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: penicillins attending: chief complaint: elevated lfts major surgical or invasive procedure: paracentesis liver biopsy colonoscopy with biopsy history of present illness: 77m with t3n2 papillary rcc s/p l. nephrectomy who recently started on pazopanib , seen in clinic on day of admission and found to have elevated lfts. . father was doing well until roughly 2weeks prior to when he began to develop increased non-bloody loose stool and mild increase in fatigue. he did not start imodium and tried to increase his fluid intake. he did well at home until yesterday when he developed llq discomfort spontaneous onset. no fevers, rare chills. pain was localized and but persisted. no n/v, no increased abdominal girth. +dark urine. no melena, baseline dark stools on iron. he went to osh ed yesterday where cr 3.0, hco3 12, hct 33, wbc 6.7 with 60% polys, but tbili 4.8, alkphos 619, alt 710, ast 281. ct done at osh but report not available. . he was told he had ascites and discharged with no speicific therapy. today he notes that his abdominal discomfort has nearly resolved. he continue to have loose stool up to 6 times per day without blood. he denies cough, fevers. no chest pain, orthopnea or le edema. no n/v. no ruq pain. urine remains dark. he denies rash. . vs in clinic: bp: 125/71. heart rate: 85. weight: 147.8. height: 69. bmi: 21.8. temperature: 96.5. resp. rate: 16. pain score: 0. o2 saturation%: 100. past medical history: past oncologic history: -- developed hematuria and mild flank pain and was found to have a large lobulated 6cm mass in his left kidney consistent with renal cell carcinoma. -- he underwent further preoperative evaluation and was found to have a 1 cm lesion in the right kidney as well as a lesion in the l4 vertebrae which was positive by bone scan. -- he underwent laparoscopic left nephrectomy at hospital by dr. . he was felt to be at high risk of recurrence, particularly given the lesion in the right renal and l4 areas. -- until present he has been managed conservatively with q3 month ct scans with most recent being in where all lesions were noted to be slightly increasing in size. -- noted to have 13lb unintentional weight loss, increased fatigue and worsening anemia with hct of 26. -- transfused 2u prbc for worsening anemia -- ct torso for worsening fatigue: disease progression with enlargment of known lesions and new ascites. consented for ancillary trials df-hcc 08-078 and df-hcc 06-105. -- asl mri per df-hcc 08-078 done, started on pazopanib 800mg po qd . past medical history: status post left shoulder surgery, nephrolithiasis, history of lumbar radiculopathy, esophageal stricture status post dilatation, macular degeneration, hypertension, hypercholesterolemia, osteoarthritis status post epigastric hernia repair social history: he continues to smoke cigarettes/day and drinks 2-4beer/week. he is a retired priest, and continues to work for the . he does still perform occasional weddings. family history: no history of kidney cancer. mother with breast cancer after 60. no siblings. physical exam: on admission vs: t95.2 bp 130/60 hr 82 rr18 o2 sat 98% ra gen: nad seated comfortably, no jaundice heent: pupils equal round and reactive, extraocular movements intact, oropharynx clear w/o lesions or petechiae, sclera anicteric neck: supple cv: nl s1s2, regular rate and rhythm, pulm: clear to auscultation bilaterally w/good air movement, no crackles/wheezes abd: soft, nd, +bs. mild tenderness in llq ext: warm, well perfused, no cyanosis/clubbing/edema, no open lesions skin: no rashes neuro: aox3, cn2-12 grossly intact, 5/5 strength in all extremities, grossly normal sensation, gait steady. . . discharge exam: temp 98.7 133/70 77 16 98% ra gen: nad heent: scleral and skin icterus, mmm, no jvd cv: nl s1s2, regular rate and rhythm, no m/r/g pulm: cta anteriorly abd: ntnd, bs +. ext: 1+ pulses, bil tibial edema trace skin: icteric, no rashes neuro: grossly intact pertinent results: 12:00am glucose-136* urea n-70* creat-3.1* sodium-143 potassium-4.0 