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: no known allergies / adverse drug reactions attending: chief complaint: respiratory distress major surgical or invasive procedure: intubation/extubation chest tube placement history of present illness: history of present illness: 55 y/o male with copd (not on home oxygen) and etoh cirrhosis who came to 2 weeks ago with a report of increased shortness of breath. he was diagnosed with lll pneumonia, left pleural effusion, and small nodule in the rll. pulmonary was consulted and recommended a thoracentesis and bronchoscopy. he declined these procedures. he was discharged on po levofloxacin. . he completed 5 days of therapy, but then developed cough, worsening sputum production, and increasing dyspnea. he had a repeat ct scan of the chest which confirmed dramatic progression of disease when compared to prior ct scan of . there was a large loculated pleural effusion on the left c/w possible empyema. there is extensive atelectasis in the residual left lung apex where there are cavitary or emphysematous changes. left main stem bronchus is no longer visible and occluded. there are diffuse infiltrates throughout the r lung and small r pleural effusion, ascites, cirrhosis, and enlarged spleen. . prior to transfer, patient received vancomycin and zosyn, and flagyl. . vitals on transfer were: hr 64, bp 138/72, 92% on 50% fio2. . on the floor, patient reports that he is mildly uncomfortable with breathing. he denies fevers. reports cough with greenish phlegm. denies chest pain. . review of systems: (+) per hpi. also reports 8 lb weight loss in 1 mo. past medical history: -etoh cirrhosis -copd -htn social history: married. resides in a single family home. currently retired. denies tobacco, etoh, or illicts currently. - tobacco: 40 pack year history of smoking, quit 2 weeks ago. - alcohol: quit 6years ago - illicits: denies family history: father and mother passed away in their 50s from cancer physical exam: physical exam on admission: vitals: t: 95.9 bp: 114/70 p: 86 r: 24 o2: 93% on 50% ventimask general: alert, pleasant, oriented, mild respiratory distress heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: no tracheal shift, significantly diminished air movement at left lung, dullness to percussion, rhonchi and crackles at left side. right side with more air movement, but intermittent rhonchi and decreased bs at base. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission wbc-22.9* rbc-4.07* hgb-12.0* hct-35.3* plt ct-69* neuts-96* bands-0 lymphs-0 monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-0 pt-15.8* ptt-32.6 inr(pt)-1.4* glucose-80 urean-19 creat-0.7 na-128* k-4.7 cl-93* hco3-24 angap-16 -27 ast-62* ld(ldh)-691* alkphos-203* totbili-2.1* albumin-2.6* calcium-10.2 phos-2.9 mg-2.3 iron-39* caltibc-282 ferritn-482* trf-217 art po2-60* pco2-39 ph-7.47* caltco2-29 base xs-4 intubat-not intuba cxr current study demonstrates complete opacification of the left hemithorax with minimal lucency noted at the left apex. these findings are highly concerning for a combination of large pleural effusion and atelectasis giving the absence of the right mediastinal shift. central obstruction with significant atelectasis are suspected. on the right, there is small amount of pleural effusion, partially imaged and potentially loculated (note is made that the right costophrenic angle was not included in the field of view). in addition, there is right lower lobe opacity as well as vascular prominence and questionable right upper lobe opacities. although the vascular engorgement may be physiologic, reflecting the constriction of the vascularity in the left hemithorax, it can represent volume overload ct chest w/ contrast impression: 1. moderate residual hydropneumothorax with split pleura sign suggesting empyema, which could be confirmed by examination of pleural fluid characteristics. 2. left apical cavitary lesion with an intraluminal rounded opacity suggests mycetoma or semi-invasive aspergillus. 3. complete collapse of the left lower lobe bronchus and expanded left lower lobe with low attenuation suggests drowned lung. 4. right lower lobe consolidative peribronchobronchovascular mass with vascular attenuation and associated right hilar adenopathy concerning for neoplasm or aggressive fungal infection. bronchoscopy should be considered. otherwise, ct follow up after treatment of acute symptoms is recommended. 5. multiple lytic bone lesions in the sternum, scapula and vertebral bodies may represent multiple myeloma versus metastatic disease. 6. diffuse ground-glass opacity in the bilateral upper lobes could be related to multifocal infection or aspiration. 7. small nonhemorrhagic right pleural effusion and pericardial effusion. 8. cirrhosis and at least small to moderate ascites. brief hospital course: 53yo male with copd and etoh cirrhosis presenting with worsening sob and loculated pleural effusion concerning for empyema from osh. # hypoxemic respiratory failure: on presentation patient's respiratory distress appeared to be related to the osh diagnosed pneumonia and likely parapneumonic effusion or empyema. cxr showed nearly complete white-out of the l lung and osh ct chest showed large loculated pleural effusion on the left with extensive atelectasis in the residual left lung apex, and occluded left mainstem bronchus. he was started on vancomycin, cefepime, and flagyl as he has not improved with levofloxacin monotherapy from osh and considered he may have anaerobic infection. the patients copd seemed to play a minimal role in his respiratory distress. there was no evidence of chronic co2 retention per review of abg or chemistry. interventional pulmonary performed a thoracentesis. and patient showed symptomatic improvement. cytology revealed very abnormal cells concerning for malignancy but cell block was required for definite diagnosis. he also had a ct chest which showed rll consolidative mass with right hilar adenopathy concerning for neoplasm, a consolidation of the lll with complete collapse of the lll bronchus, and multiple lytic bone lesions in the sternum, scapula and vertebral bodies which suggested a metastatic process. patient was maintaining adequate oxygenation on a venti mask. on hd2 patient became tachypnic and tachycardic and required intubation. the family was informed of the high likelihood the patient had metastatic lung cancer and the dismal prognosis. they stated that his wishes would be consistent with being made cmo. however, they wanted family members to have the opportunity to come and visit with him. on hd4 patient was noted to have cyanotic right foot, bleeding from iv sites and lab work consistent with a diagnosis of dic. on hd5 his family was able to come see him and he was made cmo. he was pronounced dead at 5:35pm on . medications on admission: -aldactone 25 mg daily -potassium chloride -metoprolol 25 mg daily -lasix 40 mg daily -albuterol 2 puffs qid prn discharge medications: n/a discharge disposition: expired discharge diagnosis: respiratory failure from suspected lung cancer discharge condition: expired discharge instructions: n/a followup instructions: n/a md procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube thoracentesis closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified unspecified pleural effusion unspecified essential hypertension alcoholic cirrhosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified acute respiratory failure malignant neoplasm of bronchus and lung, unspecified pressure ulcer, lower back encounter for palliative care do not resuscitate status other and unspecified alcohol dependence, unspecified empyema without mention of fistula hypercalcemia pressure ulcer, stage ii polycythemia vera 

Answer: The patient is high likely exposed to