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: transfer from for worsening hypoxia major surgical or invasive procedure: none history of present illness: the patient is a 49yom with advanced anorectal carcinoma s/p anterior pelvic resection and colostomy, xrt and chemo with a recent admission to for metastatic mets to the spine () who presented to on with 3 days of nausea, vomiting and increasing shortness of breath and dry cough. on initial evaluation at , o2 sats were found to be 88% on ra. admission cxr revealed what was thought to represent b/l pneumonia so he was started on levofloxacin. wbc was elevated to 17k with 93% neutrophils at that time. a ct chest performed on showed diffuse b/l reticularity, b/l lower lobe dense consolidation vs. atelectasis and b/l effusions. . over the course of his stay, o2 requirement increased daily from 2l->3l-->5l and then last evening he was placed on nrb. he received 10mg iv lasix last evening without improvement in respiratory status. additionally, he was tranferred to the icu and was placed on bipap overnight with some decrease in wob. cta chest was ordered at today to r/o pe, but pt. was unable to tolerate laying flat, less because of worsened dyspnea, more as a result of severe back pain to his bony mets. given suspiscion for pe, he was started empirically on heparin gtt prior to transfer. . most recent abg prior to transfer while on nrb was 7.48/29/57. . ros: + fatigue, + anorexia, no fevers and chills. he does endorse dry mouth. no chest pain. he has been having some lower extremity edema (l>r) without orthopnea or pnd. he does say he has been having shortness of breath over the past few days with cough, but not prior to this. nausea and vomiting has improved, but not taking good po given need for nrb/bipap. no current lower back pain. past medical history: pmh: # anal/rectal cancer, metastatic to spine t12,l1,l3,l4 and paraspinal retroperitoneal mass around l2, mets to lungs, liver # rectal fissure # hearing impaired, wears hearing aids . onc hx: diagnosed in by rectal mass resection and biopsy demonstrating anal adenocarcinoma, he received chemoradiation with mitomycin and 5-fu up until of this , and had an anterior pelvic resection and pathology revealed a t3, n0 adenocarcinoma. he then received adjuvant 5-fu and leucovorin, which was completed on . in he noticed some new lumps above his left clavicle. he had a x-ray of the clavicle done which was unremarkable. biopsy of a left cervical node that was consistent with his anal adenocarcinoma, and he was then treated with folfox and avastin winter . patient tolerated these treatments reasonably well, but did experience prolonged myelosuppresion (low plts) and due to adequate response, the treatment was stopped. last dose in , cycle initiated . social history: married, lives in with wife, no children, works as physicist, cat at home. no tobacco, social etoh. family history: mother deceased , stroke and pancreatic ca physical exam: pe: t 98.9 hr 128 bp 100/65 rr 30-38 o2 sat 91-96% nrb heent: perrl, dry mm neck: large left sided supraclavicular ln, neck supple cv: sinus tachy, no mrg apprec. resp: decreased bs bibasilar, crackles mid lateral lung field (unable to sit pt. fully forward ) abd: ostomy bag with liquid brown output ext: nonpitting edema lle, no palpable cord nor calf pain, rle w/o edema, 2+ dp/pt pulses b/l neuro: cn 2-12, strength, sensation grossly intact pertinent results: cxr at osh: new bibasilar patchy opacities, most likely representing an underlying pneumonia. . ct chest from osh: interval increase in pulmonary metastases and hepatic metastases. development of hilar and mediastinal lymphadenopathy. interval development of bilateral pleural effusions, underlying atelectasis or consolidation. interval increase in periaortic lymphadenopathy. development of large left supraclavicular lymph node. . ekg: sinus tachy to rate of 135, nml axis, no significant st/t wave changes. . bilateral le doppler us: neg for dvt . lue doppler us: neg. for dvt brief hospital course: the patient is a 49yom with h/o of metastatic anorectal ca to spine, liver, lungs presents with worsening hypoxia in the setting of nonproductive cough. he was found to have probable lymphangitic spread of metastatic disease and transferred to for close respiratory monitoring and possible chemotherapy. hospital course by problem is as follows: . # hypoxic/hypercarbic respiratory distress: in review of chest ct, reticular pattern appears c/w lymphangitic spread of his disease and was likely the major precipitant in the decompensation of his respiratory status. had been on face mask, but clinical evidence of increasing resp distress persisted(increased work of breathing, increased o2 