chloride-114* total co2-14* anion gap-19 12:00am alt(sgpt)-637* ast(sgot)-250* ck(cpk)-23* alk phos-612* tot bili-5.3* dir bili-4.9* indir bil-0.4 12:00am tot prot-5.6* albumin-3.3* globulin-2.3 calcium-8.3* phosphate-4.8* magnesium-1.3* 12:00am tsh-less than 12:00am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 12:00am wbc-5.9 rbc-3.05* hgb-9.0* hct-26.6* mcv-87 mch-29.6 mchc-34.0 rdw-16.7* 12:00am neuts-64.9 lymphs-22.3 monos-7.1 eos-5.2* basos-0.4 12:00am plt count-204 12:00am pt-12.9 ptt-27.3 inr(pt)-1.1 09:06pm urine hours-random 09:06pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 09:06pm urine color-yellow appear-clear sp -1.011 09:06pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-sm urobilngn-neg ph-5.0 leuk-neg 03:24pm lactate-2.6* 03:05pm urea n-71* creat-3.5* sodium-142 potassium-4.2 chloride-110* total co2-17* anion gap-19 03:05pm estgfr-using this 03:05pm lipase-58 03:05pm tot prot-6.7 albumin-3.9 globulin-2.8 calcium-9.5 phosphate-5.5* magnesium-1.4* 03:05pm acetmnphn-neg 03:05pm wbc-6.5 rbc-3.84* hgb-11.0* hct-33.7* mcv-88 mch-28.7 mchc-32.7 rdw-16.1* 03:05pm plt count-228 03:05pm plt count-228 03:05pm gran ct-4020 . . 06:42am blood hbsag-negative hbsab-borderline igm hbc-negative 12:00am blood hbsag-negative hbsab-negative hbcab-negative hav ab-negative igm hbc-negative igm hav-negative 01:44pm blood antitpo-less than 06:42am blood ttg-iga-18. . discharge labs: . 09:20am blood wbc-8.7 rbc-2.73* hgb-8.1* hct-25.0* mcv-92 mch-29.8 mchc-32.5 rdw-16.9* plt ct-347 06:42am blood pt-18.5* ptt-34.2 inr(pt)-1.7* 01:43pm blood fibrino-744* 09:20am blood glucose-138* urean-16 creat-2.9*# na-138 k-3.0* cl-105 hco3-24 angap-12 06:42am blood alt-28 ast-42* alkphos-484* totbili-13.0* 09:20am blood calcium-7.8* phos-3.0 mg-1.7 06:42am blood caltibc-143 vitb12-1109* folate-7.2 ferritn-2427* trf-110* 08:45am blood t4-8.4 t3-85 calctbg-1.07 tuptake-0.93 t4index-7.8 free t4-1.4 . brief hospital course: this is a 77yo m with t3n2 papillary rcc s/p l.nephrectomy who recently started on pazopanib , who was originally admitted for elevated lfts thought to be pazopanib heptotoxicity, c diff colitis and acute on chronic renal failure. . . # acute on chronic renal failure: pt s/p nephrectomy with baseline cr ~. developed acute on chronic rf in the setting of sepsis which did not improve. cr went up to 8.0. tunnled dialysis line was placed and recieved 4 dialysis treatments . planned to start out patient 3 weekly dialysis sessions on tuesday . continues calcium carbonate 500mg tid for phos chelation, nephrocaps 1 cap qd low potasium diet. . # infection: initiatially treated for sepsis + c.dif with iv vanc/flagyl + po cipro + vanco from . now repeated stools for c.dif neg, otherwise bcx/ucx negative. was treated with total 10 days of po vanco after disconinuing other systemic antibiotics. . # diarrhea: initially had c.dif for which recieved treatment now repeated c.dif assays negative yet diarrhea continues. colonoscopy showed diffuse erythema, friability, exudates and ulceration likely pseudomembranes in the rectum and sigmoid but biopsies were normal. continues to have diarrhea, stool studies repeated and for c.dif tox, culture and ova/parasites all negative. celiac serology negative. qualitative stool for fat is positive. d.d. for continuing diarrhea - 1. malabsorption: supported by positive fat, possibly to his intra-hepatic cholestasis. 2. drug side effect to abx 3. infection: less likely now with neg cultures and repeated ng c.dif 4. inflammatory: unlikely in the setting of normal colonic biopsies. diarrhea is now improved on loperamide. continues loperamide 2mg tid. consult with gi in the out patient seetting of no resolution. . # a fib: a number of afib/flutter/rvr episodes during this admission. on rate control with metoprolol. score = 2 per age + htn, but with liver failure, increased inr anticoagulation differed d/t bleeeding risk. now well controlled with metoprolol po 50 tid today. aspirin 81mg daily is given for stroke prevention. . # grave's disease: newly diagnosed per elevated tfts ( ft4 2.3 