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: lisinopril / ceftriaxone attending: chief complaint: dyspnea, hypoxia, cough major surgical or invasive procedure: intubation, mechanical ventillation right internal jugular venous catheter placement right chest tube placement history of present illness: mr. is a 46 yo m with pmh htn, hyperlipidemia presenting with dyspnea and abdominal pain. he reports that his symptoms started on friday, 5 days prior to admission with nausea, vomiting and diarrhea. the following morning he also noted onset of shortness of breath as well as a nonproductive cough. he also developed discomfort in the right side of his abdomen which he believed was due to vomiting. otherwise he reports feeling "hot and cold". he denies any chest pain, lower extremity swelling, dysuria, hematuria, sick contacts. reports presenting to the hospital 4 days after onset of symptoms primarily due to shortness of breath and abdominal discomfort with breathing. . of note he reports that he had a physcial exam three weeks ago with blood work which he reports was all normal. he denies any history of kidney problems. does report 25 year history of exposure to noxious chemicals including methylene chloride. during his employment refinishing furniture. . he initially presented to hospital. initial vitals were t: 98.1 p: 111 bp: 80/53 rr: 22 o2: 92% on ra. laboratories were notable for a wbc count of 7.2 with 74% polys and 9% bands. cxr was concerning for a right middle and right lower lobe consolidation. he received 2 liters normal saline, toradol 30 mg iv, ceftriaxone 1 gram iv x 1, flagyl 500 mg iv x 1 and levofloxacin 750 mg iv x 1. he was transferred to for further management as there were no beds available in their icu. . in the ed, initial vs were: t98.6 p107 bp90/61 r20 o2 sat 97% on 15l nrb. patient was given a total of 7 l ivf for hypotension and tachycardia with sbp as low as 80/50. due to hives and concern for allergic reaction to ceftriaxone at osh he was also given benadryl 50mg iv, pepcid 20mg iv. he was given levaquin 750mg iv. rij was placed in the ed with cvp of 19 following placement. he was also started on neosynephrine which is at 1mcg/kg/min on arrival to the floor. he was noted to be in afib with rvr and was started on heparin gtt in the ed. given the patient reports of toxin exposures at work toxicology was consulted in the ed. past medical history: hypertension hyperlipidemia right brachial plexus injury during shoulder surgery left leg sciatica social history: lives with his wife, smoked 2ppd since yo, quit in , now smokes cigars daily since, reports "heavy" etoh uses for about 10 years, cut back in now only has 1-2 drinks on occasion, denies any current drug use, did occasionally use cocaine or marijuana when he was young. recently laid off from his job, had worked in furniture refinishing. family history: nc physical exam: vitals: t: bp: p: r: 18 o2: general: alert, oriented, appears slightly dyspnic although speaking in full sentences. heent: nc at perla, eomi sclera anicteric, dry mucous membranes, oropharynx clear neck: supple, jvp not elevated, no lad lungs: bronchial breath sounds to way on the right with crackles and dullness to percussion, left with slight basilar crackles, no wheezing cv: tachycardic, irregularly irregular, no murmurs, rubs, gallops abdomen: soft, non-tender, slightly distended, bowel sounds present, no rebound tenderness or guarding ext: warm, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission: na 131 k 3.1 cl 95 hco 18 bun 88 creat 4.1 gluc 112 ca 5.8 mg 1.2 p 5 ast 68 alt 25 ap 60 tbili 1.2 lip 82 serum osm 294 wbc 5.8 (n45 b24 meta 16) hct 30 plt 110 lactate 1.3 vbg: 7.29/42/138/21 lactate 0.8 serum tox negative urine tox negative . ua: moderate blood, trace protein fena: 1.2% feurea:35% micro: bcx: pending ucx: pending images: cxr: rij with tip terminating in right atrium, no pneumothorax, right middle and lower lobe opacities with associated right pleural effusion suspicous for pneumonia. portable tte (complete) done at 3:34:20 pm final general comments: resting tachycardia (hr>100bpm). the rhythm appears to be atrial fibrillation. the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is moderate global left ventricular hypokinesis (lvef = 35 %). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is a trivial/physiologic pericardial effusion. impression: moderate global left ventricular systolic dysfunction. moderate pulmonary artery systolic hypertension ct chest w/contrast study date of findings: 1. multifocal consolidation and ground glass opacity, mostly in the right lower lobe, consistent with multifocal pneumonia. 2. moderate nonhemorrhagic right pleural effusion, mostly superior to the consolidation, raising suspicion of loculation. 3. enlarged mediastinal lymph nodes, likely reactive, should be followed. 4. mild emphysema. 5. mild cardiomegaly. possible anemia. 6. fatty liver. 7. 