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: right ventricular infarct major surgical or invasive procedure: intra-aortic balloon pump history of present illness: 62 yo m with k-ras wt moderately-differentiated mixed carcinoid/mucinous appendiceal adenocarcinoma metastatic to peritoneum with peritoneal carcinomatosis s/p folfox, folfiri, iritecan and most recently c3d15 cetuximab (), s/p colonic stent placement for malignant obstruction, also s/p lrd-renal xplant , hcv, x-fer from for management of large inferior wall stemi with bms to prox rca, with revascularization resulting in timi-1 flow caused by cardiogenic shock. pt was hypotensive during procedure requiring pressors due to large infarct of his right-dominant system, on dopamine, levo and neo, with iabp in place and temporary pacer. . per pt's wife, he had been complaining o intermittent abdominal pain for several days with recent admissions (discharged and ) for management of colonic obstruction, first with ngt decompression, then with palliative stenting (on ). he again complained of severe abdominal pain radiating to his back, nausea and vomiting, so was taken to local ed in for evaluation. initial ekgs showed st elevations in ii,iii,avf concerning for inferior stemi so pt was taken emergently to catheterization lab where 100% thrombotic proximal occlusion to large dominant rca was seen. pt was in cardiogenic shock on arrival to cath lab w/ bp ~80s. cath showed r-dominant system w/ 100% prox thrombotic occlusion in rca and 90% culprit stenosis in proximal to mid vessel treated with single bms. scattered thrombi throughout distal vessels (large pda and2 large pl branches). final flow was timi 1. as pt was progressively bradycardic thorughout procedure, temporary pacing wire was placed via r femoral vein. rv pacing at 80bpm. after placement of bms, pt went into runs of nsvt which broke spontaneously. pt was given amiodarone bolus and rhythm was stabilized. iabp placed at 1:1. pt required intubation in ccu and 3 pressor support. on arrival to ccu, pt was intubated but not sedated, unresponsive to commands or painful stimuli, had bilateral fixed blown pupils, mottled skin, and cold extremities. abg on arrival: 7.05/33/65 on ps 5/5 w/ fio2 100%. . on the floor, he is not responsive to verbal or tactile stimulation. past medical history: onc history: pt underwent an appendectomy for acute appendicitis in . pathology from the procedure showed a mixed tumor containing carcinoid and adenocarcinoma invading the appendiceal wall and penetrating through the visceral peritoneum (pt4) with perineural and venous invasion. the tumor involved the proximal resection margin. an mri of the abdomen on showed fatty infiltration of the liver, but no evidence of metastatic disease. on , he underwent right hemicolectomy and regional lymphadenectomy. pathology showed goblet cell carcinoma in the mesenteric fat and a <2 mm focus of gist in the cecal wall near appendiceal stump. thirteen pericolonic lymph nodes removed and were negative, rendering him stage ii (pt4 pn0 m0). the resection margins were negative. mr. was treated with weekly adjuvant 5-fu and leucovorin from , but treatment was discontinued after five weeks because of diarrhea and an increase in his creatinine. he was subsequently followed with serial no, after which his insurance refused to pay for additional studies. in , mr. reports developing abdominal pain and hematochezia. later that month, he became increasingly fatigued and anemic despite using procrit. a colonoscopy on showed a partially circumferential 3-cm mass located 11-13 cm proximal to the anus which appeared to be a metastatic lesion growing through the bowel rather than a primary lesion. a ct scan of the abdomen on revealed peritoneal carcinomatosis most evident in the omentum, a small amount of ascites, and rectal wall thickening consistent with the mass seen on colonoscopy. a chest x-ray on was negative, and on , a percutaneous biopsy of an omental lesion revealed moderately differentiated metastatic mucinous adenocarcinoma, consistent with metastatic colon cancer. . past medical history: kidney transplant from living related donor, doing well. renal failure was due to e. coli infection. hepatitis c osteoarthritis benign brain tumor which caused partial paralysis of the face on the right side. social history: social history: married. no coffee or alcohol or tobacco. family history: noncontributory physical exam: vs: afebrile, bp 110/79 on 3 pressors, hr 70s (paced, iabp), sao2 100% on ps gen: intubated, not sedated, unresponsive to commands or painful stimuli heent: fixed dilated pupils b/l, unresponsive to light cv: paced, hr 70s, iabp in place lungs: coarse ventilated bs, bibasilar crackles abd: +bs soft, well-healed surgical scars from hemicolectomy ext: no peripheral edema, 1+ distal pulses, multiple pedal excoriations l>>r neuro: intubated, unresponsive pertinent results: admission labs: 07:59pm wbc-37.3*# rbc-4.08* hgb-11.6* hct-37.6* mcv-92 mch-28.4 mchc-30.9* rdw-17.2* 07:59pm neuts-78* bands-14* lymphs-3* monos-5 eos-0 basos-0 atyps-0 metas-0 myelos-0 07:59pm pt-15.0* ptt-37.9* inr(pt)-1.3* 07:59pm calcium-6.4* phosphate-5.6*# magnesium-1.7 07:59pm ck-mb-181* mb indx-8.5* ctropnt-9.27* 