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: dilantin attending: chief complaint: slurred speech, headache major surgical or invasive procedure: endotracheal intubation history of present illness: mr. is a 36-year-old man with a history of metastatic, dedifferentiated thyroid cancer on doxarubucin (c1d18) and celiac disease, presenting with one day of headache and altered mental status. patient developed a headache after using a suppository for constipation yesterday. he has had several weeks of low grade temperatures to 99.5 and night sweats. this morning, he was noted by his family to not be making any sense when they were speaking with him. he states he was having difficulty word finding, following commands, and writing sentences at that time. it resolved, but re-occured during his appointment with his oncologist later that day. he was referred to the ed where his symptoms resolved again, but then re-occurred in the ed where he was noted to be having difficulty finding words, making paraphrasic errors, and appearing overall globally confused. he has been on dexamethasone daily and his last chemotherapy was cycle 1 day 1 of doxorubicin on . . in ed vs were 98.9 103 123/82 14 100% on ra. labs sig for na of 123, hct of 22.7, wbc of 9.9 with 15% bands. lactate 0.8 he received iv vancomycin, cftx, and acylovir (meningitis dosing) and 3 l ns. neurology and neurosurgery were both consulted. neurosurgery did not recommend any intervention for the sdh noted on head ct, stating it was subacute. neurology recommended lp for rule out meningitis which was performed in the ed and demonstrated wbc of 8, normal protein and glucose, and rbcs that did not clear from tube 1->tube 4. . review of systems: (+) overall weakness (-) denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: past oncologic history (per dr. note): -: nodule felt on physical examination, biopsy revealed papillary thyroid cancer and patient underwent a total thyroidectomy. per reports, patient had 1.1 cm tumor with lymph node involvement. this was done in . he underwent radioactive iodine therapy, and was followed frequently with lab tests and scans. abnormalities were detected in with evidence of possible remnant thyroid tissue, and he underwent repeat radioactive iodine ablation with good result. was followed closely for a time, had last been seen in when he lived in , and was lost to follow up until move to in . -as part of initial evaluation, he had an ultrasound done of his neck. the ultrasound demonstrated three enlarged morphologically abnormal lymph nodes on the left at level iv and further evaluation was recommended. the largest lymph node was 1.9 x 1.7 x 1.0 cm. he then underwent a thyrogen radioactive iodine uptake scan, which was negative for residual thyroid uptake and had no evidence of metastatic disease. he subsequently went on to an ultrasound-guided biopsy and cytology from this procedure was positive for malignant cells consistent with carcinoma. the malignant cells had a large nuclei with prominent nucleoli and high nuclear to cytoplasmic ratios. the tumor cells were positive for ck7 and ck20, and negative for ttf-1 and thyroglobulin. these findings were consistent with dedifferentiated papillary carcinoma of the thyroid, but second primary could not be entirely excluded. as a result of this pathology, the patient underwent pet-ct scan, which demonstrated fdg avid nodal disease in the left neck at levels iv and iia within the right thyroidectomy bed. there was atypical diffuse fdg avid nodal disease within the thorax along the periaortic and paraesophageal chain. the findings were consistent suggestive of dedifferentiated metastatic thyroid cancer; however, the pattern was atypical. there were no other sites of abnormal fdg uptake to suggest a secondary malignancy. biopsy of the paraesophageal mass on with pathology consistent with his previously diagnosed, dedifferentiated papillary thyroid carcinoma. lastly, his pet/ct scan in revealed stable disease. . other past medical history: celiac disease social history: the patient works as a consultant. his girlfriend and mother are present at the bedside. he does not smoke. occasional etoh use, none in last 5 weeks. denies any illicit drug use. family history: mother had papillary carcinoma of the thyroid. father died of colon cancer at age 63, was diagnosed at age 57. he has a brother and a sister who are healthy. his family history is significant for heart disease, specifically chf. physical exam: vitals: t: 98.7, bp: 123/74, p: 130, r: 24, o2: 91% 6l nc general: tachypnic, anxious, alert, oriented x 3 heent: nc/at, mild scleral icterus neck: supple, jvp 6 cm, no lad lungs: decreased bs at right base, dull to purcussion, occasional crackles r > l cv: tachycardic, regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission: 