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: dimetapp attending: chief complaint: leg weakness major surgical or invasive procedure: none history of present illness: 25yom with no significant transferred from an osh with bilateral leg weakness and acute renal failure. on he had 3-4 beers, following which he "did lines" of cocaine and acknowledges potential snorting of oxycontin. on he woke up upable to stand with weakness and associated numbness on the anterior of his legs r > l. he presented to osh and was found to be in arf with elevated cks. he was transferred to the and admitted to micu. . in the micu he had foley placed and was treated for rhabdomylosis with ivf. his labs inititally showed ck of , ast of 1900, alt of 1400 and cr of 5.5. most recently ck of 9000, ast of 800, alt 600, tbili of 0.7 and cr of 6.4, inr 1.1. past medical history: remote hx of knee surgery social history: lives with mother, father and sister in . longshoreman in . pack of cigarette daily for 2 years. etoh on beers (up to 10), 3-4x/week since and + coccaine 1x /wk (snorting) for the last year. denies ivdu or other drug use. family history: non-contriburtory physical exam: vitals: afebrile. satting well on room air. good urine output. gen: nad, a0x3 heent: perrla, eomi, anicteric sclera, seborrheic dermatitis on face neck: supple, no lad resp: ctab b/l. card: s1 s2 no murmurs, rubs or gallops. abd: soft mild tender on deep palpation llq, non-distended, bs+. negative murphys extr: no clubbing, cyanosis or edema. 2+ dp. neuro: a0x3. pertinent results: admission labs: 11:45pm cerebrospinal fluid (csf) protein-21 glucose-83 11:45pm cerebrospinal fluid (csf) wbc-1 rbc-3* polys-0 lymphs-60 monos-40 10:14pm urine hours-random 10:14pm urine bnzodzpn-neg barbitrt-neg opiates-pos cocaine-pos amphetmn-neg mthdone-neg 10:14pm urine color-yellow appear-clear sp -1.015 10:14pm urine blood-lg nitrite-neg protein-100 glucose-tr ketone-tr bilirubin-sm urobilngn-1 ph-5.0 leuk-neg 10:14pm urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-<1 10:14pm urine granular-0-2 10:14pm urine amorph-few 05:47pm comments-green top 05:47pm lactate-1.5 05:35pm glucose-135* urea n-57* creat-5.5* sodium-133 potassium-4.8 chloride-94* total co2-23 anion gap-21* 05:35pm estgfr-using this 05:35pm alt(sgpt)-1492* ast(sgot)-* ld(ldh)-1843* ck(cpk)-* alk phos-82 amylase-47 tot bili-0.8 05:35pm lipase-31 05:35pm ck-mb-168* mb indx-0.8 ctropnt-0.15* 05:35pm albumin-4.2 calcium-8.6 phosphate-2.1* magnesium-1.8 05:35pm crp-256.5* 05:35pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 05:35pm wbc-10.7 rbc-5.00 hgb-16.2 hct-43.4 mcv-87 mch-32.3* mchc-37.2* rdw-13.2 05:35pm neuts-92.5* lymphs-5.7* monos-1.5* eos-0.2 basos-0.1 05:35pm plt count-132* 05:35pm pt-13.0 ptt-26.1 inr(pt)-1.1 05:35pm sed rate-21* hospital and discharge pertinent labs: cbc: 05:25am blood wbc-11.2* rbc-4.37* hgb-13.9* hct-37.6* mcv-86 mch-31.8 mchc-37.0* rdw-13.4 plt ct-232 coags: 03:00am blood pt-12.6 ptt-29.8 inr(pt)-1.1 esr: 03:00am blood esr-30* chemistry: 05:25am blood glucose-86 urean-95* creat-10.2* na-137 k-4.0 cl-100 hco3-23 angap-18 05:25am blood calcium-8.9 phos-7.5* mg-2.5 lfts: 05:25am blood alt-107* ast-22 ld(ldh)-346* alkphos-52 totbili-0.6 ck: ck(cpk)-154 06:00am blood ck(cpk)-275* 11:36am blood ck(cpk)-7015* 05:35pm blood ck(cpk)-* cardiac enzymes: 04:25am blood ck-mb-6 ctropnt-0.42* 02:57pm blood ck-mb-9 ctropnt-0.35* lipids: 11:36am blood triglyc-277* hdl-22 chol/hd-5.3 ldlcalc-40 hepatitis serologies: 11:36am blood hbsag-negative hbsab-positive hbcab-negative hav ab-positive igm hav-negative, blood hcv ab-negative crp: 03:00am blood crp-175.2* hiv ab: 02:57pm blood hiv ab-negative blood tox screen: 05:35pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg lactate: 05:47pm blood lactate-1.5 mri: spine impression: 1. no evidence for cord compression or spinal canal narrowing. 2. mild fluid accumulation in the right retroperitoneal space, possibly related to history of rhabdomyolysis. 3. bilateral lobe opacities concerning for pneumonia. 2. no evidence for aortic dissection on this study, however, this study is inadequate to rule out dissection given significant flow related and pulsation artifacts. given the patient's acute renal failure, would recommend non- contrast time-of-flight mra to further evaluate vascular structures. echo: the left atrium is mildly dilated. the left ventricular cavity is mildly dilated. transmitral and tissue doppler imaging suggests normal diastolic function, and a normal left ventricular filling pressure (pcwp<12mmhg). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. an aortic dissection cannot be excluded. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mildly dilated left ventricular cavity (probably normal when indexed to patient's body size). normal global and regional biventricular systolic function. no diastolic dysfunction, pulmonary hypertension or significant valvular disease seen. no evidence of aortic dissection however, the sensitivity of trans-thoracic echo in detection of aortic dissection is low. mra ab: impression: 1. no evidence of aortic dissection. 2. widely patent appearance of both renal arteries. 