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: neck swelling. major surgical or invasive procedure: svc venogram with initiation of tpa therapy picc line placed in ir tpa cath check history of present illness: mr. is a 71-year-old man with adenocarcinoma of the rectum (diagnosed in ) who underwent neoadjuvant chemoradiation followed by proctosigmoidectomy and a left lower lobe resection for pathologically confirmed lung metastases. following two cycles of folfox chemotherapy, he underwent resection of a 1.7 cm solitary liver metastasis in . he then began further adjuvant therapy with 5fu/lv at 500 mg/m2. oxaliplatin was eliminated due to neuropathy. he started cycle 2 of 4 planned cycles of 5fu/lv on (one week prior to this admission). . he was admitted to omed for prehydration and ctpa following discovery of non-occlusive thrombus around his port and finding of hypoxia with tachycardia in clinic on day of admission. . he was seen at oncology clinic (day 8 of 5fu/lv) with neck swelling. he had been seen by his primary care physican two days prior and noted to have neck swelling, at which time a ct was done that showed non-occlusive clot around his port. the plan had been to start lovenox with ir clot stripping. however, when at clinic he was noted to be dyspneic with minimal exertion. his o2 sat dropped to 90% and hr up to 110 with ambulation. with rest hr down to 90's and o2 back up to 97%ra. decision was made to admit to hospital for further monitoring and work-up of pulmonary embolus. . on further review of systems, patient notes that he has been increasingly dyspneic with normal activities (lawn-moving, walking around house, to and from mailbox, etc) at home. he had attributed this to the chemotherapy he is recieving, as he has experienced these symptoms in the past in conjunction with chemotx. he denies symptoms of chf, including orthopnea, pnd, lower extremity swelling. he notes that he has had an mi in the past; also he has significant smoking history, history of hypertension, hyperlipid, and diabetes (diet-controlled?). he denies h/o palps, dizziness, cough, or fever, though does endorse intermittent lightheadedness that is neither exertional nor postional. past medical history: 1. hypertension. 2. hyperlipidemia. 3. ascvd, status post mi in status post ptca. 4. status post appendectomy. 5. diabetes. . past oncological history metastatic adenocarcinoma of the rectum - : the patient presented with a change in bowel habits and was noted to have an abnormal rectal exam by his primary care physician, gastrointestinal evaluation. - colonoscopy: exophytic cancer of the rectum 8-12 cm above the anal margin. polyp noted at the anorectal junction. biopsy: invasive, moderately differentiated adenocarcinoma arising in association with adenoma. polyp: adenoma with high-grade dysplasia. - rectal ultrasound: t3 posterior midline tumor with luminal narrowing of the rectum. - ct scan of the torso: irregular, polypoid lesion seen within the rectum, with multiple subcentimeter presacral and pericolic lymph nodes identified. two pulmonary nodules seen in the left lower lobe, the largest measuring 2.9 x 2.2 cm. multiple low-attenuation lesions seen within the liver, the largest of which may represent cyst, smaller lesions are not fully characterized. low-attenuation lesions seen within the left kidney, possibly a cyst, although too small to characterize. per report, a ct pet performed elsewhere demonstrated uptake in the left base of the lung. - to : neoadjuvant chemoradiation with continuous 5-fu at 225 mg/m2/day and radiation therapy five days weekly. - : proctosigmoidectomy with stapled coloanal anastomosis and diverting loop ileostomy. pathology revealed adenocarcinoma of the rectum, low-grade, with invasion into the perirectal adipose tissue and metastasis to 7 of 13 regional lymph nodes (t3n2). the resection margins were uninvolved. - pet scan: interval progression of disease with an increase in the size of the previously identified lung metastasis. there is a new fdg-avid focus in segment 4a of the liver which most likely represents metastasis. - : ileostomy takedown with simultaneous flexible bronchoscopy and vats with left lower lobe resection. pathology from the ileostomy stoma demonstrated findings consistent with ileostomy stoma with no evidence of malignancy. the left lower lobe wedge resection demonstrated an adenocarcinoma, 4.1 cm, consistent with metastasis of rectal origin. the pleural and apparent stapled margins were free of malignancy. - : evaluation by the hepatobiliary surgery consult team due to the finding on his recent pet scan of a likely liver metastasis. it was felt that the lesion was amenable to surgical resection, and it was planned that the patient would undergo two cycles of chemotherapy prior to proceeding with hepatic resection. - : folfox chemotherapy initiated. the patient completed two cycles of therapy on . - : hepatic resection of a 1.7cm segment 4a metastatic lesion by dr. . - : cycle 1 day 1 5fu/lv for further adjuvant chemotherapy. oxaliplatin eliminated due to neuropathy. - : presented to clinic to begin cycle 2 of 5fu/lv for his resected colon cancer. social history: the patient is divorced and has three sons in their 40s. he is a construction inspector. he denies alcohol and uses no illicit drugs. he smoked one pack of cigarettes daily for approximately 30 years before quitting in . family history: the patient's maternal uncle had an abdominal cancer, details unclear. his father died of an mi. his mother died of disease. he has two brothers who are well. physical exam: physical exam at admission vitals: bp 133/63, hr 90, rr 14, sat 95% gen-well appearing man, nad, appears stated age, ruddy complexion heent-nc/at, perrla, eomi, +plethoric face/ruddy complexion, anicteric, mmm neck-swelling without obvious jvd, no lad, supple chest-b/l ae no w/c/r heart-s1s2 rrr no m/r/g abd-+well healed abdominal surgical scars, +bs, soft, nt, nd ext-no c/c/e, l.arm-with instrumentation 1+edema, 2+pulses neuro-aaox3, cn2-12 intact, non-focal . physical exam at discharge gen awake, alert and oriented; nad; breathing and speaking comfortably in bed heent decreased facial swelling/redness from admission lungs cta bilaterally obese, non-tender neuro cn ii-xii grossly intact, strength 5/5 and symmetric upper and lower extremities pertinent results: labs on admission 11:10am wbc-7.2 rbc-3.96* hgb-12.5* hct-34.3* mcv-87 mch-31.6 mchc-36.5* rdw-17.9* 11:10am plt count-226 11:10am pt-13.2 inr(pt)-1.1 11:10am gran ct-4860 . labs on transfer out of icu 04:30am blood wbc-7.6 rbc-3.54* hgb-11.2* hct-31.0* mcv-88 mch-31.6 mchc-36.1* rdw-19.6* plt ct-134* 08:07am blood pt-14.2* ptt-34.8 inr(pt)-1.2* 04:30am blood glucose-146* urean-21* creat-1.2 na-137 k-4.3 cl-104 hco3-25 angap-12 04:30am blood alt-27 ast-31 alkphos-121* totbili-1.1 04:30am blood albumin-3.6 calcium-8.6 phos-3.4 mg-2.2 . cta chest: impression: 1. no gross pulmonary embolism, subject to suboptimal pulmonary arterial opacification. that if evaluation of pe is needed in the future, it should be evaluated by ivc rather than upper extremity injection. 2. svc thrombosis with extension in right and left brachiocephalic veins. left inferior pulmonary vein thrombosis. 3. new and enlarging lung nodules, worrisome for metastasis. 4. unchanged unevenly distributed subpleural fibrosis, could be drug related. 5. prior left lower lobe wedge resection and partial liver resection with no signs of local recurrence. 6. unchanged t4 lesion since of indeterminate clinical significance. . tte: the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. there is moderate regional left ventricular systolic dysfunction with severe hypokinesis/akinesis of the inferior, inferolateral and basal inferoseptal segments (proximal rca lesion). the remaining segments contract normally (lvef = 35-40%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. there is no aortic regurgitation .the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: moderate regional left ventricular systolic dysfunction, c/w cad. mild mitral regurgitation. . ct head: normal non-contrast head ct with no evidence of metastasis. if metastasis is of clinical concern, mr is a more sensitive modality for the evaluation of intracranial metastasis. . pta venous impression: 1. repeat svc venogram demonstrated flow improvement in the svc with no collateral veins across the midline. 2. venous angioplasty with balloon dilation with further improvement of the flow in the svc. plan: heparin infusion to further declot the residue clots in the svc and may switch to coumadin in the near future to prevent the development of clots in the svc. brief hospital course: in summary, this is a 71 year-old man with history of metastatic colon cancer s/p multiple surgeries, including proctosigmoidectomy, lung and liver resections, now on cycle 2 of 5 fu/lv presenting from clinic with hypoxia, tachycardia and dyspnea with mild exertion. . dyspnea on exertion / hypoxia differential diagnosis at admission included pulmonary embolism, pulmonary infectious process, svc syndrome, and chf (given cardiac risk factors). after prehydration, ctpa was done that showed svc thrombosis with extension into the right and left brachiocephalic veins. there was no pulmonary arterial embolism. patient was started on heparin drip. pulmonary service was consulted and agreed that given imaging findings and history of facial swelling and redness, svc syndrome was a very likely explanation for his symptoms. ir was then consulted and planned for intravenous thrombolysis to break-up clot. prior to procedure, ct head was done that showed no intracranial metastases. . on , patient underwent local thrombolytic tx to the svc clot and was transferred to the icu for overnight monitoring. he returned to the floor the following