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: hemoptysis major surgical or invasive procedure: intubation ir embolization bronchoscopy cpr history of present illness: this is an 86-year-old gentleman with a history of metastatic renal cell ca metastasized to r lung with endobronchial disease who is osh transfer for massive hemoptysis. . pt has history of rcc, first dx 12 yrs ago sp resection, then recurred in with mets to r lung and endobronchial disease sp bronchial stenting in with multiple episodes of non-massive hemoptysis and recent rigid bronchoscopy with balloon dilation of bronchus intermedius. . pt was seen by dr (pulm surgery) last week for hemoptysis (discharged ) where he had scope that showed fractured bronchus intermedius stent with friable tissue around it causing main stem bleeding. the tissue was cauterized. dr had plans to open a stent in the near future. . pt was discharged from hospital on , he was in his usual state of health until this morning when he coughed up 1 pint-1 quart of blood. he was rushed to osh for hemoptysis. he was intubated there (with double lumen) and then transfered to for further management. of note, patient was formerly dnr/dni which was reversed on arrival to osh. . at ed: pt was hemodynamically stable with hr 80s, bp 120-140s. pt noted to have double lumen tube, ventilating through the left lung with right clamped. he was given propofol which dropped his pressures to 60s. got fluids which improved bp, did not require any pressors. he has two 18 g peripherals. internventional pulm was contact as was ir. ir has plans to embolize first and then allow ip to open stent. pt was typed/crossed x 2 units. he is being sedated with fent/versed. og tube was placed which drained 300cc blood, thought likely to be hemoptysis. ng lavage performed, after 250cc. gi was consulted to asses whether or not they felt they needed to scope. pt is guiac positive. felt this is likely swallowed blood, esp given clear ng lavage after 250cc. told to call gi again if any fresh blood in og tube. made total 350cc uo. . on arrival to the micu, pt is comfortable, intubated. spoke to family who said that they want dr to evaluate patient to see if any intervention is indeed warranted/reversable. if not, they would want to proceed with dnr/dni route. as of now, pt is full code until evaluated by dr . after discussion with dr , plan is to attempt intervention given this patient's very high functional status. past medical history: oncologic history: - in mr. had a right-sided kidney lesion found incidentally. he underwent a right nephrectomy at . pathology noted a 3-cm clear cell lesion, grade i - ii, confined to the cortex. ureteral & vascular margins were free of tumor, no vascular invasion was seen. right adrenal gland was (-). he was followed serially with ct scans. - in late , developed recurrent hemoptysis which prompted ent evaluation & chest imaging, which showed a compressive mass in the right bronchus. he had a flexible bronchoscopy at complicated by significant bleeding & was transferred to . chest ct showed a mass encasing the right pulmonary artery & invading the bronchus intermedius. he underwent a rigid bronchoscopy w/ tumor biopsy, debridement, & stent placement . underwent argon plasma coagulation. - he had brachytherapy at . - on he had a metal stent placed by ip. - on started on sunitinib. - on developed hemoptysis requiring sutent hold through & again . - sutent was restarted, completed 1 cycle; but bloodwork showed low wbc/plts, drug was again held through . he returned & reported scant hemoptysis x 2 days & his sutent was stopped. he was then on 25mg x14 days of 28 day cycle. - on , saw dr. for bronchoscopy which showed stent in good position, no endobronchial lesions were seen. - with ongoing cough, sputum production. trial of albuterol inh & pulmonology recommended use of ppi/fluticasone. he was seen again 2 weeks later, w/o improvement in his symptoms. - platelets>150 and ct chest showed interval growth of right hilar mass, w/ worse occlusion of the r mainstem bronchus. we then increased sutent dosing to 37.5mg/day on 2 week on, 2 week off basis. - in follow-up , his cough had improved but plts were low, necessitating hold - on , restarted once plts 98 - follow-up , he was doing well apart from ongoing respiratory symptoms of cough, sputum production & scant hemoptysis/mild epistaxis. his platelets were 109. at that time we discussed possibly resuming sutent earlier than 2 weeks off therapy if respiratory symptoms persisted. he resumed drug 1 week later & returned . he did well w/ only scant hemoptysis. he had stopped flonase due to epistaxis. - on bronchoscopy w/ dr. which showed a large endobronchial lesion in the , friable w/ stent % occluded. - on was doing well apart from scant hemoptysis. platelets were stable at 95. - on , for follow up, doing well apart from 2-3 days of pruritic rash on left sided torso consistent with herpes zoster. we initiated valacyclovir tid for 14 days. he developed pain at the site which continued despite use of tylenol and was prescribed a lidocaine patch. - on ct appeared to show overall minimal decrease to affected area and decreased compression of the right main stem bronchus. stable appearance of the stent within