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: past medical history: 1. ovary removal with endometriosis. 2. status post phyllodes tumor with a wide excision in . she had a normal mammogram in . 3. history of oophorectomy. medications on admission: 1. zoloft. 2. wellbutrin. allergies: the patient has no known drug allergies. social history: she is a former teacher. she has a 27-year-old son in . two packs per day since age 18. two glasses of wine per day. no drug use. family history: notable for a family history of lung cancer in her father. physical examination on admission: vital signs: temperature 96.4, pulse 91. the blood pressure was 164/94, respirations 18, saturating 97% on room air. general: the patient was a pleasant female in no acute distress. alert and oriented times three. heent: the pupils were equal and reactive to light. the extraocular muscles were intact, 3 to 2 mm bilaterally. the neck was supple. heart: regular rate and rhythm. lungs: the lungs were with diffuse wheezing bilaterally. abdomen: positive bowel sounds, soft, nontender, nondistended. extremities: with no edema, clubbing, or cyanosis. neurological: the patient had cranial nerves ii through xii intact, 5/5 strength bilaterally. sensation grossly intact. laboratory data upon admission: white count 4.6, hematocrit 30.9, platelets 101,000. sodium 138, k 3.0, chloride 95, bicarbonate 27, bun 19, creatinine 0.6, glucose 114, calcium 10.7, alt 171, ast 90, alkaline phosphatase 217, lipase 53, total bilirubin 0.4, free calcium 1.36. hospital course: the patient had a hospital course which is notable by systems as follows. 1. hematology/oncology: the patient is a 54-year-old female with a left upper lobe lung mass with multiple liver and bony metastases in the spine seen by imaging studies over the last month. the ultimate diagnosis of small cell lung cancer was made and the patient had been treated with cisplatin and etoposide. in further detail, the patient had a ct scan on of the chest, abdomen, and pelvis. the ct of the chest, abdomen, and pelvis at this time showed a new large mass in the left upper lobe of the lung concerning for lung cancer. there were multiple liver masses concerning for metastatic disease. the lung mass in the upper lobe measured approximately 5 by 10 by 6.5 cm. there was also a precarinal lymph node measuring 13 mm. the patient also had an mr of the cervical lumbar spine. the mr of the cervical and lumbar spine dated were notable for diffuse marrow signal abnormalities, indicative of marrow hypoplasia or infiltrative processes. focal signal abnormalities involving l1, l3, and l4 vertebra were seen consistent with metastatic disease. degenerative changes in the lumbar spine lesion were noted as well. in regards to the cervical spine, the study was limited since only sagittal t2 images could be obtained because of patient discomfort. this was a limited examination but on a sagittal t2 weighted images of the cervical area, there were no foci or abnormal signal intensities in these regions. further hematology/oncology workup included a bone marrow biopsy on . the bone marrow biopsy showed that the aspirate was almost entirely infiltrated with neoplastic cells with high nucleocytoplasmic ratio. the biopsy slides also showed marrow packed with approximately 90% of the trabecular space infiltrated by malignant cells showing scant amount of cytoplasm. by immunohistochemistry, the cells were diffusely positive for pankeratin and exhibit extremely weak diffuse immunoreactivity for synaptophysin. they were negative for chromogranin. the remaining of the 10% of the space had positive cellularity of 80% with trilineage hematopoiesis and increased m:e ratio. finally, of note, the patient had her left upper lobe lung biopsy which showed cells consistent with small cell carcinoma. the corresponding bronchial washings obtained with the biopsy were positive for malignant cells consistent with small cell carcinoma. the cells were positive for cytokeratin, very rare tumor cells were positive for chromogranin. the cells were negative for lca. this was on the bronchial brushings. since diagnosis, the patient had received chemotherapy with cisplatin and etoposide. the patient received 80 mg per meter squared of cisplatin on day number two and 80 mg per meter squared of etoposide on days one, two, and three. since the treatment with the chemotherapy, the patient had afterwards become neutropenic with white blood cell count of approximately 0.3. during the hospital course, the patient had received blood cell transfusions with red blood cells. she also had platelet transfusion for low platelets as well. 2. pulmonary: the patient, during her hospital course, presented with a left upper lobe nodule. during the hospital course, she had episodes of desaturation and hypoxia. her 02 saturations on had gone down to the mid 80s on room air which had improved to the low 