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: aspirin attending: chief complaint: generalized tonic-clonic seizures major surgical or invasive procedure: none history of present illness: 61m who presents after a generalized tonic-clonic seizure at home on the morning of admission. according to patient's wife, he was in bed on the morning of admission when his whole body began to shake uncontrollably and he began foaming at mouth. the episode lasted approximately 15 minutes before resolving spontaneously. the patient's wife states that the patient has had low grade fevers and a weight loss of 15 pounds over the past month. for the past 3 days the patient has been experiencing night sweats. he has never experienced a seizure prior to the morning of admission. . as the patient was being transferred into the ambulance, he began seizing once again. he was given 2 mg ativan x 2, after which time the seizure stopped; however, the patient's respiratory status deteriorated quickly requiring rsi. on arrival to ed, vs: t 100.8 rectal 106 24 100% on vent. he was moving all extremities. labs were significant for wbc 28.3, lactate 10.2, inr 1.4. the patient was given vecuronium in order to obtain a head ct. ct head showed large mass centered in left frontal sinus with lytic bony destruction and posterior extention into left frontal lobe. neurology was consulted, who recommended an mri w/ and w/out contrast to r/o an infectious process. neurosurgery was consulted who agreed with stat mri. decision was made not to lp patient in ed given low likelihood of infection. cxr showed a large right hilar pulmonary mass causing post obstructive atelectasis. the patient was given ceftriaxone and azithromycin. he was given fosphenytoin 1000 mg and dexamethasone 10 mg iv x 1. vent settings on transfer were: fio2 100%, rr 24, peep 5, o2 100%. . according to omr notes, the patient was admitted to 3 weeks prior with flu-like symptoms and r shoulder pain. his cxr showed a rul consolidation, however there was concern for an underlying lesion on a ct. he was treated witha course of augmentin. after discharge from the hospital, he continued to have low-grade fevers and night sweats. he had a bronchoscopy performed at on friday along with a biopsy of a presumed lesion. the pathology results are pending at this time. past medical history: - recent rul pneumonia and likely underlying mass - hypertension - hyperlipidemia social history: lives in , ma. on disability due to back pain from merchant marines. quit smoking in - smoked from teenage years. 1 drink/night. no illicit drug use. family history: mother - died in old age father - prostate cancer physical exam: admission physical exam: vitals: t: 36.7 bp: 123/72 p: 90 general: intubated, sedated heent: perrl 4 to 3mm and brisk, et tube in place neck: jvp not elevated lungs: diminished bilaterally, no wheezes, rales, ronchi cv: rrr, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no edema discharge physical exam: pertinent results: admission labs: wbc-28.6* rbc-3.95* hgb-11.0* hct-35.2* mcv-89 mch-27.9 mchc-31.3 rdw-13.9 pt-14.6* ptt-31.2 inr(pt)-1.4* fibrinoge-969* asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg urine blood-sm nitrite-neg protein-30 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg rbc-1 wbc-1 bacteria-none yeast-none epi-0 urea n-19 creat-1.1 glucose-204 lactate-10.2 na-139 k-4.6 cl-105 tco2-16 csf wbc 150 rbc poly 89 lymph 11 mono 0 eos total protein 119* glucose 83 ldh 21 hsv pcr- negative negative for malignant cells on cytology microbiology: blood culture ()- x3, no growth to date csf ()- cultures gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. fungal culture (preliminary): no fungus isolated. viral culture (preliminary): no virus isolated. aspergillus galactomannan- negative beta glucan- negative imaging: ct head w/o contrast ()- large predominantly hyperattenuating mass centered in the left frontal sinus associated with aggressive lytic osseous destruction and posterior extension into the left frontal lobe, most concerning for neoplastic process, particularly given known right lung mass. supervening infection must be considered. recommend correlation with prior exams when available, and mri for assessment of full disease extent. mri head w&w/o contrast ()- large heterogeneously enhancing mass in the frontal sinus with intracranial extension and destruction of inner and outer tables of the frontal sinus, bilateral cribriform plates and invasion of the anterior portion of the superior sagittal sinus. in view of history of lung mass, this is likely to represent metastasis. however, a primary sinus neoplasm with intracranial lesion cannot be entirely ruled out. wegener's granulomatosis is another differential consideration. ct head w&w/o contrast ()- large peripherally enhancing mass centered predominantly in frontal sinuses with associated vasogenic edema and mild mass effect on the frontal of the left lateral ventricle. adjacent bones demonstrate a permeative destructive pattern. the above findings are most compatible with metastatic disease, given the reported history of right upper lung mass