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: cefazolin / hydromorphone attending: chief complaint: acute on chronic fatigue/hypotension/productive cough major surgical or invasive procedure: arterial line placement history of present illness: 68 y/o gentleman with metastatic renal cell cancer to lungs, acute on chronic fatigue and sob, presented to ed with abdominal pain. he has experienced worsening fatigue for many days. his abdominal pain is crampy in nature and diffuse. patient has had chronic dry cough but has experienced clear sputum production since yesterday. denies fevers, chills, nausea, vomiting, black stools or chest pain. he recently stopped pavluzimab on tuesday, to start sutinib this week. . in the emergency department initial vitals were t 98.5, bp 82/40, hr 94, rr 16, 96% in ra. patient recieved 2 units of prbc and 2l ns. his hct was low at 23.7 (bl 29-30). he was guaic negative. he also recieved vancomycin 1 gram iv, zosyn 4.5 grams iv and levaquin 750 mg iv for possible pna. he also was started on levophed 0.09 given bp was still in 90s/40s. patient made a urine output of 350ml. he was transfered to ed for further evaluation. . review of systems is negative for headache, change in vision, hearing, focal weakness, numbness, diarrhea. he has chronic constipation. . oncologic history: mr. is a 68-year-old gentleman who was in his usual state of health until early when he developed dyspnea. cxr revealed a large right-sided pleural effusion. ct torso on showed a large right pleural effusion. it also revealed a 2.3 cm rml nodule and pleural studding. a 9-cm mixed attenuation mass was seen in the mid portion of the right kidney, extending laterally into the left renal vein. there were no focal liver abnormalities and no adenopathy. thoracentesis on drained 1.4 l of bloody pleural fluid. cytology was negative. he was seen at on and was admitted on for recurrent pleural effusion. he underwent thoracentesis which was negative for malignancy and bronchoscopy which revealed no endobronchial lesions. he returned on for an elective thoracoscopy, pleural biopsy, talc pleurodesis, and pleurex catheter placement. pathology from the pleural biopsy showed metastatic poorly differentiated carcinoma with clear cell features. he was then readmitted on with a severe drug rash, felt to be due to dilaudid. his pleurex catheter was removed on . he underwent laparoscopic nephrectomy on and pathology revealed renal cell carcinoma, conventional clear cell type, grade ii, greatest dimension 7.5cm. tumor extended into perinephric tissues and renal vein. margins at gerota's fascia were positive for tumor. papillary adenomas were also seen. no lymph nodes were sent for review. he initially enrolled in clinical trial 04-117, with the goal of creating a dendritic cell + tumor fusion vaccine, but he had radiographic and clinical signs of disease progression so was taken off trial. he was admitted for hypercalcemia from to . he enrolled in clinical trial 08-219, comparing pazopanib vs. sunitinib for locally advanced or metastatic rcc, on and was randomized to receive pazopanib. treatment was held from to for grade 3 elevation in his alt (grade 2 in ast). he was restarted at 600mg daily when his lfts normalized. his pazopanib was on hold from thru because he needed urgent dental surgery including bone removal. during this time he had rapid growth of an intramuscular lesion on the right chest wall. past medical history: -metastatic renal cell carcinoma. -history of recurrent malignant pleural effusion, s/p right pleurodesis. -right chest wall pain as well as dyspnea and worsening disease in the right lung. -hypthyroidism, started on levothyroxine two days ago -hypertension -severe dermatitis reaction, which was thought secondary to ancef prior to his pleuroscopy social history: married, has 2 daughters one is a nurse at . former smoker, quit 26 years ago. drinks 1 glass wine/week. retired from customer service. family history: no immediate family history of ca, aunt died of gastric ca. physical exam: general: pleasant gentleman, in nad heent: normocephalic, atraumatic. cconjunctival pallor present. eomi. mmm. op clear. neck supple. cardiac: regular rhythm, normal rate. normal s1, s2. i/vi systolic murmur best at rusb. jvp 7 cm lungs: decreased bs at right lower lung field. abdomen: soft, nt, nd. no hsm extremities: no edema or calf pain, 2+ dorsalis pedis neuro: a&ox3. appropriate. preserved sensation throughout. strength throughout. psych: listens and responds to questions appropriately, pleasant pertinent results: 09:35pm haptoglob-372* 09:35pm albumin-3.0* calcium-11.2* phosphate-3.3 magnesium-2.1 09:35pm ctropnt-0.01 09:35pm ck-mb-notdone 09:35pm alt(sgpt)-8 ast(sgot)-13 ck(cpk)-16* alk phos-57 tot bili-0.4 09:35pm estgfr-using this 09:35pm glucose-103 urea n-23* creat-1.5* sodium-133 potassium-5.3* chloride-101 total co2-25 anion gap-12 09:40pm ret aut-2.1 09:40pm plt count-412 09:40pm neuts-77.9* lymphs-15.7* monos-5.0 eos-0.8 basos-0.5 09:40pm wbc-5.4 rbc-2.58* hgb-7.8* hct-23.7* mcv-92 mch-30.4 mchc-33.1 rdw-17.3* 09:43pm glucose-105 lactate-1.7 na+-133* k+-5.0 cl--100 tco2-24 01:46am urine rbc-0 wbc-0-2 bacteria-occ yeast-none epi-0 01:46am urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 01:46am urine color-yellow appear-clear sp ->1.050 03:40am ret aut-1.7 . chest ct: 1. worsening right lung consolidation since the prior examination, with stable appearance of pleural abnormalities. soft tissue components of pleural abnormality cannot be differentiated from pleural fluid without contrast. 