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: no known allergies / adverse drug reactions attending: chief complaint: abdominal pain major surgical or invasive procedure: ercp history of present illness: 66 year-old man with metastatic lung adenocarcinoma, currently neutropenic (s/p navelbine on ), presenting with 1 week of intermittent ruq pain and vomiting, found to have acute gallstone pancreatitis. transferred to the for evaluation and management of hypotension. . in the ed, initial vs were: pain 8, 100.7, 114, 114/59, 18, 98% ra. labs were notable for wbc of 0.5, cr of 2 (bl 1.8), and significant transaminitis (ast 1266, alt 643, alkp 333, ldh 1235, t bili 1.5). lipase was 3360. ct a/p revealed findings concerning for gallstone pancreatitis with 16mm distal cbd dilation. advanced endoscopy was consulted and decided to perform ercp in am. additionally, sbps fell to the 70s and improved to the 90s after a total of 6l ns. per record, made 280 cc of uop. blood cultures were obtained. he was given vancomycin and zosyn. no cvc was placed because he has a port for access. . on presentation to the the patient appeared comfortable and was answering questions appropriately. he confirmed recent abdominal pain, vomiting, and rigors. denied hematemesis, hematochezia, or melena. . review of sytems: (+) per hpi, + hx of neuropathy (-) denies fever, chills, night sweats. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied diarrhea, constipation. no dysuria. denied arthralgias or myalgias or rashes. past medical history: past medical history: -metastatic lung cancer -chronic obstructive pulmonary disease -fe deficiency anemia -erosive gastritis -psoriasis and psoriatic arthritis -hypertension -osteoarthritis -peripheral vascular disease -diverticulosis -hypercholesterolemia -aaa repair . onc hx (abbreviated) -lul lung mass seen on cxr in ?, with multiple small contralateral metastases seen on following ct -ct-guided bx at on showed well-differentiated adenocarcinoma with acinar and solid features -has underwent three different chemotherapuetic regimens and currently on his 4th- navelbine (last received on ) social history: -divorced, two children -lives with sister, independent in adls -tobacco: quit 8 years ago -etoh: 1-2 drinks weekly at most, had 2 beers last night -illicits: none family history: -mother had some type of cancer. no family hx of pancreatitis. physical exam: admission physical exam: vitals: 98.6, 109/56, 83, 97% ra general: well-nourished, alert, oriented, no acute distress heent: perrl, sclera anicteric, dry mm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation anteriorly, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, + sem best heard at lusb, radiating to clavicle and carotids b/l abdomen: soft, bowel sounds present, diffuse tenderness with voluntary guarding to palpation on r side and epigastrium gu: + foley ext: warm, well perfused, trace non-pitting le edema, clubbed fingernails neuro: moves all extremities, face symmetric, gait not observed discharge physical exam: vs: tm 99.3, tc 98.3, bp 110/70, hr 78, rr 20, 95%ra general: well-nourished, alert, oriented, no acute distress heent: perrl, sclera anicteric, mm mildly dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation anteriorly, few scattered wheezes cv: regular rate and rhythm, normal s1 + s2, + sem best heard at lusb, radiating to clavicle and carotids b/l abdomen: soft, bowel sounds present, no ttp ext: warm, well perfused, trace non-pitting le edema, clubbed fingernails pertinent results: admission labs -wbc-0.5* rbc-3.67* hgb-10.5* hct-31.7* mcv-86 mch-28.6 mchc-33.2 rdw-17.6* plt ct-187 neuts-74.2* lymphs-21.1 monos-3.2 eos-0.7 baso-0.8 -pt-12.7 ptt-30.9 inr(pt)-1.1 -glucose-87 urean-43* creat-2.0* na-139 k-3.8 cl-106 hco3-24 angap-13 -alt-643* ast-1266* ld(ldh)-1235* alkphos-333* totbili-1.5 -lipase-3360* -ctropnt-<0.01 -albumin-3.5 calcium-8.6 phos-2.7 mg-1.4* cholest-130 -triglyc-116 hdl-34 chol/hd-3.8 ldlcalc-73 -lactate-1.2 -freeca-1.08* . abdominal xray: no signs of ileus or obstruction. no signs of free air below the right hemidiaphragm . ct a/p: 1. marked extra-hepatic biliary ductal dilation to 1.6 cm with mild-to-moderate intra-hepatic biliary ductal dilation with high-density material within the distal cbd with pancreatitis in the head and neck, raising the question of gallstone pancreatitis. consultation with ercp service is recommended. the gallbladder is moderately distended without other secondary findings of acute cholecystitis noted. 