13-mm right adrenal nodule, should be evaluated by mri if not already known. brief hospital course: mr. is a 46 year-old man with pmh htn, hyperlipid, h/o etoh abuse who presented with septic shock, rll pna, alcohol withdrawal, and arf, but improved with antibiotics and iv fluids. # pneumonia/sepsis: he presented with sepsis secondary to a rll pneumonia that later developed into a multifocal pneumonia. he required icu admission for sepsis and was intubated from for airway protection in the setting of alcohol withdrawal and hypoxia. he was also briefly on phenyephrine. he also had a large right sided effusion, with diagnositic thoracentesis consistent with complicated parapneumonic effusion; a chest tube was later placed. he was initially treated with vanocmycin, levofloxacin, and aztreonam to cover for community acquired pneumonia, but given areas of necrosis on his chest x-ray, clindamycin was added. as he improved, his antibiotics were tapered to vancomycin, levofloxacin, and clindamycin. # acute renal failure: he was prerenal on admission with a creatinine of 4.9 in the setting of sepsis, alcohol abuse, and likely volume depletion. his creatinine normalized with ivfs. # alcohol withdrawal: he has a history of alcoholism and experienced alcohol withdrawal 48 hours after admission, requiring a ciwa and high doses of diazepam. he was ultimately intubated for airway protection in the setting of withdrawal as described above. after extubation, he no longer required a ciwa scale. social work was consulted and arranged an alcohol rehab day program, in which he agreed to participate. # atrial fibrillation: he briefly developed af while septic, and this was thought to be secondary to a toxic-metabolic syndrome. he was briefly started on a heparin gtt in the ed presumably in case of need for cardioversion given his concurrent hypotension but he converted to sinus rhythm on hospital day 3. because of his chads score of 1, he was started on aspirin. he remained in sinus rhythm for the remainder of his hospital stay. # systolic dysfunction: he was found to have lvef of 35% in the setting of sepsis. though there were no prior echos to compare this ef with, the systolic dysfunction was thought to be secondary to myocardial stunning and toxic-metabolic syndrome. he was advised to undergo a repeat echo in weeks. # right adrenal nodule: he was found incidentally to have a 13mm right adrenal nodule. the size suggested a very low risk (<5%) of malignancy, and he had no evidence of pheochromocytoma, cushings, or disease. he was advised to undergo a follow-up imaging exam as an outpatient. medications on admission: diovan 160mg daily xanax one daily vitamin b12 folic acid cholesterol medicine - can't remember name discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 2. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). disp:*1 bottle* refills:*2* 3. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 8. valsartan 160 mg tablet sig: one (1) tablet po daily (daily). tablet(s) 9. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: pneumonia septic shock acute renal failure alcohol abuse and withdrawal discharge condition: good discharge instructions: you were admitted because of shortness of breath. we diagnosed you with pneumonia and shock from a bacterial infection in your bloodstream, and we treated you with antibiotics. we also helped you develop a plan to help overcome some of the problems you have had with alcohol. you will follow-up at: for partial hospitalization program. intake appointment tomorrow at 10:30am on . address is , , . phone . while you were here, you were noted (to have an abnormal heart rhythm called atrial fibrillation while you were in the icu, and we treated you with aspirin to reduce your risk of having a blood clot in your heart. you were also noted to have decreased heart function (also known as systolic ventricular dysfunction) and will need a follow-up echo (ultrasound of the heart) in four weeks. you were also found to have a 13mm nodule in your right adrenal gland that will also need follow-up. please take all of your medications as prescribed. please keep all of your follow-up appointments. your medications are attached to the following sheet but include aspirin , valsartan (for blood pressure), folic acid, thiamine, and sertraline. please call your doctor or return to the hospital if you experience fevers, chills, sweats, chest pain, shortness of breath or anything else of concern. followup instructions: please call your doctor an appointment within the next 2-4 weeks. during your admission, we incidentally identified a small nodule in your right adrenal gland. your doctor can determine what kind of follow-up is appropriate for this nodule and also address the issues noted above. pcp: , n. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube thoracentesis arterial catheterization other incision of pleura diagnoses: pneumonia, organism unspecified unspecified pleural effusion congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia severe sepsis atrial fibrillation other and unspecified hyperlipidemia acute respiratory failure septic shock abscess of lung acute systolic heart failure empyema without mention of fistula other and unspecified alcohol dependence, continuous other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria alcohol withdrawal delirium 

Answer: The patient is high likely exposed to