requirement, tachycardia), and the patient was intubated on for worsening respiratory distress and hypercarbia. broad spectrum antibiotic coverage with zosyn, vancomycin, and azithromycin was initiated on admission for a question of pna on admission cxr with leukocytosis and left shift. . # fever: the patient spiked temperatures to 101s-102s during hospital course. there was no clear source of fevers. infectious etiology was a possibility (e.g. vap), but it was difficult to assess for new infiltrate on cxr and the patient was on broad-spectrum antibiotics (zosyn, vancomycin, and azithromycin) for the duration of admission. all cultures were negative to date. dvt/pe was considered with lue swelling on exam; however doppler us was negative for dvt. etiolgy may be related to fever of malignancy. . # sinus tachycardia: the patient demonstrated sinus tachycardia for the duration of admission. etiology was most likely physiologic (tachypnea, fever, profound hypoxemia) with stable hemodynamics. there was lack of response to ivf boluses, making hypovolemia less likely. this was monitored closely for concern for development of tachyarrythmia. . # metastatic anorectal ca: last chemo in 2/. with known metastatic disease to bone, liver, lungs (worsening liver mets on ct as well as hilar/mediastinal lns). xrt in performed for back pain to his bony mets (low thoracic-lumbar spine). his cancer has previously been very chemosensitive, but since last treatment, appears to have rapid progression of disease given imaging as outlined above. the patient completed cycle of 5fu and g-csf, which was tolerated well without significant side effects; however, there was little effect on metastatic disease during chemotherapy. during hospital course the patient developed a leukocytosis, most likely due to g-csf treatment. towards the end of his hospital course he developed a pancytopenia, likely related to the progression of his disease. . # thrombocytopenia: the patient is chronically thrombocytopenic w/ platelet count 65k-154k in review of omr labs, with evidence of declining platelets during admission. heparin was held briefly for the question of hit, but was restarted after hit ab panel was negative. most likely etiology is either progression of metastatic disease versus 5fu treatment. . # ?dvt/pe: on admission the patient was started on a therapeutic heparin drip for concern of pe given hypercoagulable state, tachycardia, and tachypnea. he was unable to tolerate cta per back pain from spinal metastases. heparin drip was discontinued on after le doppler us were negative for dvt. . # fen: the patient had evidence of hypernatremia that responded well to free water repletion; this was likely hypovolemic hypernatremia given his poor po intake. he was maintained on tpn given the inability to take po during admission, and was started on tube feeds after intubation. . # during admission the patient was maintained on , iv ppi, and heparin (gtt or sq) for prophylaxis. . # communication: wife is patient's hcp . # code: after discussion with the patient's oncologist and the icu team regarding the lack of response to chemotherapy and the poor prognosis, the patient and his family decided to opt for comfort measures. on , while the family was present the patient was bolused with fentanyl and was extubated to room air with a respiratory rate of 10. he became asystolic and was pronounced dead at 9:35am. medications on admission: meds on admission to : 1. ms contin 10 twice a day, last dose on day of admission. 2. zofran p.r.n. 3. protonix 20 daily. . medication on transfer: 1. heparin gtt 2. levaquin 500 mg qday (day 1 = ) 3. prilosec 20 mg po qday 4. zofran 4 mg iv q8 hr prn 5. duonebs q 4-6 hr prn 6. ativan 1 mg po q6 hr prn discharge disposition: expired discharge diagnosis: respiratory failure secondary to lymphangitic spread of anorectal carcinoma discharge condition: expired procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances insertion of endotracheal tube non-invasive mechanical ventilation injection or infusion of cancer chemotherapeutic substance diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified malignant neoplasm of liver, secondary unspecified pleural effusion hyposmolality and/or hyponatremia other and unspecified hyperlipidemia acute respiratory failure other specified cardiac dysrhythmias disorders of phosphorus metabolism pressure ulcer, buttock hypoxemia secondary malignant neoplasm of lung secondary malignant neoplasm of bone and bone marrow leukocytosis, unspecified colostomy status secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck anal fissure personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus 

Answer: The patient is high likely exposed to