90s on nasal cannula. she had a ct angiogram at that time which revealed no evidence of pe; however, the study was somewhat limited due to motion artifact. in addition, the ct angio revealed a large left upper lobe mass and hilar adenopathy which had been seen on previous cts. the mass almost surrounded the left pulmonary artery, nearly compressing it. in addition, on the ct, there were new patchy bilateral opacities predominantly in the upper lung zones. at this time, the patient was noted to have a temperature to 101.7 and had been started on a ten day course of levofloxacin and clindamycin for the infiltrate and fever. otherwise, regarding the remainder of the patient's pulmonary course, she had undergone bronchoscopy on . the left upper trunk was noted to be occluded with an overlying mucosal abnormality and the lower trunk was significantly narrowed, probably due to extrinsic compression. to the lower trunk was an additional abnormal white nodular area. the valvular segments were patent. the left upper lobe occlusion/mucosal abnormality was brushed. following the brushing, there was significant bleeding with rapid clot formation of that nodule. at the end of the procedure, the left main stem was almost completely occluded by clot. given these findings, the patient was transferred to the micu for further observation. a repeat bronchoscopy showed complete obstruction of the left main stem bronchus with multiple clots. these clots were resectioning the mass completely and included the left upper lobe bronchus. since then, the patient had been noted to have an increase in shortness of breath and increasing tachypnea with 02 saturations decreasing to the mid 80s on 6 liters which had improved on nonrebreather. chest x-ray at that time revealed partial clot to the left upper lobe and interstitial involvement of the right lung field. the patient had been transferred to the micu for further evaluation of her respiratory status. the patient's respiratory status had improved with continuing her treatment of the pneumonia as well as some diuresis. she had an echocardiogram performed at the bedside to further evaluate the etiology of the patient's shortness of breath. the echocardiogram had a left ventricular systolic function low normal at 50-55%, mild 1+ aortic regurgitation, mild 1+ mitral regurgitation. there was mild pulmonary artery systolic hypertension with this study. the patient's pulmonary status had improved during this hospital course and oxygen had been decreased as she had tolerated this. 3. infectious disease: the patient is a 54-year-old female who presented during this hospital course on her second day with increasing shortness of breath and new upper lobe infiltrates seen on ct. the infiltrates showed that there were patchy bilateral infiltrates, predominantly in the upper lung zones. there may have been a pulmonary edema; however, given that the patient spiked a fever at this time, the development of the pulmonary infiltrates had developed, she had been started on levofloxacin and clindamycin for a ten day course for treatment of a potential aspiration pneumonia. otherwise, during this hospital course, the patient's infectious disease status had been notable for the development of herpetic lesions which have been on her lower back. the patient has had these lesions in the past. she had been started on valtrex for these lesions. the patient had developed thrush in her mouth and had been started on fluconazole for the thrush. after the patient had completed her treatment course with levofloxacin and clindamycin for the pneumonia, she developed a fever to 102.1 on in the evening. at this time, the patient had been neutropenic with a white blood cell count of 0.3. for febrile neutropenia, she had been started on cefepime and flagyl for coverage of febrile neutropenia. at this time, the patient had significant diarrhea associated with this. a chest x-ray at this time revealed the persistent left hilar mass with collapse of the left upper lobe; however, the remainder of the lung fields were well aerated and the opacities previously seen on the right side were not observed and there was interval improvement of the pleural effusion on the left side. of note, this is a preliminary discharge and will be addended upon the patient's discharge. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified biopsy of bone marrow closed [endoscopic] biopsy of bronchus injection or infusion of cancer chemotherapeutic substance other radiotherapeutic procedure diagnoses: malignant neoplasm of liver, secondary candidiasis of mouth hemorrhage complicating a procedure pneumonitis due to inhalation of food or vomitus malignant neoplasm of upper lobe, bronchus or lung other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other disorders of neurohypophysis secondary malignant neoplasm of bone and bone marrow 

Answer: The patient is high likely exposed to