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: altered mental status major surgical or invasive procedure: mechanical ventilation arterial line cental line history of present illness: 69 m with small lung ca metastatic to brain on recent outpatient corticosteroid taper who was brought to the ed by ems after an acquaintance reported altered mental status. reportedly seen normal around 6:30-6:45 pm and then at 7:30 pm was confused, ataxic, and aphasic. on arrival in the ed, a code stroke was called. his initial oral temp was 100f. minimally responsive with left eye gaze. he was observed to havea an possible seizure activity, described as generalized tonic movements with eye deviation to the left only lasting 40 secs. given ativan 2 mg iv with resolution. respirations became more rapid and shallow so was intubated without complication given depressed sensorium after induction with etomidate and succinylcholine. sbp dropped to 80s with propofol sedation. subsequently spiked rectal temp 102.6. blood cx sent, given vanc 1 g, ctx 2 g iv. head ct showed right temporoparietal vasogenic edema signifying underlying lesion, no ich, and underlying small vessel ischemic disease. given dexamethasone 10 mg iv and dilantin 1000 mg iv after evaluation by neurology. also reportedly had coffee ground out of ngt - given protonix iv. vital signs prior to transfer 102.6 91 132/70 100% on vt 500 f16 peep 5 fio2 100%. . on the floor, pt arrived intubated unresponsive, sedated with propafol. vent settings were ac with volume control at 500vt, peep 5, fio2 of 100% which was decreased to 50%. . of note, pt was initially diagnosed with small lung cancer in . s/p 4 cycles fo chemo with cisplatin/etoposide, s/p radiation tx to mediastinum, hilum, and lung mass, s/p phrophylatic whole brain radiation. following brain mri in showed 2 metastatic lesions for which he received gamma knife to brain lesions. he has also developed horseness due to partially paralysed left vocal cord r/t cancer . review of systems: (+) per hpi, as per his daughter he was coughing the day before. (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. . past medical history: lung ca metastatic to brain hypercholesterol bph social history: pt lives independently with his son who has mental retartdation. he retired ~ 1 year ago around the time of his diagnosis. he has a daughter who is physician, on . he drinks on average 2-4 beers per day. he has >50 pack years smoking hx, he quit in . family history: nc physical exam: vitals: t: 98.3, hr 85, bp 142/69, rr 19, sat 100% on vent ( ac 500vt, peep 5, fio2 50%, rr 16 ) general: pale, with hue discoloration, cachetic, non-responsive in no acute distress heent: sclera anicteric, mm dry, ng tube to sx small amount of coffee ground fluid in the tube neck: supple, prominet ej, no lad lungs: clear to auscultation bilaterally, expect for crackles at the bases l >r. 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: foley-> bsd with clear yellow urine ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 08:23pm glucose-119* lactate-1.0 na+-135 k+-3.7 cl--93* tco2-30 urea n-14 creat-1.1 wbc-3.5* rbc-3.61* hgb-12.1* hct-34.7* mcv-96 plt count-264 pt-10.8 ptt-22.9 inr(pt)-0.9 fibrinoge-346 discharge labs: 09:00am wbc-4.3 rbc-3.67* hgb-12.0* hct-36.0* mcv-98 plt ct-269 glucose-84 urean-12 creat-0.8 na-138 k-3.9 cl-100 hco3-31 chest ct: 1. no pe identified. extreme lung bases were not imaged. 2. moderate bilateral non-hemorrhagic pleural effusions associated with basal atelectases. 3. spiculated nodule in the left upper lobe not significantly changed in size from with bronchial wall thickening and peribronchial opacities in the apical posterior segments in lul similar in appearance to prior study. 4. spiculated opacity in the right apex also without significant change. 5. paraseptal and centrilobular emphysema. 6. right hilar and subcarinal lymphadenopathy, increased in size from . head mri: there are two ring-enhancing parenchymal lesions. there is a 1.8 cm round lesion in the posterior right temporal lobe, which demonstrates evidence of chronic blood products on the gradient echo sequence. the rim of this lesion also demonstrates slow diffusion, which may indicate hypercellularity. the nonenhancing center of the lesion does not demonstrate slow diffusion, suggesting that this does not represent an abscess. there is moderate vasogenic edema involving the right temporal, occipital, and parietal lobes. the second ring-enhancing lesion is located in the posterior left temporal lobe. it is round, measuring 1.1 cm. there are no associated blood products or diffusion abnormalities. there is mild associated vasogenic edema. brief hospital course: 69 yo with metastatic small cell lung cancer who presents with change in ms, fever and seizeures who was found to have vasogenic edema. # seizure: intubated in ed for airway protection. mri showed two previously known metastatic lesions. he was evaluated by neurology and started on levetiracetam, dexamethasone, and phenytoin. he was also evaluated by radiation oncology. dilantin was tapered off as keppra was increased, and he is being discharged on keppra and decadon alone. if his steroids are to be continued long-term, he should be started on ca/vit d/bisphosphonate/bactrim. ppi continued at discharge but can be discontinued when steroids are stopped. the patient was instructed that he should not drive until he has been seizure-free for 6 months. # fever: initial concern for aspiration pneumonia vs. ventilator associated pneumonia. multiple chest x-rays showed no evidence of infection and antibiotics were stopped. he had no fevers while on the general medicine floor. # shortness of breath: patient had an acute episode of shortness of breath on after being laid flat for removal of a central line. he improved with supportive care alone. chest cta showed no evidence of emboli or infiltrates, but did show small bilateral pleural effusions, likely related to volume resuscitation in the icu. patient improved and had oxygen saturations of 97-99% on room air. medications on admission: mvi i tab once daily -mucinex 600mg twice daily -decadron 1.5 mg, 2 tablets last dose on -pepcid 20mg daily discharge medications: 1. dexamethasone 4 mg po/ng q8h disp #*30 day(s) refills:*0 2. levetiracetam 1000 mg po/ng disp #*30 day(s) refills:*0 3. pantoprazole 40 mg po q12h disp #*30 day(s) refills:*0 discharge disposition: home discharge diagnosis: lung cancer seizure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with seizures and were initially treated in the icu. you were started on steroids and anti-seizure medications and had no further witnessed seizures. while on the medical floor you had an episode of shortness of breath, which was thought to be secondary to mucous vs. fluid in your lungs. you had a chest ct which showed no evidence of infection or clot. followup instructions: please follow-up with your outpatient oncologist and radiation oncologist, and arrange follow-up with a neurologist as well. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization insertion of other (naso-)gastric tube diagnoses: unspecified septicemia personal history of malignant neoplasm of bronchus and lung other convulsions personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) sepsis acute respiratory failure secondary malignant neoplasm of brain and spinal cord cerebral edema unilateral paralysis of vocal cords or larynx, partial 

Answer: The patient is high likely exposed to