day with significant improvement in symptoms. his facial swelling had improved also. he was seen by physical therapy on day prior to discharge and cleared for discharge to home. . he is discharged on lovenox injections 1 mg/kg , which he will likely need to continue for 6 months. he will follow-up with his outpatient oncologists, dr. and dr. . . low platelets platelets were downtrending at time of discharge. there is concern of hit given that he was on heparin throughout hospitalization, although his platelet count is still high at 117 (and there were several fluctuations in platelet levels from day to day). we have asked that vna visit him two days after discharge. his cbc will be faxed to his primary oncologist. if his platelet count continues to fall, he may need readmission and bridging to coumadin with dti like argatroban. . metastatic colorectal adenocarcinoma on cycle 2 of 5fu/lv; further plan for chemotherapy is per dr. and dr. . . hypertension we continued his outpatient beta-blocker while hospitalized. acei was held for concern of worsening renal failure in setting of multiple contrast loads for ctpa and intravenous thrombolysis. . chronic congestive heart failure full echocardiogram report is above. findings are consistent with cad and sytolic dysfunction. he is on a bb, statin, and acei. aspirin is being held in the setting of receiving chemotherapy. this can be restarted per his oncologist's recs. . hyperlipid we continued his outpatient statin. . diabetes mellitus (?diet-controlled?) his blood sugars were persistently elevated during hospital course. he required 12 units of glargine hs and was placed on humalog sliding scale. hemoglobin a1c came back at 7.7. i spoke with him regarding follow-up with his primary physcian and told him there are medications that could help with blood sugar control. he knows to address this issue at his next outpatient visit. . peripheral neuropathy we continued his outpatient vitamin b6. . he was kept on a cardiac diet. heparin drip was given for svc thrombus with switch to lovenox at discharge. his code status remained full code throughout hospital course. medications on admission: # atorvastatin - 20 mgtablet - 1 tablet(s) by mouth daily # lisinopril - 10 mg tablet - 1 tablet(s) by mouth daily # metoprolol succinate - 100 mg sr # vitamin b12 50 mg discharge medications: 1. lovenox 100 mg/ml syringe sig: one (1) subcutaneous twice a day. disp:*60 syringes* refills:*2* 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 3. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 4. pyridoxine 50 mg tablet sig: one (1) tablet po daily (daily). 5. lisinopril oral 6. outpatient lab work patient needs cbc on friday and faxed to dr. at (. discharge disposition: home with service facility: , discharge diagnosis: primary diagnosis superior vena cava syndrome non-occlusive thrombus in the superior vena cava . hypertension hyperlipidemia diabetes, diet-controlled discharge condition: vitals signs stable. satting fine on room air. discharge instructions: you were hospitalized for treatment of a blood clot in a vein leading into your heart. you underwent a procedure to help dissolve the clot. we have started you on a medicine called lovenox to help prevent any clots from forming again. you will likely need to take this medicine for 6 months but should follow-up with your oncologist, dr. , to determine exactly how long. you have been instructed on how to administer this medicine by injection. . you will need to have your blood drawn on friday by the visiting nurses. the results will be faxed to dr. , and she will call you with any concerns. . we noticed during this hospitalization that your blood sugars were high. you should discuss this with your primary care physician, discuss whether there is any need to begin medical treatment for diabetes. . your follow-up appointments at are below. . please return to the emergency room or call your doctor if you have any fever, any worsening shortness of breath followup instructions: , md phone: date/time: 9:00 , rn phone: date/time: 10:00 procedure: venous catheterization, not elsewhere classified angioplasty of other non-coronary vessel(s) injection or infusion of thrombolytic agent angiocardiography of venae cavae angiocardiography of venae cavae procedure on single vessel diagnoses: thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of tobacco use percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure compression of vein old myocardial infarction other complications due to other vascular device, implant, and graft secondary malignant neoplasm of lung personal history of malignant neoplasm of liver unspecified hereditary and idiopathic peripheral neuropathy tachycardia, unspecified other venous embolism and thrombosis of inferior vena cava secondary and unspecified malignant neoplasm of lymph nodes, site unspecified 

Answer: The patient is high likely exposed to