lesion. alternative differential considerations include aggressive infectious, inflammatory processes or a primary sinus neoplasm. eeg ()- this portable bedside eeg gives evidence for focal slowing in the left frontal quadrant compatible with a structural lesion of that area with superimposed high voltage interictal epileptiform transients in the left frontal polar region and short runs of brief electrographic seizure activity that were without any obvious clinical accompaniment. eeg ()- this eeg gives evidence for a focal slow wave abnormality over the left frontal polar region suggestive of a subcortical/cortical junctional structural abnormality. superimposed upon this are frequent epileptiform discharges in short runs of epileptic activity without a clear clinical accompaniment. ct abd/pelvis ()- 1. right hilar mass with mediastinal invasion and a right paratracheal mass or nodal conglomeration. probable malignant right pleural effusion. bilateral adrenal metastasis, left greater than right. 2. near complete collapse of the right upper lobe due to bronchial obstruction. partial compression of the right lower and right middle lobe bronchi with resulting areas of postobstructive pneumonia in the right lung. 3. indeterminate right renal mass. the differential would include metastatic disease to the right kidney or a primary renal lesion and biopsy should be considered to help differentiate between these two possibilities. 4. soft tissue nodule posterior to the left psoas muscle in the retroperitoneum. ct chest ()- 1. right hilar mass with mediastinal invasion and a right paratracheal mass or nodal conglomeration. probable malignant right pleural effusion. bilateral adrenal metastasis, left greater than right. 2. near complete collapse of the right upper lobe due to bronchial obstruction. partial compression of the right lower and right middle lobe bronchi with resulting areas of postobstructive pneumonia in the right lung. 3. indeterminate right renal mass. the differential would include metastatic disease to the right kidney or a primary renal lesion and biopsy should be considered to help differentiate between these two possibilities. 4. soft tissue nodule posterior to the left psoas muscle in the retroperitoneum. fusion protocol maxillofacial ct ()- unchanged nsclc metastasis in the frontal sinus with destruction of surrounding osseous structures and invasion into the ethmoid air cells and frontal lobe of the brain. ct neck w/contrast ()- no evidence of metastasis in the neck. discharge labs: 06:00am blood wbc-63.3* rbc-3.50* hgb-9.8* hct-31.5* mcv-90 mch-27.9 mchc-30.9* rdw-14.1 plt ct-386 05:30am blood wbc-53.4* rbc-3.34* hgb-9.4* hct-30.4* mcv-91 mch-28.1 mchc-30.8* rdw-14.7 plt ct-405 05:45am blood neuts-93.1* lymphs-4.7* monos-1.7* eos-0.4 baso-0.1 05:30am blood glucose-88 urean-10 creat-0.8 na-141 k-4.0 cl-107 hco3-26 angap-12 05:45am blood phenyto-10.2 05:51am blood lactate-1.5 brief hospital course: 69m with recently bx confirmed nslc presenting with new onset seizures, cxr evidence of post-obstructive pneumonia and ct findings of left frontal brain mass. #. respiratory distress: in the ed, patient was initially intubated as he was somnolent likely due to benzodiazepine dosing to decrease seizures. patient remained intubated on the day of admission as he was undergoing many ct/mri scans and there was potential for ent procedure in the nasopharynx. patient was moving all four extremities and responding to commands throughout his intubation. he was extubated successfully on hd1 and was weaned off of nasal cannula by hd2. #. seizures: patient presented with generalized tonic clonic seizures. he had no history of prior seizures and toxicology screens were negative. ct scan of head in the ed showed a large mass in the frontal lobe. with further imaging (mri, ct with contrast, fusion maxillofacial ct), it was noted that the mass invaded through the bone into the frontal sinus and ethmoid air cells. patient has known rul mass, so concern that brain mass was metastatic lesion, however, as lesion crossed midline and invaded through bone, it did not follow pattern of typical hematogenously spread met. patient was loaded with dilantin in the ed, and kept on eeg in the icu. he had no further clinical seizures, but on eeg continued to have subclinical focal seizures in the frontal lobe. dilantin was titrated up for goal trough >15. on hd2, patient was no longer having seizures per eeg, so eeg was discontinued. lp performed on day of admission was not consistent with an infectious process. ent was consulted and did not feel that it was safe to biopsy this lesion, given invasion through bone and risk for post-procedure csf leak. patient was started on dexamethasone to decrease vasogenic edema. # rul and sinus mass: patient had a recent admission at with pneumonia. cxr showed a right upper lobe mass, which was followed by a ct scan which showed the same, with resulting post-obstructive pneumonia. patient was treated with antibiotics, and underwent bronchoscopy with biopsies of mass. preliminary reports of this biopsy showed poorly differentiated non-small cells. pathology and