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: lower extremity weakness, hypotension major surgical or invasive procedure: none history of present illness: 62 y/o f newly diagnosed rectal mass who presents with lower extremity weakness, numbness and acute urinary retention. prior to her aortofemoral bypass () she had progressively worsening weakness of the bilateral lower extremities and ascending numbness (l > r) which somewhat improved following bypass but did not completely resolve. 1-2 weeks ago patient began to experience worsening weakness and numbness and today she had difficulty walking which prompted her to present to . due to concern of urinary retention patient transfered to for evaluation where she was evaluated by several services. . neurology, neurosurgery and radiology felt most likely her neurological symptoms were due to lumbosacral plexus invasion of tumor. based on exam and imaging available (mri unable to be completed) they did not feel she was suffering from cauda equina or cord compression. no saddle anesthesia on exam. patient later denied above urinary retention and described difficulty urinating due to preference of foley instead of bed pan. they did not recommend steroids or surgical involvement. vascular service saw patient and found no acute vascular issues (palpable femoral and dp pulses b/l, normal ct aortic graft, no acute vascular issues). colorectal surgery also consulted. . vs on presentation to ed t 98.2, bp 147/74, hr 84, rr 18, 99% ra. patient received valium 20 mg iv (for mri), fentanyl 100mcg and ciprofloxacin in the ed. following valium doses patient bp dropped to 68-75/43-60 and improved to sbp 90s following 4 l ns. vitals on transfer hr 101, 90/64, 16, 99%ra. patient mentated and with good urine output with low bps. she was admitted to the icu due to hypotension and concern she would trigger on the floor. on arrival to the icu her vs bp 131/56 and hr 105. past medical history: - aortofemoral bypass for actute aortic thrombus - rectal ca, discovered at time of surgery in , not yet staged, not treated - diabetes on insulin - left humerus fracture secondary to le weakness - cad s/p mi 8 years ago (no intervention) - chronic pain - hypercholesterolemia - htn - bed bound due to l. humerus fracture psh: aortobifemoral in , r scv port placement. social history: lives with partenr of 25 years, here with her. smoked 1ppd x 50 years - quit in . three children. denies etoh use. denies current drug use. family history: mother 83 - cva father 39 - mi no family history of colon, breast or ovarian cancer physical exam: gen: thin, comfortable, nad heent: perrl, eomi, anicteric, drymm, op without lesions, no jvd resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii intact. lower extremity: left , right . gross sensation intact. upper extremity: left , right . gross sensation intact. reflexes: patella 0 b/l. toes downgoing. rectal: per ed and patient rectal tone intact. . on discharge: vs - tm/c: 99.0/97.1, bp 146/80 (132-156/60-80), hr 86 (86-80), rr 20, sats 98% on ra, gen: nad, cachectic, lying in bed, comfortable heent: perrl, eomi, frontal, oral mucosa pink not op lesions, not lad, no increased jvp axilla: 1cm lymph node palpated bilaterally cv: tachycardic, s1s2 no s3s4, no m/r/g lungs: fine crackles at the bases bilaterally, no wheezes, rales, rhonchi abd: large midline surgical scar, +bs, soft nt, nd, no hsm ext: 2+ peripheral pulses, calf and thigh muscle wasting bilaterally neuro: a&ox3, cn ii-xii intact, rue: elbow flexion/extension , wrist flexion/extension , deltoid lue: deltoid , elbow extension , elbow flexion , wrist flexion/extension rle: hip flexor , knee extension , knee flexion , ankle flexion/dorsiflexion lle: hip flexor , knee extension , knee flexion , ankle flexion/dorsiflexion reflexes: patellar - no reflexes elicited bilaterally achilles - no reflexes bilaterally down going toes bilaterally sensation intact throughout pertinent results: 12:45pm blood wbc-8.5 rbc-4.08* hgb-13.3 hct-37.9 mcv-93 mch-32.5* mchc-34.9 rdw-14.3 plt ct-285# 03:50am blood wbc-16.9*# rbc-3.90* hgb-12.4 hct-37.1 mcv-95 mch-31.7 mchc-33.4 rdw-14.3 plt ct-302 12:45pm blood neuts-58.1 lymphs-31.0 monos-4.6 eos-5.5* baso-0.8 12:45pm blood glucose-160* urean-15 creat-0.6 na-138 k-3.4 cl-101 hco3-26 angap-14 03:50am blood calcium-7.9* phos-3.4 mg-1.5* 09:37pm blood lactate-1.7 . micro: mrsa screen negative blood culture pending blood culture pending urine negative . imaging: cta abd: impression: 1. large locally invasive rectal mass with increased pelvic lymphadenopathy. 2. patent aortobifemoral graft with a right groin collection most likely seroma, although an abscess cannot be excluded. 3. nodular adrenal glands with adjacent prominent lymph nodes. given known history of a rectal mass, this may represent distal nodal and adrenal metastases. . mri t&l spine: impression: 1. no evidence of spinal canal narrowing is demonstrated involving the thoracic or lumbar spine. 2. there is a wedge compression deformity of the superior endplate of l2. chronicity of this is inconclusive given no prior exams for comparison and no stir sequence (the patient refused completion of the study) to evaluate for acute edema. the posterior wall of the l2 vertebral body is intact without retropulsion. if clinically warrented, a second attempt at acquiring the stir sequence can be attempted. 