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: heparin agents / motrin attending: chief complaint: shoulder pain major surgical or invasive procedure: s/p acd s/p posterior cervical reconstruction history of present illness: 68 m pmh thyroid ca with mets to bone and liver, history of intrathecal narcotics requirement, who p/w increased pain. the pain is located in the l shoulder scapular to humoral region, with no obvious radation, and was in severity. he also describes other chronic pains, including leg and some chest pain with heavy coughing, but these have been stable. he was seen by dr. on , where he was also noted to have some l sided weakness, and was sent for an mri to evaluate for metastatic disease, which as noted below showed no new changes. he was attempting to increase his decadron as indicated by dr. , when he couldn't handle the pain this am, and came to the ed. he has also described some diffuse paresthesias of both fingertips, although primarily on the l--no apparent pattern. otherwise, he denies focal weakness, numbness, incontinence of stool or urine, urinary retention, ha, as well as any f/c/ns, lh, appetite changes, sob, n/v, or abdominal pain. he has a chronic cough radiation, and also noted poor fluid intake over the past few days, although no apparent reason. he requires a walker to ambulate, but notes no change over the past few days. . in the ed, given dilaudid 4mg iv x 2, with pain that was not completely revolved, but "tolerable." past medical history: thyroid ca s/p thyroidectomy , with mets to bone and liver -s/p implanted epidural narcotics on prior admission; hx of infected port-a-cath system s/p carboplatin s/p cyperknife to t1 clear cell ca of l kidney s/p l nephrectomy s/p appy social history: history of smoking cigarettes, 1 pack-per-day, for 10 years--stopped in . occasional alcohol, 1-2 drinks per week. he does not use any illicit drugs. family history: his mother died of tuberculosis at age 36 in . his father died at age 73 from coronary artery disease. his brother died of smoking-related lung cancer. his sister and his children are healthy. physical exam: vitals: t 98.8 bp 150/91 hr 93 r 20 sat 97% ra * pe: g: nad, wn, wd heent: clear op, mmm neck: supple, no lad, no jvd lungs: bs bl, no w/r/c cardiac: rr, nl rate. nl s1s2. no murmurs abd: soft, nt, nd. nl bs. no hsm. ext: no edema. 2+ dp pulses bl. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. strength ue r, 4/5 l throughout--no pattern and pt denies pain limiting, bl le. 2+ reflexes, equal bl. ungoing toes bl. past-pointing on l ue, nl on r. pertinent results: mr : there is no change from . there is metastatic disease at c7-t1 and t2 with collapse of t1 and resultant kyphosis. there is stable epidural disease. there have been posterior laminectomies and there is no spinal cord compression, although there is probably some myelomalacia and atrophy at the level of the surgery, unchanged. * l shoulder/humerus plain film: read pending; no obvious fracture, ? metastatic involvement. . cxr : patchy opacities most prominent in the right lower lobe, worrisome for pneumonia. . ct spine : progression of the lytic osseous and epidural metastases, with progressed malalignment. fracture through the t2 pedicle screws bilaterally . cta : 1) right lower and right middle lobe air space consolidation consistent with pneumonia. there appears to be narrowing of the bronchus intermedius. 2) left lower lobe atelectasis and patchy multifocal bilateral generalized foci of air space disease most likely reflecting consolidations though metastases are not excluded. 3) progression of osseous vertebral and hepatic metastasis. 4) no evidence of pe. 5) possible cervical instability. . bone scan : 1) no abnormal uptake in the left upper extremity. 2) uptakecorresponding to known metastases in the sternum, cervical spine as above. the new uptake in the left 11th and 12th rib ends likely post-traumatic. brief hospital course: 68m thyroid ca to bone + liver p/w increased pain l shoulder/ humerus. pt was admitted to the medicine service and treated for the following problems: . # pneumonia: patient had altered ms and low grade fevers and cxr performed which suggested pna. started on levo/flagyl with concern for aspiration. , patient had new hypoxia and hemoptysis. hematocrit has remained stable. cta negative for pe but did confirm significant pneumonia. no fevers since starting levo/flagyl. . #l shoulder/humerus pain: evaluated by radiation oncology who felt that risks of radiation in setting of multiple prior episodes was quite high especially given instability. neurosurgery consulted for cervical spine. his pain was initially difficult to control, but was ultimately dramatically improved when he was changed to a dilaudid pca--he did not have relief from fentanyl patch, likely b/c of soft tissue wasting and future efforts at long acting medications should be po. . #thyroid