2. known metastatic lung cancer with partially visualized probable metastases within the right lower lobe and left lower lobe. small left pleural effusion and trace right pleural effusion. periosteal reaction in femoral shafts likely secondary to hypertrophic pulmonary osteoarthropathy. 3. moderate-to-severe colonic diverticulosis with no findings of acute diverticulitis. no pneumoperitoneum. . cxr: . increasing mild vascular congestion and bilateral pleural effusions, left greater than right. 2. decreased density of left upper lobe and left lower lobe opacities. 3. stable position of right port-a-cath. no pneumothorax. 4. multiple subcentimeter nodules in the right lung. ercp report: impression: stone fragments and sludge in the biliary tree. full cholangiogram not obtained given cholangitis. normal limited pancreatogram. a biliary sphincterotomy was performed. stone fragments and sludge were removed using a balloon. a biliary stent was placed. normal pancreatic duct (sphincterotomy, stent placement, stone extraction) otherwise normal ercp to third part of the duodenum echo: conclusions the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 60%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is no pericardial effusion. ruq u/s : impression: 1. no evidence of gallstone. 2. thickened and hyperemic gallbladder wall and mildly distended gallbladder. this could reflect secondary inflammatory changes from pancreatitis, though clinical correlation is suggested and hida scan could be performed for further clarification if indicated. 3. no evidence of choledocholithiasis, though presence of air within much of the extrahepatic biliary system limits assessment. 4. right pleural effusion. brief hospital course: 66 yo m with nsclc s/p recent chemo, now neutropenic, presenting with abdominal pain and found to have acute pancreatitis, transferred to the initially for hypotension. . s/p gallbladder pancreatitis: patient presented with hypotension and sepsis which resolved with significant iv fluids (10l on night of admission). he also preseted with a lipase of 3360 and findings on ct suggestive of gallstone etiology (1.6 cm cbd dilation, distended gallbladder, and new transaminitis). other etiologies entertained, but highly unlikely included alcoholic, chemotherapy-induced, or hypertriglyceridemia (labs normal). criteria on admission was difficult to calculate correctly given neutropenia; however, he had at least 3 points predicting a mortality of 15-20%. advanced endoscopy was consulted and an ercp with sphincterotomy was performed on and plastic stent was placed wo complication. lfts continued trending down and abdominal pain improved after stent placed. pt started liquids and regular soft diet . surgery was consulted to determine if pt would benefit from prophylactic ccy. they wanted a ruq us to determine if there were residual gallstones and pt might benefit from a perc chol tube. ruq u/s showed no gallstones so surgery decided they would not place a decompressiont tube, and already decided he wasn't a surgical candidate for ccy. lipase was downtrending from 3360 to 123 from to . patient sent to rehab tolerating a regular diet without abdominal pain. . # enterobacter baceteremia - patient presented with hypotension and sepsis. his bcx on returned positive for enterobacter aerogenes, that was acutely cipro sensitive. his sepsis is now resolved. he was on zosyn intially, narrowed to cipro/flagyl, then just cipro on when his bcx sensitivities returned. he needs a 14 day total course, with at least 10 days of iv cipro for full treatment. he will go to rehab to finish 10 days of iv, which finishes on , then start po cipro on , to finish . . # transaminitis: likely secondary to his acute gallstone pancreatitis. other possible etiologies include recent chemotherapy or other toxic medications (such as his outpatient statin). he denied any recent consumption of acetaminophen. we trended his lfts, which improved post-procedure, and held his simvastatin during the hospitalization and also at discharge as pt's life expectancy is 6 months and the benefit of simvastatin is over the course of many years. # systolic ejection murmur: best heard at lusb, radiating to the clavicle and carotids bilaterally, concerning for aortic stenosis. no prior echo was available. we obtained a tte, which showed no as. therefore, likely a flow murmur in the setting of lots of fluids. . # anemia: known fe deficiency thought to be gastritis from nsaid use for pain control of arthritis. but also in the setting of pancytopenia so may be secondary to marrow suppression. he has no s/sx of bleeding on exam throughout this admission, so we continued him on a ppi. . # cki: baseline cr is 1.8-1.9. currently 2.1, even with aggressive hydration. this will