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: history of present illness: this is a 72 year old male with transitional cell metastatic carcinoma of the left kidney receiving chemotherapy, diverticulosis and asthma, who presented with black stools. the patient states that four days ago he was bearing down secondary to constipation and had some dark black stools. this continued to go on for one to two times per day for three days. he had positive nausea when standing which was associated with some dizziness. he denies any hematemesis, denies any abdominal pain. he still managed to have a good appetite. early the morning of admission, the patient experienced one episode of chest pressure for several minutes with some shortness of breath that then resolved on its own. the pain itself is not associated with nausea, vomiting or diaphoresis. the pressure did not radiate. he has had no similar episodes of chest pain in the past. of note, the patient had an esophagogastroduodenoscopy, colonoscopy in , for workup of melanotic stools that demonstrated prior peptic ulcer disease, diverticulosis of the sigmoid colon and polyps in the rectum and hepatic flexure. the gastrointestinal workup was after two cycles of gemcitabine and cisplatin which were stopped for the gastrointestinal evaluation. the patient was started on cycle number three of his chemotherapy prior to admission. the patient has had a history of peptic ulcer disease and upper gastrointestinal bleed with hematemesis fifteen years ago. in the emergency department, the patient was given nasogastric lavage which was negative for blood or bile and received two units of packed red blood cells and 40 meq of potassium chloride before transfer to the floor in stable condition. past medical history: 1. transitional cell carcinoma of the left kidney, most likely metastasis to the left periaortic and aortocaval nodes. status post a left nephrectomy , on cycle number three of his chemotherapy. 2. asthma with p.r.n. inhalers at home. 3. gout and on colchicine and allopurinol at home. 4. occult gastrointestinal bleed , status post esophagogastroduodenoscopy , and colonoscopy . the patient has a history of diverticulosis and colonic polyps with adenoma at hepatic flexure, hyperplastic rectal polyp with biopsy negative. 5. history of peptic ulcer disease fifteen years ago. 6. superficial bladder cancer, status post bcg treatments . social history: the patient has positive tobacco history for greater than fifty years. he drinks wine with his medications, about two glasses per day. he lives with his wife and has two children. family history: mother died at age of 96 and father died with an accidental death. allergies: he has no known drug allergies. medications on admission: 1. allopurinol. 2. colchicine. 3. p.r.n. albuterol. 4. the patient is not on aspirin nor coumadin therapy. physical examination: on physical examination, temperature is 99.3, heart rate 94, blood pressure 134/47, respiratory rate 25, and oxygen saturation 99% in room air. generally, the patient is pleasant and in no acute distress. head and neck examination - pale sclera. left eye with pterygium. the pupils are equal, round, and reactive to light and accommodation. extraocular movements are intact. cranial nerves ii through xii are grossly intact. jugular venous pressure to midneck. the neck is supple, positive lymphadenopathy in the submandibular glands, 2+ carotid pulse bilaterally, no bruits. cardiac examination - regular rate and rhythm, ii/iv crescendo decrescendo midpeaking murmur at the right upper sternal border radiating to the carotids and a ii/iv holosystolic murmur radiating to the axilla with laterally displaced point of maximal impulse. pulmonary examination - bilaterally expiratory wheezes with no crackles. abdomen was soft, nontender, nondistended, normoactive bowel sounds, no bruits, well healed midline surgical scars. extremities - feet warm to touch, palpable pedal pulses with no edema. laboratory data: on admission, white blood cell count was 2.9, hematocrit 13.0 and platelets 51,000, mcv 94. sodium 140, potassium 3.2, chloride 107, bicarbonate 23, blood urea nitrogen 38, creatinine 1.1 and glucose 141. complete blood count differential 31 neutrophils, 3 bands, 53 lymphocytes. prior studies on , esophagogastroduodenoscopy showed a normal esophagus and normal duodenum. the pylorus suggested prior peptic ulcer disease. the colonoscopy dated on , showed diverticulosis of the sigmoid, polyps in the rectum and polyps in the hepatic flexure. he had grade ii internal hemorrhoids. electrocardiogram done on , showed normal sinus rhythm, 95 beats per minute, normal axis and normal intervals. no st elevation, 2. depression in v3 through v6. left ventricular hypertroph. flattened t wave in lead i. chest x-ray on , showed no infiltrates and no heart failure. hospital course: the patient was given an esophagogastroduodenoscopy and colonoscopy to find the source