07:59pm alt(sgpt)-76* ast(sgot)-304* ck(cpk)-2127* alk phos-115 tot bili-0.7 07:59pm glucose-233* urea n-34* creat-3.8* sodium-133 potassium-6.6* chloride-107 total co2-12* anion gap-21* 08:08pm type-art po2-63* pco2-44 ph-7.05* total co2-13* base xs--18 09:01pm type-art temp-35.3 peep-5 o2 flow-100 po2-65* pco2-33* ph-7.18* total co2-13* base xs--14 intubated-intubated 10:45pm type-art temp-35.6 peep-8 po2-67* pco2-29* ph-7.25* total co2-13* base xs--12 intubated-intubated vent-spontaneou 10:45pm lactate-5.6* . echo the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate regional left ventricular systolic dysfunction with severe hypokinesis/akinesis of the inferior and inferolateral walls and hypokinesis of the inferior septum. the remaining segments contract normally (lvef = 35 %). the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is top normal. there is no pericardial effusion. there is prominent ascites. impression: mild symmetric left ventricular hypertrophy with regional systolic dysfunction c/w cad (proximal rca distribution leading to rv infarction as well). mild mitral regurgitation. brief hospital course: 1. cardiogenic shock- etiology of cardiogenic shock is large rv infarct (proximal rca) of a large r-dominant system, leading to hypotension that requires use of 3 vasopressors. pt intubated but not initially sedated; sedation would prove necessary later on. pt initially unresponsive w/ fixed dilated pupils b/l, repeat exam w/ some purposeful movement, pt able to squeeze hands b/l and wiggle toes b/l on command. the patient received atorvastatin, aspirin,and plavix. integrillin was run for 18 hours. serial abgs were taken; bicarbonate was given and ventilator settings adjusted based on acidosis. th epatient required continues use of 3 vasopressors levophed, dopamine and neosynephrine, initially and a fourth was later added. the patient's pressure was further supported by an intra-aortic balloon pump. the patient's family kept the patient full code until son could arrive from . given the patient's prognosis, the patient's family then agreed to withdraw pressor support. shortly thereafter, the patient expired. . 2. metabolic acidosis- lactic acidosis as lactate >7 from ischemia and hypotension. repleted bicarbonate and treated hyperkalemia with ca gluconate, bicarb, insulin, and glucose. . 3. mucinous appendiceal adenocarcinoma- mixed carcinoid/mucinous tumor metastatic to peritoneum, (peritoneal carcinomatosis) s/p folfox, folfiri and irinotecan/cetuximab (stopped for diarrhea and disease progression, respectively). per heme/onc fellow pt's disease has progressed beyond further chemotherapeutic options and likely focus will be on palliative efforts. pt has palliative colonic stent in place as recurrent obstruction not responding to ngt decompression. heme/onc saw patient and family; no further heme/on treatment provided. . 4. acute on chronic renal failure- chronic allograft nephropathy now complicated by multifactorial acute renal insufficiency, with recent chemotherapeutic regimen nephrotoxicity combined with decreased renal perfusion from hypotension inferior wall mi and cardiogenic shock contributing to acute decompensation. contrast nephropathy from catheterization unlikely to present so acutely. patient w/ poor uop. cvvh not an option, as family not interested in that care. medications on admission: amlodipine - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth daily diphenoxylate-atropine - 2.5 mg-0.025 mg tablet - 1 tablet(s) by mouth q3-4h as needed for prn diarrhea epoetin alfa - 20,000 unit/ml solution - 20,000 units subcutaneously twice weekly insulin lispro - (prescribed by other provider) - 100 unit/ml solution - sliding scale lorazepam - 0.5 mg tablet - tablet(s) by mouth q4-6 h as needed for prn anxiety/nausea prednisone - (prescribed by other provider) - 5 mg tablet - 1.5 tablet(s) by mouth once a day aspirin - (prescribed by other provider) - 81 mg tablet - 1 tablet(s) by mouth once a day carboxymethylcellulose-glycern - (prescribed by other provider) - 0.5 %-0.9 % drops - 2 gtt(s) ou twice a day multivitamin - (prescribed by other provider) - capsule - 1 capsule(s) by mouth daily discharge medications: none. patient expired. discharge disposition: expired discharge diagnosis: death secondary to cardiogenic shock from myocardial infarction. discharge condition: the patient expired. discharge instructions: none. followup instructions: none. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: acidosis hyperpotassemia acute kidney failure with lesion of tubular necrosis unspecified viral hepatitis c without hepatic coma other specified intestinal obstruction secondary malignant neoplasm of other specified sites cardiogenic shock personal history of malignant neoplasm of large intestine other ascites surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation acute myocardial infarction of other specified sites, initial episode of care complications of transplanted kidney secondary malignant neoplasm of retroperitoneum and peritoneum nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney secondary malignant neoplasm of large intestine and rectum heart failure, unspecified 

Answer: The patient is high likely exposed to