3. multifocal consolidation throughout both lungs but predominantly in the lower lobes, with small right-sided pleural effusion cxr: reason for examination: followup of a patient with rhabdomyolysis and acute renal failure. portable ap chest radiograph was compared to prior study obtained on . the lung volumes are lower compared to the prior study with new bibasal linear opacities that might represent atelectasis or aspiration. the more pronounced opacity is on the right and given it's progression since , , might represent infection. there is no evidence of failure. there is no pneumothorax. the cardiomediastinal silhouette is stable. brief hospital course: 25m with recent cocaine use now with lower extremity weakess with rhabdomyolysis, arf, shock liver, + troponins # rhabdomylosis: ck >20k on admission this am, 10k overnight. pt received 5l of fluid prior to coming to the floor. u/a with 0-2 rbcs but large blood indicative of myoglobin. source is potentially in legs given his focal weakness. however no focal finds indicative of necrosis on exam. lactate wnl. pt seen by nephrology that recommended decreasing from 100ccc/hr and then subsequently d/c'd. cks eventually trended down without any intervention. patient was discharged with instructions to follow up in renal clinic and with pcp. . # arf: pts cr up to 5.8 from 5.0 at osh on presentation from presumed normal levels since no baseline levels availbale. initial etiology potentially mulit-factorial including: glomerular damage secondary to myoglobinuria, pre-renal secondary to cocaine vasoconstriction, atn secondary to hypotensive and/or ischemia from cocaine as evident by 0-2 granular casts. pt was anuric on sunday/monday, patient had 20cc/hr during his hospital icu course, and was given lasix 20mg iv x 1 without change in uop. creatinine increased to 11.2 and started to trend down before discharge. he was making good urine and was not dialysed. he will follow up in the renal clinic. # transaminitis: ast/alt in >1000 on admission. etiologies include shock liver in setting of cocaine use, less likley viral hepatitis. during his icu cours the patients transaminitis improved, tuberculosis and inr remained stable. his hepatitis serologies were negative. lfts improved and were trending down on discharge. . # + troponins: trop 0.15 on admission without cp. pt without known cardiac disease. etiology potentially ischemia secondary to cocaine with troponins remaining elevated in setting of arf. no troponins available found from osh. the pt's transaminases remained elevated in setting of arf. tte was performed and echo found to have >60%. possible that patient had small infarct with global preservation of heart function. . # metabolic acidosis: pt presented with gap metabolic acidosis on presentation to e.d. with gap of 16 which resolved to 11 upon arrival to the icu. since lactate not drawn prior to closure unclear the etiology. lactate wnl. repeat abg now with very mild respiratory alkalosis with pt slightly tachypnic. the pts gap improved . # ?pna: pt afebrile, without leukocytosis, or increased sputum. cxr and mr demonstrated potential evolving pna. pt receive abx on arrival. abx were held in the setting of low clinical suspicion for pna. the pt was given insentive spirometry and remained afebrile. given his lack of symptoms clinically he was not treated for pneumonia. . # neurologic deficits: patient complained of r leg weakness and decreased sensation anteriorly. seen by neurology that stated his deficits were possibly from lumbar plexopathy or upper cervical involvement and unlikely a central involvement. pt was given acyclovir for ?hsv which was later held by the micu team. mr of the revealed a r psoas fluid collection. his strength in his legs increased although was not back to his baseline upon discharge. # medication changes: patient started on docusate and senna as needed for constipation started on metoprolol 50mg . after discharge he was called and sent a letter instructing him not to take metoprolol. amlodipine 5mg daily medications on admission: none discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. disp:*30 capsule(s)* refills:*0* 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. disp:*30 tablet(s)* refills:*0* 3. dextromethorphan poly complex 30 mg/5 ml suspension, sust.release 12 hr sig: ten (10) ml po q12h (every 12 hours) as needed for cough. 4. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* --> instructed to not take after discharge. 6. outpatient lab work check chem-10 including creatinine. please fax results to clinic attn dr. fax # and dr. fax #. discharge disposition: home discharge diagnosis: rhabdomyolysis acute renal failure cocaine abuse alcohol abuse discharge condition: all vital signs stable, kidney function improving. discharge instructions: you were admitted with acute muscle breakdown (likely caused by cocaine use) that caused damage to your kidneys. eventually this your kidney began to heal from this damage without dialysis. you should not take cocaine again. you should also avoid medications such as ibuprofen, advil, or naproxen until your kidney function returns to normal. you will need to follow up with a new primary care physician and kidney doctor. you should also decrease your alcohol intake as you are at risk for becoming and alcoholic. you discussed options for treatment with the social worker. new medications: 1) metoprolol 50mg one tab twice a day 2) amlidpine 5mg one tab daily please take all your medications as prescribed and attend all your follow up appointments. please call your doctor or return to the emergency room if you notice a sharp decrease in the amount of urine you make, experience chest pain, shortness of breath or any other symptom that concerns you. followup instructions: provider: , medical unit phone: date/time: 1:00 procedure: spinal tap incision of lung diagnoses: acidosis tobacco use disorder acute kidney failure with lesion of tubular necrosis acute and subacute necrosis of liver alcohol abuse, unspecified cocaine abuse, unspecified rhabdomyolysis 

Answer: The patient is high likely exposed to