononitrate, and this may have worsened his respiratory status as it may have dilated pulmonary vasculature that was contracting to try and keep his v/q match. also, the patient had been anorexic over the past several weeks and had probably lost wean by mask, though his dialysis was being maintained at the same dry weight. when the patient was dialyzed off 3 liters later in the morning on the day of admission, the patient's respiratory status improved. the patient will most likely require establishment of a new lower dry weight. there was an immediate suspicion for a pulmonary embolism on admission; however, given the patient's metastatic status, history of bleeds, and improving oxygen saturations, the patient was not fully heparinized at that time. however, on day two of admission the patient was sent for a computed tomography angiogram to rule out a pulmonary embolism. in the medical intensive care unit, the patient continued to improve his oxygenation and was switched to 6 liters nasal cannula and was breathing comfortably. 2. metabolic alkalosis issues: the patient was admitted with a bicarbonate of 35. this may have enhanced his respiratory distress as the patient is oliguric. this likely was an iatrogenic elevated bicarbonate level due to either over bicarbonated dialysis solution and/or his phos-lo and/or renagel. those two medications were held in the medical intensive care unit, and he was dialyzed again with a low bicarbonate solution, and his bicarbonate resolved down to 27 after that. it seemed that this may no longer be an issue for this patient. 3. hypertensive issues: the patient was hypertensive to 200/80s to 90s on admission to the medical intensive care unit. the patient was initially placed on a labetalol drip with good affect. this was after the nitroglycerin drip was stopped. the next day we attempted to take the patient off the labetalol drip and maintain him on his metoprolol 75 mg p.o. twice per day; however, this was not sufficient overnight, and the patient was placed on hydralazine 20 mg intravenously every six hours for blood pressure maintenance which worked well. 4. end-stage renal disease issues: the patient was last dialyzed on . he was dialyzed again on with 3 liters removed. the patient seemed to have an improvement in his respiratory status after this and had no signs of being overly dried out by this dialysis. it was very likely that due to the patient's recent anorexia he had lost dry weight and needed to be dialyzed to a lower dry weight. 5. coronary artery disease issues: the patient had a distant history of a myocardial infarction. a recent echocardiogram from showed a preserved ejection fraction and left ventricular function. the patient did have a small troponin leak by enzymes at approximately 0.2, but his creatine kinase levels were flat at around 50 to 60. we had a low suspicion that the patient had a cardiac event and thought that this was more likely due to his respiratory distress and his end-stage renal disease. however, the patient received another echocardiogram with a bubble study. this echocardiogram on showed a small right-to-left shunt across the atrium, left ventricular function was preserved and normal size, normal ejection fraction of greater than 55%, mild aortic regurgitation, and mild mitral regurgitation. the patient did have moderate pulmonary artery systolic hypertension. the patient was also switched from ticlid to plavix for an anti-platelet which the patient is presumably on in lieu of aspirin which he is allergic to. 6. type 2 diabetes mellitus issues: the patient was placed on an insulin sliding-scale and a diabetic diet with fingersticks four times per day. 7. renal cell carcinoma issues: the patient recently learned that he had metastases to his lungs. his family and outpatient oncologist were notified of this situation. 8. prophylaxis issues: the patient was maintained on subcutaneous heparin and ranitidine for gastrointestinal prophylaxis. , m.d. dictated by: medquist36 procedure: hemodialysis diagnoses: congestive heart failure, unspecified other pulmonary insufficiency, not elsewhere classified pulmonary collapse hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease alkalosis primary pulmonary hypertension kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure secondary malignant neoplasm of lung 

Answer: The patient is high likely exposed to