2. slight enlargement of now trace-to-small left pleural effusion with associated left lower lobe atelectasis. 3. sift tissue abnormalities of the left chest and upper abdominal wall as previously noted. . echo: poor technical quality due to patient's body habitus. left ventricular function is probably normal, a focal wall motion abnormality cannot be fully excluded. the right ventricle is not well seen but may be dilated and hypokinetic. moderate pulmonary artery systolic hypertension. . us of rue, and le bl neg for dvt. brief hospital course: 68 y/o gentleman with metastatic renal cell cancer to lungs who presents with acute on chronic fatigue and sob admitted to icu. . #. anemia: ptaient received 2 units prbc in the ed for a hct of 23.7. hemolysis work up was negative, and guaic negative. an iron panel showed iron deficiency. pelvic fluid collection was noted on ct, otherwise there were no obvious sources of bleeding. subsequently his hct remained stable between 26-29. patient did not require further transfusions throughout hospital course. - please check weekly cbc; transfuse for hct <21 . #. hypotension/sepsis/pneumonia: the patient was initially transfered to medical icu for monitoring. his hypotension was thought to be secondary to sepsis in the setting of pneumonia. the differential diagnosis included hemorrhagic shock given the pelvic fluid collection noted on ct. however, the patient's hematocrit remained stable. in the icu the patient initially required norepinephrine for blood pressure support but was weaned off of this on . otherwise, the patient's blood presure was supported with iv fluids and by holding his home antihypertensives. the patient was treated with vancomycin, zosyn, and ciprofloxacin given frequent contact with healthcare. ciprofloxacin was discontinued on . upon transfer to the floors, patient remained afebrile but was orthostatic and required ivfs. vancomycin and zosyn were transitioned to po levofloxacin to complete a course of antibiotic therapy for community acquired pneumonia. patient was found to be iron defecient and hypothyroid (as stated below). orthostasis resolved with fluids on discharge. - can restart home antihypertensives if patient becomes hypertensive . #. acute on chronic renal failure: on admission, the patient's creatinine was elevated to 1.5 from baseline 1.3. this was thought to be prerenal and returned to baseline with ivfs. creatine on discharge was 1. . # hypercalcemia: in the icu, patiently initially found to have elevated ca, that resolved with ivfs. calcium again trended up while on the floors and patient was given iv pamidronate. calcium on discharge was 8.8. . #. metastatic renal cell carcinoma: patient is s/p laparoscopic nephrectomy on and pazopanib therapies. on this admission a chest ct done was done that showed extensive neoplastic invasion of the right hemithorax, extending across the chest wall and into the abdomen overlying the right psoas. patient was started on sutinib and this is to be continued while in rehab. - please continue sutinib - please check weekly cbc . #. hypothyroidism: prior to admission patient recently started on levothyroxine. his tsh on this admission was 17. no changes were made to his home dose of levothyroxine as he had only been recently started on this medication. patient was discharged with plans to follow up with his oncologist. medications on admission: fentanyl 50 mcg/hour patch furosemide 20 mg prn, has only taken two doses levothyroxine 25 mcg daily lidocaine-prilocaine 2.5 %-2.5 % cream apply 1 hour prior porta-cath access as directed lisinopril 5 mg daily lorazepam 1 mg q8h prn anxiety/nausea megestrol 400 mg daily methylphenidate 5 mg oxycodone 2.5 - 5 mg by mouth q 2hours as needed for trouble breathing; pain docusate sodium 100 mg multivitamin daily polyethylene glycol prn senna 17.2 mg prn discharge disposition: extended care facility: for the aged - discharge diagnosis: primary: anemia pneumonia acute on chronic renal failure metastatic renal cancer discharge condition: stable: t 97.8, bp 119/55, o2 96/ra discharge instructions: you were seen in the hospital for your fatigue. you were found to have low blood pressure, low hematocrit, and a pneumonia. while in the emergency room you received blood transfusion. you were in the icu, and were treated with iv antibiotics and iv fluids. you improved with this therapy. we have made the following changes to your home medications: 1. we have stopped your lisinopril and lasix because your blood pressure was low, please follow up with your pcp to decide when to restart these medications 2. please take levofloxacin to treat your pneumonia until . 3. we have increased your fentanyl patch to 62mcg/hr every 72 hours. 4. we have changed your morning methylphenidate dose from 2.5mg to 5 mg. you can continue your afternoon dose of 2.5mg. 5. we have started you on an iron supplement. 6. please continue sutent; this is the chemotherapy you were started on while in the hospital. if you should experience fevers >101, lightheadedness, or any concerning symptoms please contact your pcp or return to the emergency room. followup instructions: provider: , md phone: date/time: 10:30 please follow up with your pcp . on 9:45am, she will decide if you should be restarted on lisinopril and lasix. she will also follow up on your tsh and determine if your synthroid dose should be changed. procedure: arterial catheterization diagnoses: pneumonia, organism unspecified anemia, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified secondary malignant neoplasm of lung hypercalcemia 

Answer: The patient is high likely exposed to