tsh < 0.02) and positive tsi ab ( = 337 normal < 140). except for af episodes remains non-thyrotoxic clinically. started low dose methimazole 5mg q 48h. will require repeated tft's in three weeks. follow up with endocrinology has been arranged. . # cholestatic liver injury and jaundice: secondary to pazopanib heptotoxicity. imaging w/o structural abnormalities or ductal dilatation. pt mentating well, no asterixis. continues cholestyramine and topical camphor menthol for pruritus. will need continued follow-up of his liver functions including inr and ptt. follow-up with liver service has also been arranged. . # anemia: normocytic, high rdw. no b12/folate/iron deficiencies per labs, but ferritin may be falsely elevated in the setting of his other conditions. has possible malabsorption and a few guiac positive stools. thus anemia is likely multifactorial and secondary to chronic illness + crf + possible malabsorption and occult gi bleeding. epo was not started in the setting of malignancy. cbc's should continue to be trended. iron labs should be followed and repletion considered. gi may be consulted for his intestinal issues. . # renal cell carcinoma: per patient's oncologist no further treatment is considered at this point due to patient's various other complicating medical issues. . # htn: was on several agents at home which were d/c'ed in the setting of sepsis and hypotension. during his admission was well controlled on metoprolol alone. . # tobacco abuse: was on bupropion at which was held during this admission. continued abstinence was advised. . # pvd: was on home cilostazol, this was held during this admission. . # goals of care and code status: prognosis discussion, goals of care and code status issues were broached and discussed during this admission. at this point patient wishes to remain at full code. continued discussion of the above is advised. . # dvt ppx - treated with sq heparin . # discharge planning: screened and accepted to holy trinity nsg home in . will continue dialysis with dialysis in as well. medications on admission: amlodipine - 10 mg tablet - one tablet(s) by mouth daily bupropion hcl - (prescribed by other provider) - 100 mg tablet sustained release - 1 tablet sustained release(s) by mouth daily calcitriol - 0.25 mcg capsule - one capsule(s) by mouth every day cilostazol - (prescribed by other provider) - 100 mg tablet - 1 tablet(s) by mouth twice a day hydrochlorothiazide - (prescribed by other provider) - 25 mg tablet - 1 tablet(s) by mouth daily lisinopril - (prescribed by other provider: ) - 40 mg tablet - 1 tablet(s) by mouth once a day lovastatin - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth daily metoprolol succinate - 100 mg tablet sustained release 24 hr - 1 tablet(s) by mouth once a day omeprazole - (prescribed by other provider) - 20 mg capsule, delayed release(e.c.) - 1 capsule, delayed release(e.c.)(s) by mouth daily pazopanib - 200 mg tablet - 4 tablet(s) by mouth once a day medications - otc cholecalciferol (vitamin d3) - 1,000 unit capsule - 1 capsule(s) by mouth once a day ferrous sulfate - 325 mg (65 mg iron) tablet - 1 tablet(s) by mouth twice a day omega-3 fatty acids - (otc) - dosage uncertain sodium bicarbonate (antacid) - (otc) - powder - tsp twice a day vit c-vit e-copper-znox-lutein - (prescribed by other provider) - dosage uncertain discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for itching. 3. cholestyramine-sucrose 4 gram packet sig: one (1) packet po bid (2 times a day). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po q8h (every 8 hours). 6. methimazole 5 mg tablet sig: one (1) tablet po q48h (every 48 hours). 7. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid with meals (). 8. loperamide 2 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for diarrhea. 9. