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: dyspnea major surgical or invasive procedure: none history of present illness: mr. is a 45 y/o man with pmh of metastatic renal cell carcinoma with known malignant pleural effusions who presents with and increased dyspnea. the patient had melenotic stools yesterday morning and was taken to after his wife called ems. at , he was noted to have overt and hct 23.8. cxr revealed worsening left pleural effusion. he was treated with levofloxacin 500 mg iv x 1 and 1 l ns. his bp was 80s-90s/40s-50s with hr in the 100s. he was placed on bipap for transfer. as his primary physicians are at , he was sent here for further management via . . he also had increased dyspnea for the past few days per his wife. she reports decreased amounts of pleural fluid drainage from his pleurx catheter (150-170 cc daily down from 200 cc daily). he has had increased abdominal girth lately and is status s/p 3 l paracentesis on per dr. . his pleurx catheter was also drained at that time. wife reports no fevers or sputum production. she has noted him to have new hiccups with altered respiratory pattern, especially at night (loud inspiratory sounds, like hiccups). . in the ed, initial vitals t 97.5, bp 116/59, hr 105, 100% on bipap. in our ed, he received vancomycin 1 g iv and zosyn 4.5 g iv x 1. he also received vitamin k 10 mg sc due to elevated inr. he was found to have elevated potassium and received calcium gluconate 1 amp x 1, kayexalate 30 g pr x 1, insulin 10 u x 1, and dextrose 1 amp iv x 1. follow up blood sugar was 78 and he received a second dose of dextrose 1 amp iv. he also received morphine 4 g iv x 1. . on arrival to the icu, the patient endorses worsening dyspnea and chest pain which he cannot localize. he also notes upper abdominal pain. he denies pain in other places. he did vomit yesterday but cannot tell me when that occurred. he does not recall when he first saw blood in the stool. . ros: no fevers, chills. no sore throat. decreased po intake and some choking with po intake. no sputum production. + recent hiccups per wife. + nausea (uses reglan/ativan at home). + one episode of vomiting (brown in color). + abdominal pain. wife reports usual amount of urine output with usual urine color. overall body swelling similar to prior. past medical history: renal cell carcinoma - debulking nephrectomy with regional lymph node dissection on - dendritic cell fusion vaccine trial- -sutent & gemzar on () protocol # 04-385; taken off study for posterior leukoencephalopathy (see dc summary ) -torisel () -sutent,continuous () social history: he is married with 3 children. employed as a lawyer at a pharmaceutical company. he denies tobacco, alcohol, or ivda. family history: sister with disease. no other history of gastrointestinal diseases. physical exam: vs: t 96.8 rectal bp 124/67 p 91 rr 20 o2 100% on 6l nc gen: cachectic male in minimal distress, frequently shutting eyes but answering questions and responding appropriately, total body anasarca heent: mm slightly dry, op clear, tongue midline, sclerae pale, eomi, perrl bilaterally resp: coarse breath sounds bilaterally, r > l, decreased breath sounds bilateral bases, dullness to percussion at bases, no wheezing cv: heart sounds distant, no appreciable murmur ext: right arm in sling, 3+ pitting edema skin: no rash neuro: alert, oriented to self, place, and month ()answering questions, intermittently drowsy, perrl, eomi, tongue midline, moving left arm spontaneously pertinent results: ========= labs ========= 12:28am blood wbc-20.1* rbc-2.40*# hgb-8.0*# hct-23.9* mcv-100* mch-33.2* mchc-33.3 rdw-19.7* plt ct-37* 11:39am blood wbc-18.8* rbc-1.88* hgb-6.2* hct-19.8* mcv-106* mch-33.1* mchc-31.4 rdw-19.2* plt ct-44* 07:45am blood wbc-21.1* rbc-2.19* hgb-7.2* hct-22.6* mcv-103* mch-33.1* mchc-32.1 rdw-20.3* plt ct-76* 12:28am blood neuts-94.1* lymphs-3.0* monos-2.9 eos-0 baso-0 11:39am blood neuts-93.2* lymphs-3.3* monos-3.3 eos-0 baso-0.1 07:45am blood neuts-93* bands-1 lymphs-1* monos-5 eos-0 baso-0 atyps-0 metas-0 myelos-0 07:45am blood hypochr-1+ anisocy-2+ poiklo-1+ macrocy-3+ microcy-normal polychr-normal ovalocy-1+ stipple-1+ 12:28am blood plt ct-37* 12:28am blood pt-18.4* ptt-41.2* inr(pt)-1.7* 11:39am blood plt ct-44* 11:39am blood pt-19.7* ptt-44.3* inr(pt)-1.8* 07:45am blood plt smr-very low plt ct-76* 07:45am blood pt-19.1* ptt-41.7* inr(pt)-1.8* 12:28am blood glucose-100 urean-108* creat-2.8* na-133 k-6.5* cl-105 hco3-18* angap-17 11:39am blood glucose-115* urean-101* creat-2.7* na-132* k-6.5* cl-103 