of possible gastrointestinal bleed. the most likely cause was a bleeding arteriovenous malformation that was between the second and third portion of the duodenum. he was transfused a total of seven units with his hematocrit stabilizing in the low 30s. there was no further evidence of active bleeding. his stools were turning brown. ct of the abdomen was reported as negative for metastatic disease. the patient had another episode of chest pain on , with no associated symptoms. the vital signs were unchanged. the chest pain was described as substernal and did not radiate and lasted for a few minutes. electrocardiogram at that time showed normal sinus rhythm at 90 beats per minute, normal intervals, normal axis, v4 to v6 with normalization of st as compared to admission electrocardiogram which showed 2. depression in v1 to v6; otherwise was unchanged. the patient then had a second episode of chest pain overnight on , and again with no changes. his cardiac panel at that time showed a ck of 97, followed by 132, 128, ck mb 12 and then 10, ck mb index 9.1 and then 7.8 and troponin of 15.0 and 15.8. the patient was considered to have ruled in for myocardial infarction. an echocardiogram was done which showed the left atrium mildly dilated with left ventricular cavity normal. overall left ventricular function was mildly depressed with posterior hypokinesis. the aortic valve was mildly thickened, mitral valve was moderately thickened, severe 4+ mitral regurgitation, mild pulmonary arterial systolic hypertension. the patient's cardiac ischemia was thought to be most likely due to demand ischemia secondary to a profoundly low hematocrit of 13.0 upon presentation. the patient was placed on lopressor and lisinopril. aspirin was held in view of the gastrointestinal bleed. the patient had thrombocytopenia with platelets on presentation of 51,000. this was thought to be secondary to his chemotherapy and also to his bleeding and climbed nicely during his hospital stay. the patient's asthma was stable throughout his hospital stay on albuterol as needed and atrovent as needed for his wheezing on , the patient was considered stable for transfer to the medicine floor. during this point, his hematocrit was 30.8, platelets were 151,000. the patient had no further gastrointestinal events and no further cardiac events and was ready for discharge, however, the patient then spiked a temperature and was found to be neutropenic with white blood cell count of 1.1 and absolute neutrophil count of 350. an erythematous right arm was noted and his right intravenous line was removed. the patient also had some crackles on the left lower base during lung examination and was given a chest x-ray which showed left lower lobe consolidation possibly consistent with atelectasis or infiltrate. the patient was placed on levaquin 500 mg q.d. and neutropenic precautions. ceftazidime 1 mg q8hours was added at this time and after consultation with oncology staff, the patient was placed on gcsf. the white blood cell count increased gradually from 1.1 to 4.3 and then to 8.5. his neutrophil count came up from 350 to and then 5320 after doses of gcsf. the patient's ceftazidime was discontinued at this time. the patient was considered to be stable for discharge and was discharged on , with follow-up recommended on , with his outpatient oncologist in order to get a blood draw to check for his current anc and white blood cell count levels with possibility of needing another injection of gcsf. medications on discharge: 1. levaquin 500 mg q.d. for ten more days making a total course of fourteen days. 2. metoprolol 25 mg b.i.d. 3. lisinopril 5 mg b.i.d. 4. protonix 40 mg q.d. 5. albuterol two to four puffs p.r.n. as needed for wheezing. 6. colace 100 mg b.i.d. as needed for constipation. 7. prevpac one dose per day for ten days for positive h. pylori test. the patient developed a red eye three days prior to discharge which was consulted with ophthalmology. the patient was diagnosed with subconjunctival hemorrhage likely secondary to thrombocytopenia and severe anemia. recommended for lubrication and monitoring. the patient was discharged with a prescription for lacri-lube artificial tears one drop in the left eye as needed for redness. condition on discharge: good. discharge status: to home. discharge diagnoses: 1. upper gastrointestinal bleed. 2. febrile thrombocytopenia. 3. pneumonia. follow-up: with his primary care physician , dr. , and , with cardiologist, dr. . , m.d. dictated by: medquist36 procedure: other endoscopy of small intestine diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified mitral valve disorders gout, unspecified asthma, unspecified type, unspecified malignant neoplasm of kidney, except pelvis angiodysplasia of intestine with hemorrhage acute myocardial infarction of unspecified site, initial episode of care secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes 

Answer: The patient is high likely exposed to