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: patient is a 71-year-old man with history of metastatic carcinoid tumor of bronchial origin (metastatic to bone and liver) status post multiple chemotherapy treatments, resection of tumor from left upper lobe of lung in , chemoembolization of liver metastases (, ), and is currently on a clinical trial of an oral tyrosine kinase inhibitor affecting vegfr/pdgfr families, su011248, also known as sugen and concurrently taking sandostatin. over the years he has had multiple episodes of flushing/diarrhea with carcinoid crises. the patient was in his usual state of health until five days prior to admission when he developed facial and upper thoracic flushing, tachycardia, tachypnea, diaphoresis, nausea, vomiting, and fatigue. over the course of the few days, the emesis became bloody and the patient developed maroon-colored stools. when his fatigue became intolerable, his wife brought him to an outside hospital, where he was found to be hypotensive blood pressure 77/52, and tachycardic, heart rate 122. he was given fluid boluses, had a single episode of syncope with a blood pressure of 56 systolic/palp. he received 1 unit of packed red blood cells and his vital signs stabilized. he was transferred to the intensive care unit on as he primarily gets his care at the . past medical history: 1. carcinoid tumor. 2. upper gastrointestinal bleed in found to be candidal esophagitis. 3. formally used alcohol, but quit in . medications on admission: 1. ibuprofen prn--increased use prior to admission 2. sandostatin q month. 3. sugen. allergies: horse serum - the patient develops a rash. social history: the patient is married with five children. lives with wife. is a retired lawyer and formally drank drinks per day, but quit in . family history: significant for a brother with hepatic and pancreatic cancer. father liver cancer. mother abdominal cancer and grandparents both died of cancer. physical exam on admission: temperature 98.0, blood pressure 100/60, heart rate 121, respirations 16, and oxygen saturation 94% on room air. generally, patient was pale, pleasant, and lethargic gentleman in no apparent distress. heent revealed no oral lesions, but dry oral mucosa. neck was supple with no jugular venous distention and no lymphadenopathy. lungs were clear bilaterally. heart sounds were regular, but tachycardic, no murmurs. abdominal examination was benign. liver margin palpated 1 cm below costal margin. extremities showed no edema. patient had no rashes. neurologic examination: patient was alert and oriented times three, full strength, 1+ deep tendon reflexes at patella, but absent ankle jerk reflexes. laboratories on admission: white count 11.3, hematocrit 23.7, platelets 125. inr 1.6, pt 15.4, ptt 25.4. normal electrolytes. bun and creatinine 54 and 0.8. alt 232, ast 688, alkaline phosphatase 159, total bilirubin 0.8. lactate dehydrogenase 1870, ck 1553. summary of hospital course: 1. atrial fibrillation: on admission to the , the patient was found to be in atrial fibrillation and was converted to normal sinus rhythm with 5 mg of iv lopressor, and he has remained in normal sinus rhythm ever since. 2. gi: an esophagogastroduodenoscopy was performed on the morning of , and revealed severe esophagitis, mild antral gastritis, but no site of active bleeding. the patient was started on iv protonix for 24 hours and then was switched to protonix 40 mg po bid, which he is to continue for at least one month. with regards to his maroon-colored stool, it was felt that although this could be secondary to the upper gi bleed, a lower source of bleeding should be ruled out and a colonoscopy is recommended as an outpatient. as patient had a history of candidal esophagitis, he was also started on an empiric course of nystatin swish and swallow this admission, however, no biopsies were obtained during the egd to confirm this diagnosis. 3. elevated liver function tests: these were likely secondary to shock liver from the hypotensive episode the patient had the outside hospital. lfts continued to trend down throughout his admission as blood pressure remains stable. on day of discharge, alt was 50, ast 28, alkaline phosphatase 151, and a total bilirubin of 1.4. no further intervention was necessary at this time. 4. anemia: patient was found to have a very low hematocrit of 23 on admission. he was transfused 4 units of packed red blood cells in the intensive care unit, and required another 2 units on the floor. his hematocrit remained above 30 a few days prior to discharge. he was to followup closely regarding need for a subsequent transfusion. 5. infectious disease: once transferred out of the unit onto the floor, the patient complained of a chest pain across the lower right aspect of his sternum and he developed a fever of 101.2. although he was sating well on room air at rest, it was noted that the patient had an ambulatory saturation in the mid 80s. a chest x-ray was done, which initially was negative for an infiltrate, however, clinical suspicion was high. a ct scan was performed which showed left lower lobe pneumonia. the patient was started on clindamycin and levaquin. he remained afebrile and by the day of discharge had an ambulatory oxygen saturation greater than 95%. 6. pneumothorax: on admission to the intensive care unit, a right sided triple lumen catheter was placed, which resulted in a small pneumothorax, which was stable throughout his hospital per serial chest x-rays and ct scans. no further intervention was required. 7. rule out myocardial infarction: when patient first presented to the intensive care unit, he had elevated cks and an electrocardiogram showing st depressions in the inferolateral leads. he proceeded to rule out for myocardial infarction via serial enzymes and follow-up electrocardiograms. this is most likely secondary to demand ischemia from hypovolemia. discharge diagnoses: 1. upper gastrointestinal bleed secondary to esophagitis. 2. paroxysmal atrial fibrillation. 3. left lower lobe pneumonia. condition on discharge: stable. discharge medications: 1. protonix 40 mg po bid. 2. lidocaine solution 5 ml swish and swallow tid. 3. nystatin swish and swallow 5 ml po qid. 4. clindamycin 300 mg po q8h for seven days. 5. levaquin 500 mg po q day for seven days. 6. colace 100 mg po bid. 7. neutra-phos one packet po bid. the patient was instructed to continue taking protonix twice a day for at least one month and to followup with his primary doctor regarding the plan for discontinuation of this medication. he was also instructed to not take any aspirin, ibuprofen, naprosyn, or other nonsteroidal anti-inflammatory medications. he was also instructed to avoid caffeine, smoking, or any other stomach irritants. it was recommended that he get a colonoscopy as an outpatient, as well as repeat egd with biopsy. he is to follow up with dr. in hematology/ clinic on at 9:30 in the morning and also to followup with dr. , clinic on at 11 in the morning. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine diagnoses: pneumonia, organism unspecified malignant neoplasm of liver, secondary atrial fibrillation personal history of malignant neoplasm of bronchus and lung hemorrhage of gastrointestinal tract, unspecified esophagitis, unspecified secondary malignant neoplasm of bone and bone marrow 

Answer: The patient is high likely exposed to