the bronchus intermedius. notable is interval development of a left adrenal nodule with rim of enhancement given characteristics and rapid growth concerning for metastasis. interval resolution of the right pleural effusion. - on pulm rigid bronch revealed his metal stent well-covered with granulation tissue was visualized in the bronchus intermedius. an 80% stenosis to the right lower lobe was seen distal to the stent, and the bronchoscope could not pass. electrocautery was used in strips along the , then forceps were used to gently open the rll to 60-70% remaining stenosis. pmh/psh: renal cell carcinoma hypothyroidism, lyperlipidemia, hypertension. status post partial right adrenalectomy, and right nephrectomy social history: he is married and he and his wife live on . his wife was recently diagnosed with early stage breast cancer and is being seen by dr. here at from breast oncology. pt worked for an investment firm in and retired 20 years ago. he smoked a pipe one to two times a day for >20 years and smoked cigars for two years. he drinks one scotch every three weeks. family history: father mastoid infection and died in his 50s. mother chf died in her 70s. older sister alive and well. three adult children alive and well. physical exam: vitals: bp 133/65, hr 84, 100% on vent, hr 82 vent settings: cmv, only ventialting left lung, tv 300, fio2 50, f 20, peep 5. given 1800 ivf. 300cc uo, 300cc coffee grounds general: sedated, comfortable heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: left lung with good aeration, right lung has decreased breath sounds since clamped. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: wbc 3.6, hb 11. hct 34, plt 88, inr 1.1, ptt 28 na 131, k 3.9, cl 95, bicarb 28, bun 12, cr 1.1. ph 7.29, co2 63, o2 349, bicarb 32 ua sh 1009, ph 6.5, urobil 2. brief hospital course: in brief, mr. was a lovely 86-year-old gentleman with metastatic rcc (s/p multiple interventional pulmonary procedures for endobronchial bleeding) who was admitted from an outside hospital with hematemesis in setting of right bronchial artery bleed. he was intubated at the osh with double lumen tube, with right side clamped in an attempt to tamponade active bleeding. he was transferred to for interventional radiology and interventional pulmonology evaluation. mr. was given 1 unit of prbcs on arrival to , and another unit was ordered for transfusion during procedures. patient's family was at bedside upon his admission to micu. on day of arrival, patient went to ir, where a branch of the right bronchial artery was embolized. he was immediately transferred to the or, where interventional pulmonary attempted further endoscopic intervention. family was aware of high risks of this procedure, but wanted to proceed in the event that there was any way to palliate symptoms. unfortunately, mr. during the procedure. family and medical team were made aware. medications on admission: medications (per recent dc summary): 1. amlodipine 5 mg tablet sig: one (1) tablet po once a day. 2. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 3. benzonatate 100 mg capsule sig: two (2) capsule po tid (3 times a day) as needed for cough. 4. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) topical once a day as needed for pain. 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 7. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 8. sunitinib 12.5 mg capsule sig: three (3) capsule po once a day: daily, two weeks on, one weeks off. (currently not taking, stopped few days ago) 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*50 capsule(s)* refills:*1* 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*50 tablet, delayed release (e.c.)(s)* refills:*1* 11. codeine sulfate 15 mg tablet sig: one (1) tablet po every 4-6 hours as needed for cough. disp:*50 tablet(s)* refills:*1* 12. guaifenesin 1,200 mg tablet, er multiphase 12 hr sig: one (1) tablet, er multiphase 12 hr po twice a day. disp:*60 tablet, er multiphase 12 hr(s)* refills:*2* 13. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) inhalation five times a day as needed for shortness of breath or wheezing. disp:*2 * refills:*1* 14. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing/dyspnea. disp:*20 ml* refills:*3* discharge medications: patient . discharge disposition: discharge diagnosis: patient . discharge condition: patient . discharge instructions: patient . followup instructions: patient . md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours injection or infusion of other therapeutic or prophylactic substance arteriography of other intrathoracic vessels aortography endoscopic excision or destruction of lesion or tissue of bronchus diagnoses: pure hypercholesterolemia unspecified essential hypertension hyposmolality and/or hyponatremia unspecified acquired hypothyroidism personal history of tobacco use cardiac arrest long-term (current) use of other medications mechanical complication due to other implant and internal device, not elsewhere classified hypoxemia surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation secondary malignant neoplasm of lung personal history of malignant neoplasm of kidney acquired absence of kidney other pancytopenia hemoptysis, unspecified 

Answer: The patient is high likely exposed to