ct imaging was sent from for further interpretation. regarding newfound pulmonary mass, it was felt by neurosurgery and ent at that the location of the mass made a biopsy too high-risk of a procedure. pt was seen by neuro-onc and rad-onc, discharged with follow up appt with rad-onc to begin xrt to sinus mass. of note, pathology was confirmed at and showed that the lung mass was poorly differentiated adenocarcinoma. block was sent for k-ras, alk, and egfr mutations. # leukocytosis/fever: elevated white count thought to be partly due to stress response, however, cxr with large post-obstructive pneumonia. patient was treated for hospital acquired pneumonia with vancomycin, cefepime and flagyl sent home with augmentin to finish a 7 day course. a picc line was placed for iv antibiotic administration in house but was pulled before discharge. blood and csf cultures showed no growth to date. it was felt that a large component of this leukocytosis was secondary to a leukemoid reaction in the setting of pulmonary malignancy. # hypertension: normotensive throughout admission, requiring only fluid boluses, never pressors. home antihypertensives were held. # hyperlipidemia: held home statin transitional issues: pt to follow up with dr. , neuro-oncology, dr. (rad-onc) and dr. . . path sent for tumor marker studies, pending at the time of discharge. medications on admission: - lisinopril/hctz 20/12.5 mg - simvastatin 5 mg daily - amlodipine 5 mg daily discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for headache. 2. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*2* 4. polyethylene glycol 3350 17 gram/dose powder sig: one (1) dose po daily (daily) as needed for constipation. 5. dexamethasone 4 mg tablet sig: one (1) tablet po as directed: take three tabs daily on , , and . take two tabs daily until follow up with dr. . disp:*50 tablet(s)* refills:*1* 6. amoxicillin-pot clavulanate 875-125 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 15 days. disp:*30 tablet(s)* refills:*0* 7. phenytoin sodium extended 100 mg capsule sig: two (2) capsule po bid (2 times a day). disp:*120 capsule(s)* refills:*0* 8. zolpidem 5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed for insomnia. disp:*45 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnoses seizures non-small cell lung carcinoma mass in frontal brain and ethmoid sinus area secondary diagnoses hypertension hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you during your recent hospitalization. you were admitted to the icu after having a seizure, and a large mass was found in the sinus area of your head communicating with the brain, which was most likely the cause of the seizures. it was decided that it would be unsafe to biopsy in this area, and most likely this was the same kind of tumor as the one in your lung. you will have follow up with radiation oncology and thoracic oncology to determine the best course of treatment. we also started antibiotics out of concern for pneumonia and we will send you home with antibiotics to continue a 14 day course. we sent you home with anti-seizure medicine (dilantin) and steroids (dexamethasone) to decrease swelling in the head. the following changes were made to your medications: started dilantin 200mg by mouth twice a day(for seizures) started dexamethasone 4mg by mouth three times a day for 7 more days, then twice a day until follow up with dr. . take this 3 times a day but before 4pm otherwise it will keep you up all night!) (to decrease inflammation in lungs and brain - started ambien (for sleep - we gave you trazodone originally which gave you heartburn so switched to ambien) started augmentin 875mg my mouth twice daily (antibiotic for pneumonia) started tylenol for headaches started docusate and senna (for constipation) in summary, the complete list of your medications is: followup instructions: please follow up with the radiation oncology appointment below. radiation oncology appointment: 11:15a xct (h3) gz building (/ complex), radiology you will have a follow up appointment with dr. , neuro-oncology. his office will call to schedule an appointment, but if you don't hear from them in 2 business days, the number is: ( . you will also have an appointment with dr. . you will also be called about the scheduling of that appointment. if you do not hear from anyone in 2 business days please call his office to schedule at . . please call dr. office on monday to schedule a follow-up appointment with him this week. you will need to have a dilantin level checked at that visit. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified unspecified essential hypertension personal history of tobacco use other and unspecified hyperlipidemia acute respiratory failure secondary malignant neoplasm of brain and spinal cord malignant neoplasm of upper lobe, bronchus or lung grand mal status swelling, mass, or lump in head and neck lumbago secondary and unspecified malignant neoplasm of intrathoracic lymph nodes secondary malignant neoplasm of other respiratory organs meningitis, unspecified secondary malignant neoplasm of adrenal gland 

Answer: The patient is high likely exposed to