3. with the above limitations in mind, remainder of the study does not show acute abnormality to explain the patient's symptoms. . cxr: impression: no acute intrathoracic process . gallbladder/liver u/s: impression: 1. mixed hyper- and hypoechoic lesion at the borders of segment vii and viii, corresponding to the approximately 2 cm lesion noted on ct, which displays more ct features of a hemangioma. the other presumed probable flash-filling cavernous hemangioma within segment vi could not be identified son despite extensive scanning through this region in multiple positions and is likely isoechoic to the surrounding parenchyma. again, ct features are most suggestive of hemangiomas and lesion would be highly atypical for rectal metastases. if further confirmation is needed, a dedicated mri would be the best examination (patient may benefit from being scanned on large bore magnet on due to claustrophobia). alternatively multiphasic ct could also be performed (less desirable given multiple prior ct's) or this could be followed on subsequent imaging. 2. enlarged right adrenal gland may reflect underlying hyperplasia and is stable from prior cts dating back to . this could also be evaluated at time of mri. brief hospital course: 62yo f w/ newly diagnosed rectal adenocarcinoma with lower extremity weakness and intitial concern for cord compression which was ruled out and determined to be related to lumbosacral compression from tumor burden. she was started on chemo/radiation therapy and transferred to to complete her treatment . # hypotension: on arrival to the hospital, patient was normotensive, in the emergency department, she was given valium and fentanly for sedation prior to mri and became hypotensive to 60/40, she was bolused 4 l ns in the ed and admitted to the micu. however, by the time she arrived in the icu sbp 130s and map > 65. patient was mentating with good urine output. hypotension is of unclear etiology likely hypovolemia versus medication side effect (occured following valium and fentanyl). no evidence of infection to suggest septic shock. no evidence of decompensated heart failure on exam or by history. no increased o2 requirement to suggest massive pe or chest pain to suggest acs. pt denied being on bp meds. her pressures remained within the 90's to 120's during the first few days and then the day prior to admission, the patient was hypertensive with sbp in the 130-150 range. she was transferred to the oncology service for work up of lower extremity weakness. she was discharged off her home metoprolol, which was not restarted. . # lower extremity weakness and numbness: on admission there was concern that this could represent cord compression or cauda equina syndrome. originally reported urinary retention but on further history actually did not want to use a bed pan and preferred a foley. mri of the t- and l-spine were done and was not complete due to patient's anxiety but were reviewed by radiology and neurology and neurosurgery and felt to be sufficient to rule out cord compression. patient also examined by neurology and neurosourgery and exam was not consistent with cord compression or cauda equina. neurology and radiology felt symptoms due to lumbosacral plexus invasion of tumor. no further imaging was done as the patient was claustrophobic and does not tolerate sedating medications well. her foley was discontinued when she arrived to the floor and was urinating without issues. she was also seen by colorectal surgery, radiation oncology and medical oncology. there was some initial concern that there was metastasis in the liver, but after further review, it was decided that they were more likely hemangiomas. her case was discussed during gi rounds and it was decided to start neo-adjuvant chemo/radiation therapy. 5fu and radiation therapy was started , the plan is for her to continue radiation for 30 treatments and 5-fluorouracil for 6 weeks however duration of therapy will be guided by outpatient oncologist. she was seen by physical therapy and because of her lower extremity weakness she was discharged to rehab. . . # rectal cancer: per patient this is a new diagnosis. per omr patient worked up at - felt to be rectal cancer stage t2n1mx. port appears to be placed for chemo but patient was unclear of plan. was contact for medical records and onc and rad onc were consulted. pain control with tylenol, prn oxycodone. please see course and plan for treatment as above. . # uti: on patient had dysuria and grossly positive ua, she was treated with ciprofloxacin and will need to continue for a total of 7 days. . # diabetes: insulin sliding scale. finger sticks were well controlled. . # aortofemoral bypass for actute aortic thrombus: vascular evaluated in ed felt no vascular issues. this was not an active issue during her hospital stay. . # cad s/p mi 8 years ago (no intervention): no chest pain. aspirin was continued once it was decided there would be no further procedures. . # chronic pain: diffuse also with l humerus fracture and rectal cancer. was on standing tylenol, gabapentin, lidocaine patch, oxycodone prn. her pain