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). discharge disposition: extended care facility: holy trinity eastern orthodox nursing & rehabilitation center - discharge diagnosis: elevated lfts secondary to pazopanib c difficile infection acute on chronic renal failure renal cell carcinoma grave's disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to due to elevated liverfunction tests concerning for liver failure due to the chemotherapy, pazopanib. the hepatology team was consulted and agreed that the elevation in liver function tests was due to pazopanib. you underwent a liver biopsy that was also consistent with drug-induced liver injury. you underwent a colonoscopy because of persistent diarrhea and biopsies were taken which were normal. you were treated with antibiotics for clostridium difficile infection. you were also noted to have an irregular heart rate. we treated you with medications for this and it improved. you also were noted to have worsening kidney function for which you were treated with dialysis, at the time of discharge your renal functions seem to have stablized and the renal team's recommendation was that you continue dialysis treatments as an outpatient. you were also noted to have an over-active thyroid during admission. you were started on medication for this. please make the following changes to your medications: - the following medications were stopped: amlodipin, bupropion, calcitriol, cilostazol, hydrochlorothiazide, lisinopril, lovastatin, metoprolol succinate, pazopanib, cholecalciferol (vitamin d), ferrous sulfate, omega-3 fatty acids(fish oil), sodium bicarbonate (antacid), preservision. . this is now your full medication list: # omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). # camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for itching. # cholestyramine-sucrose 4 gram packet sig: one (1) packet po bid (2 times a day). # aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). # metoprolol tartrate 50 mg tablet sig: one (1) tablet po q8h (every 8 hours). # methimazole 5 mg tablet sig: one (1) tablet po q48h (every 48 hours). # calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid with meals # loperamide 2 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for diarrhea. # b complex-vitamin c-folic acid (nephrocaps) 1 mg capsule sig: one (1) cap po daily (daily). followup instructions: please call your oncologist dr. phone: to arrange for further follow-up. . please also keep the following appointments: . department: div of gi and endocrine when: tuesday at 3:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage . department: liver center when: monday at 1:40 pm with: , md building: lm bldg () campus: west best parking: garage department: west clinic when: thursday at 2:00 pm with: , m.d. building: de building ( complex) campus: west best parking: garage procedure: venous catheterization, not elsewhere classified hemodialysis closed (percutaneous) [needle] biopsy of liver venous catheterization for renal dialysis percutaneous abdominal drainage arterial catheterization closed [endoscopic] biopsy of large intestine insertion of totally implantable vascular access device [vad] diagnoses: acidosis other iatrogenic hypotension pure hypercholesterolemia tobacco use disorder acute kidney failure with lesion of tubular necrosis unspecified pleural effusion acute and subacute necrosis of liver chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation malignant neoplasm of kidney, except pelvis other specified cardiac dysrhythmias loss of weight intestinal infection due to clostridium difficile macular degeneration (senile), unspecified antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use osteoarthrosis, unspecified whether generalized or localized, site unspecified other specified disorders of biliary tract carrier or suspected carrier of methicillin resistant staphylococcus aureus other disorders of plasma protein metabolism dehydration toxic diffuse goiter without mention of thyrotoxic crisis or storm other and unspecified coagulation defects acquired absence of kidney secondary malignant neoplasm of bone and bone marrow hypercalcemia oliguria and anuria secondary malignant neoplasm of retroperitoneum and peritoneum painful respiration malignant ascites 

Answer: The patient is high likely exposed to