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: lisinopril attending: chief complaint: hypotension major surgical or invasive procedure: none history of present illness: mr. is a 39m with esrd on hd and renal cell ca with brain, pulmonary, and hepatic mets. he underwent mri this morning on . shortly after receiving gadolinium contrast he developed worsening rlq abdominal pain, then developed shaking of all 4 extremities. he reports that he was awake and alert throughout the episode. he was noted to be alert and oriented x3 directly afterward. bp noted to be 70s/40s on machine and manual recheck. he has had worsening rlq pain for the last five days. today he noticed his abdomen to be more distended than usual. approximately one week ago his oxycodone was increased. last hd session yesterday. last round of chemotherapy was . in ed, he received 2l ns but sbp still in 80s. started peripheral levophed at 0.09 with response to 100s-110s. initial vs in ed: t 98.1 hr 105 bp: 104/68 rr 22 o2sat 97 on 4l nc in the ed, he started empiric vancomycin and cefepime for broad-spectrum coverage. ct revealed significant progression of his metastases (pulmonary, hepatic) but could not rule out pneumonia. new ascites but no evidence of appendicitis or acute abscess. initial vs in micu: t 98.5 hr 101 bp 105/72 rr 19 o2sat 96% on 4l nc past medical history: metastatic renal cell carcinoma: -- : cough x 2 weeks -- : chest/abd/pelvis ct with pulm nodules, rul mass, mediastinal/hilar lymphadenopathy, retroperitoneal adenopathy -- : brain mri with lesions in r choroid plexus, l parieto-occipital junction, l frontal lobe -- : vats wedge resection of rul mass; path confirmed renal cell carcinoma with clear cell features as well as the presence of a tfe3 gene fusion -- : cyberknife radiosurgery to brain met -- : cyberknife radiosurgery to brain met esrd - secondary to focal glomerulonephritis, on hd since htn anxiety past surgical history: -multiple av fistula placements/repairs -2 breast reduction procedures -2 operations for undescented testes -right orchiectomy -kidney biopsy -repair of a ruptured quadriceps tendon social history: mr. is single. he is currently on disability. smoked 1ppd x 20yrs and quit approximately one month ago. prior history of alcohol dependence, but quit approximately four years ago. he has been living with friends in . family history: his mother is healthy at age 60. his father died at age 48 from throat cancer (he consumed cigarettes and alcohol) and colon cancer. his sister and brother are healthy but another brother has the "gene" for colon cancer and gets yearly check ups physical exam: at admission: general: alert, oriented, appears uncomfortable heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops. jvp flat. lungs: shallow breathing with accessory muscle use. distant breath sounds, crackles at bilateral bases, no wheezes, rales, ronchi. posterior lung fields not examined due to patient's pain attempting to sit up. abdomen: distended, tense, diminished bowel sounds. nontender to palpation. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. av fistula in rue; scars of prior av fistula in lue. r hand exquisitely tender to palpation. neuro: cnii-xii intact, 2+ reflexes bilaterally, gait deferred. at discharge: vs: 97.4 92/60 97% on 2l pain 3 gen: nad, laying in bed neck: supple heent: op clear, poor dentition chest: faint wheezing anteriorly cv: rrr no m/r/g abd: distended ext: feet tender (chronic) no edema neuro: aaox3 psych: appropriate, pleasant pertinent results: ct c/a/p on admission: 1. new enhancing hepatic mass and increased number and size of pulmonary nodules at the lung bases compatible with worsening metastatic disease. several osseous metastatic lesions with soft tissue components are not significantly changed in the interval. 2. worsening diffuse septal thickening, likely reflective of worsening pulmonary edema, though lymphangitic carcinomatosis is not excluded. small bilateral pleural effusions, right larger than left. 3. new moderate volume ascites. 4. atrophic kidneys with multiple cysts, likely related to dialysis. dominant, peripherally calcified complex cystic lesion in the right upper pole of the kidney could reflect the patient's primary renal carcinoma. 