was well controlled during the course of her stay. . # hypercholesterolemia: continued statin. . transitional issues: - patient is to receive neo-adjuvant chemotherapy/radiation therapy - monitor for improvement in neuro exam. if no improvement in symptoms with treatment, shrinking of tumor then may need neuro exam for possible emg. medications on admission: medications at home: aspirin 81mg po daily . medications at time of transfer: ciprofloxacin 500mg po q12 (d1 = ) heparin 5000u sc tid gabapentin 300mg po daily acetaminophen 1000mg po q6 lidocaine patch 5% patch td daily miralax 17gm po daily senna 1 tab po bid colace 100mg po bid simvastatin 20mg po daily iss thiamine 100mg po daily mvi 1 tab po daily . discharge medications: 1. heparin flush (10 units/ml) 5 ml iv prn line flush indwelling port (e.g. portacath), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. 2. heparin flush (100 units/ml) 5 ml iv prn de-accessing port indwelling port (e.g. portacath), heparin dependent: when de-accessing port, flush with 10 ml normal saline followed by heparin as above per lumen. 3. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 4. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days. disp:*14 tablet(s)* refills:*0* 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): 12 hours on, 12 hours off. 6. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 7. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. fluorouracil 500 mg/10 ml solution sig: three y (350) mg intravenous once as directed by oncologist for 5 days: fluorouracil 350 mg iv days 1, 2, 3, 4 and 5. (, , , and ) (225 mg/m2) (wednesday through sunday ) . 13. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 14. lorazepam 0.5 mg iv q4h:prn anxiety or nausea 15. ondansetron 4 mg iv q8h:prn nausea 16. prochlorperazine 10 mg iv q6h:prn nausea 17. gabapentin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 18. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 19. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). 20. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous asdir (as directed): please see attached sheet for sliding scale. discharge disposition: extended care facility: hospital - discharge diagnosis: primary diagnosis: lower extremity weakness rectal adenocarcinoma urinary tract infection secondary diagnosis: type ii diabetes hypertension hypercholesterolemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms , it was a pleasure caring for you in your hospital stay at . you were transferred from hospital to for weakness in your legs. you were evaluated by the neurosurgery and neurology specialists and an mri showed that the spread of your rectal cancer is compressing the nerves that go to your legs which explains your symptoms. you started chemotherapy in this hospital stay with 5-fluorouracil and also started external beam radiation therapy. you will continue both the chemotherapy and the radiation treatments as an outpatient. while in the hospital, you were also found to have a urinary tract infection and you were started on a course of antibiotics as an outpatient which will be continued on discharge as instructed below. we have made the following changes to your medications: - 5-fluorouracil was started for chemotherapy - ciprofloxacin was started, to be taken until - gabapentin was started - oxycodone was started - tylenol was started - lidocaine patches were started - insulin was started - lorazepam was started - ondansetron was started - prochlorperazine was started - thiamine was started - docusate, polyethylene glycol, and senna were started - multivitamin was started - metoprolol was stopped - levemir was stopped but your humalog sliding scale was continued - you will be taking aspirin 81mg daily followup instructions: please keep the following appointments: department: hematology/oncology when: wednesday at 1:30 pm with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: wednesday at 2:00 pm with: , rn building: campus: east best parking: garage provider: , . department: primary care physician : tuesday, 9:30am department: vascular surgery when: friday at 10:00 am with: vascular lmob (nhb) building: lm bldg () campus: west best parking: garage procedure: injection or infusion of cancer chemotherapeutic substance other radiotherapeutic procedure diagnoses: other iatrogenic hypotension hemangioma of intra-abdominal structures other chronic pain coronary atherosclerosis of native coronary artery pure hypercholesterolemia urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled secondary malignant neoplasm of other specified sites other opiates and related narcotics causing adverse effects in therapeutic use dysthymic disorder cachexia long-term (current) use of insulin old myocardial infarction other postprocedural status aftercare for healing traumatic fracture of other bone anemia in neoplastic disease neoplasm related pain (acute) (chronic) malignant neoplasm of rectum benzodiazepine-based tranquilizers causing adverse effects in therapeutic use personal history of traumatic fracture body mass index between 19-24, adult muscle weakness (generalized) muscular wasting and disuse atrophy, not elsewhere classified 

Answer: The patient is high likely exposed to