hco3-17* angap-19 07:45am blood glucose-116* urean-98* creat-2.7* na-131* k-6.7* cl-103 hco3-17* angap-18 07:45am blood alt-9 ast-11 ck(cpk)-63 alkphos-194* totbili-0.6 07:45am blood ctropnt-0.08* 07:45am blood ck-mb-notdone 12:28am blood calcium-7.3* phos-8.6* mg-2.7* 11:39am blood calcium-6.9* phos-8.7* mg-2.8* 07:45am blood albumin-1.4* calcium-7.1* 09:03pm blood type- po2-32* pco2-34* ph-7.39 caltco2-21 base xs--4 12:21pm blood type- temp-36.0 o2 flow-3 po2-34* pco2-34* ph-7.36 caltco2-20* base xs--5 intubat-not intuba comment-nc 08:54am blood po2-73* pco2-36 ph-7.29* caltco2-18* base xs--8 comment-porta cath 07:48am blood po2-62* pco2-33* ph-7.34* caltco2-19* base xs--6 comment-porta cath . ========= radiology ========= cxr - impression: increased lung consolidation, most likely atlectasis, although pneumonia cannot be excluded. slight increase in size of left pleural effusion. . ct head - impression: no acute intracranial hemorrhage or significant edema. - bilateral le ultrasound - impression: no evidence of dvt of the right or left leg. extensive subcutaneous edema. ======== cardiology ======== tte - overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is mildly dilated with normal free wall contractility. torn mitral chordae are present. there is a moderate sized, circumferential pericardial effusion. in diastole, the effusion size anterior to the right ventricle is 1.1 cm. there is significant, accentuated respiratory variation in mitral/tricuspid valve inflows, consistent with impaired ventricular filling. no ra or rv collapse is seen. impression: moderate pericardial effusion with early signs of impaired ventricular filling. no echocardiographic signs of frank tamponade. . ecg - sinus tachycardia with a premature atrial contraction. poor r wave progression. non-specific st-t wave changes. low qrs voltage. compared to the previous tracing of sinus tachycardia and premature atrial contraction are new. there is decreased qrs voltage. . ecg - sinus tachycardia. lead v3 is missing. poor r wave progression which is non-diagnostic. non-specific st-t wave changes. low qrs voltage in the precordial leads. compared to the previous tracing of there is no significant diagnostic change. brief hospital course: # acute renal failure/hyperkalemia: patient was admitted to the icu from the ed. creatinine up to 2.7 (up from 2.3 on recent labs), likely secondary to hypovolemia (decreased po intake in combination with intravascular depletion due to hypoalbuminemia and gi bleed). patient received insulin, kayexelate, and calcium gluconate. a goals of care meeting took place between the patient's outpatient oncology team and the icu team, and family chose to make patient comfort measures only. he was transferred to the oncology floor and expired on at 7:06 am. primary cause of death was hyperkalemia from acute renal failure and secondary cause of death was gi bleed and renal cell carcinoma. # dyspnea: has known left-sided pleural effusion with pleurex catheter in place. pulmonary embolism is a possibility given underlying malignancy but lower extremities patient was not a candidate for anticoagulation given gib, regardless. . # gi bleeding: guaiac positive stool but not gross blood per rectum. has a history of hemorrhoidal bleeding, but not clear that this is due to hemorrhoids. wife reports with some small amount of red blood in stool day prior to admission. . # leukocytosis: likely leukomoid reaction underlying malignancy though does now have 1% bandemia (which is new). was started on vancomycin and zosyn until patient was made cmo in the icu. medications on admission: * tylenol prn * colace 100 * dilaudid prn (not yet taking) * glycerin suppository prn * lactulose prn constipation * levothyroxine 50 mcg daily * lorazepam 2 mg qhs and q6h prn * reglan 10 mg four times daily for nausea * milk of mag prn constipation * oxycodone 20 mg tid * percocet 5/325 mg prn * senna prn * vitamin b12 * vitamin c * zantac 75 mg daily discharge medications: none discharge disposition: expired discharge diagnosis: renal cell carcinoma hyperkalemia acute renal failure gastrointestinal bleed discharge condition: expired md, procedure: thoracentesis diagnoses: hyperpotassemia acute kidney failure, unspecified secondary malignant neoplasm of pleura secondary malignant neoplasm of brain and spinal cord hemorrhage of gastrointestinal tract, unspecified personal history of malignant neoplasm of kidney secondary malignant neoplasm of bone and bone marrow 

Answer: The patient is high likely exposed to