07:50pm cerebrospinal fluid (csf) protein-107* glucose-102 07:50pm cerebrospinal fluid (csf) wbc-8 rbc-26* polys-82 lymphs-2 monos-14 eos-1 macrophag-1 07:50pm cerebrospinal fluid (csf) wbc-3 rbc-295* polys-13 lymphs-23 monos-62 nuc rbcs-1 other-1 05:40pm comments-green top 05:40pm lactate-0.8 03:30pm urine hours-random 03:30pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 03:30pm urine color-yellow appear-clear sp -1.009 03:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 02:30pm glucose-113* urea n-16 creat-0.9 sodium-123* potassium-4.6 chloride-83* total co2-30 anion gap-15 02:30pm calcium-9.8 phosphate-6.5* magnesium-1.7 02:30pm wbc-9.9 rbc-2.97* hgb-7.9* hct-22.7* mcv-76* mch-26.5* mchc-34.7 rdw-20.6* 02:30pm neuts-50 bands-13* lymphs-14* monos-8 eos-0 basos-0 atyps-0 metas-5* myelos-9* promyelo-1* nuc rbcs-8* 02:30pm hypochrom-2+ anisocyt-2+ poikilocy-occasional macrocyt-normal microcyt-3+ polychrom-1+ schistocy-occasional 02:30pm plt smr-very low plt count-34* 02:30pm pt-13.6* ptt-22.1 inr(pt)-1.2* 12:44pm urea n-17 creat-1.0 12:44pm alt(sgpt)-80* ast(sgot)-38 ld(ldh)-828* alk phos-510* tot bili-1.2 12:44pm albumin-2.9* 12:44pm wbc-9.6 rbc-3.18* hgb-8.1* hct-24.1* mcv-76* mch-25.5* mchc-33.7 rdw-20.0* 12:44pm neuts-52 bands-11* lymphs-12* monos-5 eos-0 basos-0 atyps-2* metas-9* myelos-9* nuc rbcs-10* 12:44pm hypochrom-1+ anisocyt-2+ poikilocy-2+ macrocyt-normal microcyt-2+ polychrom-1+ spherocyt-2+ schistocy-2+ teardrop-2+ bite-2+ 12:44pm plt smr-very low plt count-34* 12:44pm gran ct-7808 brief hospital course: 36 y/o male with metastatic de-differentiated papillary thyroid carcinoma, previously managed in for altered mental status, transferred back to icu for hypoxia, tachycardia, and acute hematocrit drop, with concern for hemolysis. . # hypoxic respiratory failure: likely multifactorial. ddx is broad and includes pulmonary embolism (possible given tachycardia, hypercoagulable state in setting of neoplasm, and additional oxygen requirement), pulmonary infection (favor atypical infection such as pcp as opposed to acute bacterial pneumonia given lack of fever and leukocytosis), or, more likely rapidly rising tumor burden (favored diagnosis after reviewing his progressive disease on ct scan and discussing with radiology). of note, patient has been on pentamidine prophylaxis, making pcp somewhat less likely. also on ddx is trali given his recent prbc transfusion. abg on 6l nc: 7.53/26/73. upon arrival to the icu, patient demonstrated tachypnea, increased work of breathing on nrb, and required intubation. ett was in appropriate position. he was started on pcp coverage and iv steroids (for presumed ttp, see below). . # hct drop/anemia/thrombocytopenia: ddx includes bleeding (possible given hematuria, hematochezia, and now hemoptysis), dic (possible though unlikely given normal coagulation parameters and fibrinogen > 300), ttp-hus (possible given thrombocytopenia and evidence of schistocytes on peripheral smear). evidence for hemolysis includes elevated direct bilirubin, and marked drop in haptoglobin to 6. per oncology recommendations and given schistocytes, thrombocytopenia, and review of peripheral smear, there was overall concern for ttp-hus, for which oncology initiated iv steroids. . # subdural hematoma: known subdural hematoma with thrombocytopenia. nsgy following and patient on keppra. . # suspected seizures: he had a negative eeg for seizure activity and unremarkable lp on the omed floor. remains on keppra per neurology recommendations. . # metastatic thyroid cancer: he received a dose of chemotherapy with carboplatin and paclitaxel on and has been on decadron, calcitriol and levothyroxine. suspect markedly advanced, rapidly progressive disease given abrupt rise in ast, alt, bilirubin, and ldh. . # altered mental status: now resolved. previously with delirium likely secondary to infection, pain meds & lack of sleep icu environment. the cause of his severe agitation and ams that led to intubation & transfer to the is unclear, but there was concern for seizure with ams post-ictal state. patient was loaded with empiric keppra 1g and has since been changed to 1.5g . eeg was negative for seizure activity, but patient was placed on keppra for generalized slowing on eeg without epileptiform activity. chronic subdural hematoma was stable. patient was intially on standing haldol for agitation, which was changed to prn when mental status improved; qtc were followed daily. in the unit, patient was started on and completed course of acyclovir for presumed hsv, which was negative when csf hsv pcr came back. the patient continued keppra . # hypoxia: patient was intubated from secondary to inability to protect his airway due to sedation that was required to control his agitation and altered mental status. also being treated for hcap (vanc/cefepime/flagyl for hcap (d1= for 8 days). successfully extubated and supplemental o2 weaned. had one episode of dyspnea requiring non-rebreather secondary to volume overload. . # pancytopenia: likely recent chemotherapy. nsg recommended platelets >100 before any procedure. filgrastim was stopped on . platelets were transfused with goal >30. prbcs were transfused with hct goal >21 or if symptomatic. . ------------- micu course: patient was transferred to icu for hypoxia, tachycardia, and acute hematocrit drop, with concern for hemolysis. he was intubated upon arrival for tachypnea (rr 40s) and increased work of breathing despite nrb mask. a l ij was placed. ett and ij cvl were in appropriate position. patient underwent cardiac arrest with rhythm of ventricular fibrillation. cpr was initiated. he was resuscitated with epinephrine and shock x 2. less than one hour later, patient went into cardiac arrest with rhythm of pea. cpr was initiated with epinephrine and atropine. patient was unable to be successfully resuscitated and time of death was 01:25 hours. primary cause of death was felt to be underlying, rapidly progressive thyroid cancer. medications on admission: calcitriol - 0.5 mcg capsule - 1 capsule(s) by mouth three times a day cyclobenzaprine - 10 mg tablet - 1 tablet(s) by mouth three times a day as needed for muscle spasm dexamethasone - 4 mg tablet - 1 tablet(s) by mouth daily folic acid - 1 mg tablet - 1 tablet(s) by mouth daily lactulose - 10 gram/15 ml solution - solution(s) by mouth three times a day as needed for constipation levothyroxine - 150 mcg tablet - 3 tablet(s) by mouth once a day lorazepam - 0.5 mg tablet - tablet(s) by mouth every six (6) hours as needed for nausea/anxiety (takes rarely with no recent doses) ondansetron - 8 mg tablet, rapid dissolve - 1 tablet(s) by mouth every eight (8) hours as needed for nausea oxycodone - 20 mg tablet sustained release 12 hr - tablet(s) by mouth every eight (8) hours please take 60mg once daily (3 tabs) and 80mg twice daily (4 tabs) as needed for pain oxycodone - 5 mg tablet - tablet(s) by mouth every four (4) hours as needed for pain pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth every twenty-four(24) hours pentamidine - 300 mg recon soln - 300 mg inhaled monthly polyethylene glycol 3350 - 17 gram/dose powder - 1 powder(s) by mouth daily as needed for constipation medications - otc acetaminophen - (prescribed by other provider) - dosage uncertain bisacodyl - (prescribed by other provider) - 5 mg tablet, delayed release (e.c.) - 2 tablet(s) by mouth daily (daily) as needed for constipation calcium carbonate - (prescribed by other provider) - 500 mg (1,250 mg) tablet - 2 tablet(s) by mouth three times a day calcium ] - (prescribed by other provider) - 500 mg tablet - 2 tablet(s) by mouth three times a day 1000 mg docusate sodium - (prescribed by other provider) - 100 mg capsule - 1 capsule(s) by mouth twice a day senna - (prescribed by other provider) - 8.6 mg tablet - 1 tablet(s) by mouth twice a day discharge medications: expired discharge disposition: expired discharge diagnosis: 1. metastatic, de-differentiated thyroid cancer discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung spinal tap incision of lung insertion of endotracheal tube injection or infusion of cancer chemotherapeutic substance diagnoses: pneumonia, organism unspecified malignant neoplasm of liver, secondary unspecified pleural effusion other convulsions candidiasis of mouth other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure defibrination syndrome pneumonitis due to inhalation of food or vomitus cardiac arrest other acquired absence of organ antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use pressure ulcer, lower back ventricular fibrillation celiac disease dermatitis due to drugs and medicines taken internally fever, unspecified secondary malignant neoplasm of lung metabolic encephalopathy phlebitis and thrombophlebitis of superficial veins of upper extremities other disorders of neurohypophysis subdural hemorrhage secondary and unspecified malignant neoplasm of intrathoracic lymph nodes delirium due to conditions classified elsewhere secondary malignant neoplasm of bone and bone marrow secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck secondary malignant neoplasm of other digestive organs and spleen neoplasm related pain (acute) (chronic) pressure ulcer, stage ii hypoparathyroidism postsurgical hypothyroidism personal history of malignant neoplasm of thyroid dermatophytosis of groin and perianal area hydantoin derivatives causing adverse effects in therapeutic use other and unspecified anticonvulsants causing adverse effects in therapeutic use other secondary thrombocytopenia mucositis (ulcerative) due to antineoplastic therapy 

Answer: The patient is high likely exposed to