09:36am blood wbc-4.3# rbc-3.18* hgb-9.2* hct-29.6* mcv-93 mch-29.0 mchc-31.1 rdw-18.6* plt ct-204 09:36am blood glucose-95 urean-22* creat-6.5*# na-140 k-4.2 cl-102 hco3-26 angap-16 09:36am blood calcium-9.2 phos-4.0 mg-1.8 10:53am ascites wbc-2050* rbc-1475* polys-80* lymphs-3* monos-14* atyps-0 mesothe-3* brief hospital course: mr. is a 39m with esrd on hd and renal cell ca with brain, pulmonary, and hepatic mets admitted to the micu with hypotension after receiving gadolinium during mri on day of admission. active issues: --------------- # septic shock: sbp: he met sirs criteria (hr, rr, wbc)on admission and required levophed after 2l ns with most likely etiology sbp. he was treated with ceftriaxone (see sbp for further details). hypersensitivity reaction to gadolinium has been described but is rare, and he has previously received gadolinium. he received hd to remove gadolinum once he was hemodynamically stabilized. adrenal insufficiency was ruled out. his shock resolved and he was transferred to the general medical floor without any further infectious issues. # sbp: he completed a course of ceftriaxone and given albumin on day 1 and day 3. he will continue on norfloxacin for prophylaxis. #new onset ascites: likely due to new hepatic mets and or carcinomatosis. no portal or splenic vein thrombosis seen. # esrd: the patient received hd to remove gadolinum for mri . he then continued on a mwf hd schedule. he had difficulty removing fluid during hd due to hypotension, which had been a problem at his out patient facility as well and so he was started on midorine. # pain: pt with groin, leg, feet, back and abdominal pain. pain regimen adjusted to increased home oxycontin dose, continued home oxycodone, tramadol, started naproxen and tylenol around the clock. # htn: pt remained normo-tensive with his baseline sbp in the 100s. he was not discharged on his previous anti-hypertensive, nifedipine. # anemia: likely chronic disease and chemo. no evidence of bleeding. - cont epo # metastatic renal cell ca: pt had been followed by dr. in . will establish care in with dr. . his records from dr. were faxed to the new office on the day of discharge. he was found to have progression of known brain and pulmonary mets and new hepatic mets during admission. patient and mother are aware of this. pt expressed wishes to be resuscitated but not intubated. explained that this was not possible. discussed his poor prognosis of weeks to months and the likelyhood of suscessful resuscitation would be at most 5%. patient stated that he would remain full code for now and would discuss it with his friends and mother. medications on admission: nifedipine 60 mg qsunday/tues/thurs oxycodone-acetaminophen prn tramadol 50 mg tid discharge medications: 1. acetaminophen 1000 mg po q6h 2. docusate sodium 100 mg po bid 3. midodrine 5 mg po tid 4. naproxen 500 mg po q12h 5. nephrocaps 1 cap po daily 6. oxycodone (immediate release) 5-10 mg po q4h:prn pain hold for sedation 7. oxycodone sr (oxycontin) 30 mg po q12h hold for sedation or rr<10, 8. polyethylene glycol 17 g po daily hold if patient having daily bms. 9. senna 1 tab po bid constipation 10. tramadol (ultram) 50 mg po tid 11. lorazepam 0.5-1 mg po q4h:prn anxiety 12. norfloxacin *nf* 400 mg oral daily sbp prophylaxis discharge disposition: expired facility: center discharge diagnosis: spontaneous bacertial peritonitis new hepatic metastasis of renal cell carcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted due to an infection in your abdomen which has been treated.you will require prophylactic antibiotics from now on to prevent this infection from returning. followup instructions: department: hematology/oncology when: tuesday at 4:00 pm with: drs. / building: sc clinical ctr campus: east best parking: garage procedure: percutaneous abdominal drainage diagnoses: anemia in chronic kidney disease end stage renal disease renal dialysis status tobacco use disorder malignant neoplasm of liver, secondary unspecified septicemia severe sepsis malignant neoplasm of kidney, except pelvis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease secondary malignant neoplasm of brain and spinal cord septic shock antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use secondary malignant neoplasm of lung hypovolemia examination of participant in clinical trial disorders of magnesium metabolism personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health personal history of alcoholism neoplasm related pain (acute) (chronic) secondary malignant neoplasm of retroperitoneum and peritoneum family history of malignant neoplasm of gastrointestinal tract spontaneous bacterial peritonitis family history of malignant neoplasm of trachea, bronchus, and lung nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney antineoplastic chemotherapy induced anemia malignant ascites 

Answer: The patient is high likely exposed to