ca, metastatic disease: progressive in spine and likely contributing to current complaints. levothyroxine was continued. consider neupogen. will d/w attending oncologist . # thrush: the patient was admitted with thrush which was succesfully treated with nystatin s&s. neurosurgery team asked to eval this pt on and was transferred to our service for spinal deformity which was noted on upper level of images (ct chest) to r/o pe. ct of cervical thoracic spine was obtained and results of t1 collapse noted. pts family, at that time wanted to continue care with prior neurosurgeon/dr. . this was communicated to this neurosurgery team. some short time later the family wished against transfer out to dr. care and decided that they would want surgery to correct spinal deformity/kyphosis here. the pt was placed in halo traction at 30lbs of traction. this was in attempt to reduce kyphotic deformity for pre-operative optimization. a ct scan of the spine was obtained in traction and good reduction of the deformity was noted. the pt was then medically optimized and pre-op'd and taken to the or on for c7 t1 t2 corpectomies/ anterior approach. there was a lot of bleeding during the initial anterior approach / the case lasting approximately 7 hours. it was decided that the pt would remain intubated and return to the or on the 5th (the next day for continuation of the case. the second portion of the case was completed that day (the 5th). thoracic surgery assisted because of mediastinal mass / we needed sternotomy to control bleeding and complete ant. approach. the total ebl was 7.5 liters with the pt being given 22 units of prbc's. he had a chest tube placed on the left side intraoperatively. this was removed on approx 1/7/7. postoperatively he was started on fondiparinox on as he is hit positive. on he had a peg tube place. his postoperative head ct and spine ct's were stable. his neurological status postoperatively was stable. all extremeties are antigravity and his mentation is intact. his course complicated by intermittent low hct's for which he was transfused. temps as high as 102.+ for which he was started on zosyn. on his left upper extremity was noted to be swollen and son noted lue dvt. on the 14th, the halo ring that was initially placed for use of cervical traction and for potential halo vest placement was removed. he remains in a cervical collar and had been oob to chair. the patient required prolonged ventilation he had difficulty clearing his secretions. his family was offered a trach but they felt the patient had a difficult post operative course and was suffering they did not want to the patient to under go further procedures. the patient had made his wishes clear to his family not to be dependent or on a ventilator for a prolonged period. after a long discussion with the family and dr they decided to extubate the patient and see if he could tolerate being extubated, he quickly passed away in a few minutes with his family at his side. medications on admission: gabapentin 300/300/900, hydromorphone 4-8 mg q8h prn, tizanidine 2mg t.i.d., fentanyl patch 75 mcg per hour every three days, lidoderm patch 50, 3 patches a day lorazepam 0.5mg q4-6h prn levothyroxine 0.125 qd protonix 40 qd folic acid decadron 2mg (incr to 4mg in am today) discharge medications: n/a discharge disposition: extended care discharge diagnosis: cervical spine harware failure s/p cervical spine stabilization metestatic disease discharge condition: expired discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] excision of intervertebral disc transfusion of packed cells transfusion of other serum transfusion of platelets insertion or replacement of skull tongs or halo traction device plastic operation on pharynx spinal traction using skull device excision or destruction of lesion or tissue of mediastinum fusion or refusion of 2-3 vertebrae refusion of dorsal and dorsolumbar spine, anterior column, anterior technique refusion of other cervical spine, anterior column, anterior technique diagnoses: pneumonia, organism unspecified malignant neoplasm of liver, secondary unspecified pleural effusion unspecified essential hypertension long-term (current) use of steroids acute posthemorrhagic anemia secondary malignant neoplasm of other specified sites candidiasis of mouth hemorrhage complicating a procedure secondary malignant neoplasm of brain and spinal cord anticoagulants causing adverse effects in therapeutic use personal history of malignant neoplasm of kidney acquired absence of kidney secondary malignant neoplasm of bone and bone marrow personal history of irradiation, presenting hazards to health neoplasm related pain (acute) (chronic) pathologic fracture of vertebrae kyphosis associated with other conditions personal history of malignant neoplasm of thyroid other mechanical complication of other internal orthopedic device, implant, and graft 

Answer: The patient is high likely exposed to