need monitoring as an outpatient. # metastatic adenocarcinoma of the lung: received navelbine on . he was neutropenic on presentation and per his primary oncologist, neupogen was not indicated during the nadir of his cell counts. further management was deferred to the outpatient setting. . code: full code (per outpatient onc note "he would not want any prolonged period of intubation or any other interventions that would prolong his life in a dependent position unable to care for himself") medications on admission: (per records; pt reports he only takes statin, omeprazole) -dexamethasone 8 mg day prior to, on, and after chemo -folic acid 1 mg daily -lorazepam 1 mg q6 for nausea or insomnia -omeprazole 20 mg daily -zofran 8 mg q8 prn nausea -oxycodone 5 mg q4h for pain -prochlorperazine 10 mg q6h for nausea -simvastatin 80 mg daily (in am) discharge medications: 1. morphine 15 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 2. ondansetron 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 3. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. ciprofloxacin in d5w 400 mg/200 ml piggyback sig: one (1) intravenous q12h (every 12 hours): last day is , then pt can switch to po cipro for 4 days to finish a 14 day course. 6. lorazepam 1 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea or insomnia. 7. folic acid 1 mg tablet sig: one (1) tablet po once a day. 8. colace 100 mg capsule sig: one (1) capsule po twice a day. 9. senna 8.6 mg tablet sig: one (1) tablet po twice a day: patient may refuse. 10. bisacodyl 5 mg tablet sig: one (1) tablet po once a day as needed for constipation. discharge disposition: extended care facility: life care center of discharge diagnosis: primary: gallstone pancreatitis secondary: metastatic lung adenocarcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were seen in the hospital for abdominal pain and vomiting, and were found to have gallstone pancreatitis. you were treated with an ercp during which a biliary stent was placed, and your symtoms improved. once you were able to tolerate a regular diet, we sent you to a rehabilitation facility to finish your intravenous antibiotics course. we made the following changes to your medications: 1) we started you on morphine sulfate ir 15mg b mouth every 6 hours as needed for pain. 2) we stopped your oxycodone. 3) we stopped your simvastatin. 4) we stopped your omeprazole. 5) we started you on pantoprazole 40mg once a day by mouth. 6) we started you on ciprofloxacin iv 400mg every 12hours until . on you will start taking ciprofloxacin 500mg every 12hours by mouth, until , when your antibiotics course will finish. 7) we started you on docusate 100mg by mouth twice a day. 8) we started you on senna 8.6mg twice a day by mouth for contipation. you can stop taking this if you have loose stools. 9) we started you on bisacodyl 5mg once a day as needed for constipation. if you experience any of the below listed danger signs, please alert your doctor at your rehab facility or go to the nearest emergency room. it was a pleasure taking care of you on this hospitalization. followup instructions: please note mr arrived at and decided he would rather be at home. he called his outpatient oncologist dr who arranged for him to complete the course of antibiotics orally instead. he has been tolerating po and has no symptoms of pancreatitis on discharge. department: primary care name: dr. when: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. location: address: , , phone: department: hematology/ oncology name: dr. when: tuesday at 12:30 pm location: address: , , phone: department: endo suites when: thursday at 12:00 pm department: digestive disease center when: thursday at 12:00 pm with: , md building: building (/ complex) campus: east best parking: main garage md procedure: endoscopic removal of stone(s) from biliary tract endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct endoscopic insertion of stent (tube) into pancreatic duct diagnoses: pure hypercholesterolemia acute kidney failure, unspecified severe sepsis chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified peripheral vascular disease, unspecified personal history of tobacco use chronic kidney disease, unspecified malignant neoplasm of upper lobe, bronchus or lung other septicemia due to gram-negative organisms cholangitis other malignant neoplasm without specification of site acute pancreatitis calculus of bile duct without mention of cholecystitis, without mention of obstruction neutropenia, unspecified anemia in neoplastic disease nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] 

Answer: The patient is high likely exposed to