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: shortness of breath major surgical or invasive procedure: none history of present illness: 69m with , dm, history of pe, laryngeal and bladder cancers, initially admitted to hospital on with shortness of breath, now transferred to after complicated icu course. . he was admitted with shortness of breath with exertion for one day with orthopnea. no chest pain or fevers. mild cough. his family describes ongoing anasarca for at least one year, worse lately, requiring large doses of lasix as an outpatient. in addition, over the last three months he has had a more rapid decline since a syncopal episode thought related to overdiuresis led to hospitalization. he has since been in and out of the hospital and rehab; total of 4 hospitalizations. during these courses diagnosed with pe, hap, mucous plugging. family describes him as having intermittent worsening dyspnea on exertion and generalized weakness. his left leg (where dvt was present) was noted to be weaker than right). also seemed to have slow cognitive decline as well - slower speech and responses, though prior to admission was still living at home, managing finances, cooking at times. family admits he has seem depressed, but very certain that he would not take any ingestions in attempt to harm himself. . with current hospital course he was found to have bilateral pleural effusions, transudative on , and anasarca. on the floor he was diuresed. per notes was also c.diff positive on . he was transferred to the icu on for hypothermia, confusion, and lethargy. the following issues were noted in his icu course: - hyperammonemia: ammonia 222 upon icu transfer. ct abdomen notable for fatty liver. no major lft abnls otherwise. per notes, negative viral hep panel, , ama; no known etoh. tried on lactulose. discussed possible hemodialysis at osh. - hypotension/septic shock. thought ?line sepsis. negative cultures. on dopamine and levophed and iv albumin, now weaned off pressors. antibiotics - iv and po vanc, iv flagyl, iv cefepime, iv fluconazole. - respiratory failure. intubated due to encephalopathy. bilateral pulmonary infiltrates that were thought to be aspiration. also with bilateral effusions s/ x 2. - c.diff colitis. positive on . on po vanco and iv flagyl. - anasarca. given natrecor and edecrin during course. resulted in rising creatinine without much gains in edema. - - baseline increase from 2.8 to 3.4. - maintained on anticoagulation (most recently heparin gtt) for history of pe. - difficulty tolerating enteral feedings (?ileus). getting tpn. - anemia. unclear etiology. received 2 units prbcs. - leukocytosis. - dropping platelet count (66k today, down from 115 three days ago). pf4 antibody negative. - picc placed . - tte : ef 65% normal wall motion, mild diastolic dysfunction, normal rv, small pericardial effusion. - rash: per nursing report, progressive over the last 3 days. . on the floor, patient intubated and encephalopathic; unable to provide further history. past medical history: - , unclear etiology. ?due to underlying dm. no proteinuria per notes. baseline creatinine 2.5. - dvt/pe in . - syncope/fall thought due to overdiuresis; fractured left wrist vs. left rib (inconsistently documented) - paroxysmal afib. - htn - laryngeal cancer s/p resection. - bladder cancer - rul pneumonia (hap) . also had associated pleural effusion that was "grossly bloody" on thoracentesis. treated with vanco/zosyn. - r lung nodule on ct scan ; pet negative. - diabetes type ii. - calcified pancreas on ct scan since of unclear significance. - s/p turp - recent perirectal abscess social history: - tobacco: quit smoking 7 years ago. - alcohol: rare - illicits: none. retired from work in the supermarket deli. recently living in nursing home/rehabs (since recent hospitalizations), prior was living with wife. daughter is a nurse. family history: sister died of cad. brother died of dm and cad. no kidney disease. mother had disease. physical exam: admission: general: intubated. blinks eyes spontanously, but no other spontaneous movement. heent: sclera anicteric, perrl 3->2, periorbital and scleral edema, tongue and lips appear swollen/enlarged but without obvious mucosal ulcerations. neck: supple, jvd difficult to appreciate, no lad, rij in place. lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, distant heart sounds, no murmurs, rubs, gallops appreciated. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, liver edge palpable 2-3 cm below costal margin. no evidence of ascites. ext/skin: warm, well perfused, 2+ pulses, no clubbing, cyanosis. marked diffuse anasarca of ues, les, torso. skin of arms with diffuse ecchymoses with few skin tears. legs (particularly r leg) and to lesser degree ues with scattered large flaccid bullae; r leg with large area of erythema adjacent to fully denuded areas of skin - epidermis appears to be sloughing off at parts. neuro: minimal spontaneous movement (blinking occasionally) no movement of ues or les to painful stimuli. pertinent results: 01:38am blood wbc-13.8* rbc-3.41* hgb-10.0* hct-30.3* mcv-89 mch-29.4 mchc-33.1 rdw-19.6* plt ct-62* 03:48am blood neuts-89.7* lymphs-8.1* monos-1.8* eos-0.2 baso-0.2 11:58am blood glucose-120* urean-27* creat-3.1* na-146* k-4.9 cl-114* hco3-15* angap-22* 04:23pm blood fibrino-133* 01:38am blood alt-20 ast-35 ld(ldh)-217 alkphos-212* totbili-1.5 03:22am blood ammonia-204* 04:53pm blood caltibc-39* ferritn-855* trf-30* 05:52pm blood tsh-3.1 05:52pm blood t4-2.0* t3-38* calctbg-0.80 tuptake-1.25 t4index-2.5* 04:23pm blood free t4-0.78* 01:52am blood glucose-70 lactate-1.4 na-143 ct head w/o contrast study date of 10:25 am impression: 1. subcortical white matter hypodensities in the frontal lobes and posteroparietal lobe could reflect chronic small vessel ischemic disease, findings are not typical for anoxic or hypotensive event. mri is recommended for further assessment. 2. mucosal thickening and fluid in the paranasal sinuses, likely related to intubation. 3. opacification of mastoid air cells bilaterally. abdomen u.s. (complete study) port study date of 6:42 pm impression: 1. echogenic liver indicative of hepatic steatosis. note that coexistent forms of hepatic disease such as cirrhosis or fibrosis are not excluded. 2. patent portal vein with normal hepatopetal flow. 3. small ascites and left pleural effusion. 4. apparently dilated pancreatic duct without etiology. this finding merits further investigation with ct or mrcp. brief hospital course: mr. is a 69 year-old man with sub-acute decline in mental status, anasarca that presented to hospital with shortness of breath on . at that time his ammonia level was 223 and he was slurring speech and somewhat somnolent. he spent 10 days on the floor. during the admission he was transferred to the icu, intubated and started on pressors. it appears that hypotension was an issue at that time. he became unresponsive at this time, we think, although this is not well documented. he was transferred to with desquamative skin and comatose. he was made cmo after discussion with family on , and expired shortly after extubation. # altered mental status numerous contribitors to his ams, but the overall picture was that of vastly decreased cortical function, consistent with anoxic brain injury. his elevated ammonia, hypernatremia and low ceruloplasmin may have contributed to his ams. # adventitious head movements several muscle groups involved in these movements during ?????? therefore cortical in nature. suggestive of seizure activity and treated with dilantin prophylaxis. likely was secondary to anoxic injury with some sparing of motor neurons versus edema and mass effect. # desquamating skin reaction unclear etiology, and thought related with profound skin hypoperfusion. unifying diagnosis unclear. not likely , dermatology, who thought that it was most likely secondary to previously dramatic anasarca and then microtrauma of being in bed. treated with fluid replenishment as if burn patient. # respiratory failure agonal brainstem breathing, +/- liver breathing. brainstem also appeared to be affected based on reflexes/exam, thus likely neurologic. also contributions by expansion acidosis. # goals of care patient made cmo on and expired shortly after extubation. # hypotension clear loss of spinal reflexes and pupils small suggesting sympathetic output likely lower at brainstem or spinal level. # hyperammonemia unclear etiology. too late to present with metabolic disorder, although not impossible. no valproic acid recently. has liver failure and pancreatic calcification of unknown etiology. family claim little to no alcohol use. # hypothyroidism likely sick euthyroid. # hypernatremia corrected quite quickly ?????? concerning. 5 meq over nine hours maximal rate from labs. unlikely problem in itself, but may be edema from anoxic brain injury and the two together may become significant. # anasarca liver failure, low albumin and renal failure, now with large fluid shift and protein losses through skin. will likely worsen. # renal failure # liver failure # pe/dvt prophylaxis medications on admission: medications at home: - humibid la 600 mg - calcitriol 0.25 mg daily - pravastatin 40 mg daily - lopressor 12.5 mg - omeprazole 20 mg daily - coumadin 0.5 mg daily - humalog sliding scale - tylenol prn pain. . medications on transfer: - vancomycin 500 mg iv tid - vancomycin 125 mg ngt qid - cefepime 2 grams iv q24h - metronidazole 500 mg q8h - fluconazole 400 mg iv once today - albumin 50 grams iv bid - calcitriol 0.25 mcg daily - pantoprazole 40 mg iv daily - thiamine 100 mg iv daily - humalog sliding scale - reglan 5 mg iv q8h - colace 100 mg tid - nystatin powder tid - artificial tears - lactobacillus past medications: omeprazole, guiafenesin, coumadin, zofran, metoprolol, pravastatin, ethacrynic acid, dopamine, norepinephrine, bisacodyl, midazolam, morphine, heparin gtt, nesiritide, lactulose. discharge medications: expired; discharge disposition: expired discharge diagnosis: expired; discharge condition: expired; discharge instructions: expired; followup instructions: expired; md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more arterial catheterization diagnoses: acidosis thrombocytopenia, unspecified acute kidney failure with lesion of tubular necrosis cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis unspecified acquired hypothyroidism chronic kidney disease, unspecified acute respiratory failure defibrination syndrome septic shock intestinal infection due to clostridium difficile personal history of malignant neoplasm of bladder personal history of venous thrombosis and embolism other ascites encounter for palliative care encephalopathy, unspecified hyperosmolality and/or hypernatremia edema other specified erythematous conditions personal history of malignant neoplasm of larynx disorders of urea cycle metabolism 

Answer: The patient is high likely exposed to