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: aspirin / folic acid / milk / cephalexin / adhesive / peanuts / oxycodone attending: chief complaint: difficulty ambulating major surgical or invasive procedure: none history of present illness: patient is a 73-year-old woman with a history of primary biliary cirrhosis, atrial fibrillation s/p ppm, who was admitted with lue swelling and pain and had an ultrasound guided biopsy of her scapular mass showing adenocarcinoma. two days ago she developed walking bilateral hip pain. it has taken her longer to get up the few stairs into their home. she denies weakness, numbess. she endorses bilateral extremity edema which may be worsening. her left shoulder pain continues to be painful. she has been taking tylenol at home for pain. she had planned to see her radiation oncologist, dr. at shields radiation oncology at 3pm today to start treatment to the left shoulder with treatment planned through . she was unable to get radiation as her pacemaker is in the radiation field. she was seen in clinic for initiation of care. she was found to have lower extremity weakness l>r with exam limited by pain. she appeared to be in pain and was moaning in the clinic. she was referred for admission for evaluation of her left weakness and pain control. past medical history: past medical history: 1. colon polyps: . 2. hypertension. 3. osteopenia: bd . 4. primary biliary cirhosis. 5. eczema. 6. afib s/p pacer placement , on metoprolol and pradaxa. 7. former smoker: 30 pack yr hx. past surgical history 1. appendectomy: . 2. arthroscopy bilateral knee: , . social history: pt is married, without children. she is a retired social worker. she endorses a 30 year smoking history of 1 pack per day. she stopped drinking alcohol following her diagnosis of pbc. she denies history of other drug use. family history: mother: @50. deceased: at age: 60. mgm: unknown hx. deceased: at age: 80s. mgf: unknown hx. deceased: at age: 60s. father: renal failure after surgery. deceased: at age: 51. pgm: stroke. deceased: at age: 70s. pgf: unknown hx. deceased: at age: 60s. sis: x 1 ms. . : n/a. children: n/a. other: 3 maternal uncles with . physical exam: initial physical exam: vitals - t: bp: hr: 66 rr: 18 02 sat: 94% pm ra general: well appearing female, mild distress, occasionally moaning heent: at/nc, eomi, perrla, anicteric sclera, pink conjunctiva, patent nares, mmm, good dentition, nontender supple neck, no lad, no jvd cardiac: rrr, s1/s2, no murmers, gallops, or rubs lung: mild bibasilar crackles, otherwise ctab abdomen: nondistended, +bs, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly extremities: - rue: no edema, full rom, sensation intact - lue: 3+ pitting edema to shoulder, large subcutaneous mass palpable over left shoulder and scapula, tender to palpation, rom limited at shoulder but full at elbow and wrist - lle: 3/5 strength at hip flexor, at knee extensor/flexor, at ankle flexor, sensation intact, 2+ pitting edema - rle: 4/5 strength at hip flexor, at knee extensor/flexor, at ankle flexor, sensation intact, 2+ pitting edema pulses: 1+ dp pulses bilaterally neuro: cn ii-xii intact skin: warm and well perfused, no excoriations or lesions, no rashes pertinent results: 10:00am urea n-14 creat-0.8 sodium-134 potassium-4.3 chloride-99 total co2-27 anion gap-12 10:00am estgfr-using this 10:00am alt(sgpt)-19 ast(sgot)-31 alk phos-174* tot bili-0.5 10:00am albumin-3.3* calcium-9.7 10:00am wbc-12.4* rbc-3.55* hgb-10.2* hct-30.9* mcv-87 mch-28.8 mchc-33.0 rdw-14.7 10:00am neuts-81.5* lymphs-13.4* monos-5.0 eos-0.1 basos-0 10:00am plt count-413 brief hospital course: 73f with pmh of atrial fibrillation, primary biliary cirrhosis, with newly diagnosed metastatic adenocarcinoma of left scapula of unknown primary admitted for increased pain and difficulty ambulating with hospital course complicated by acute drop in sodium from 134 on admission to 119 on and changes in mental status. # metastatic adenocarcinoma of unknown primary: patient recently diagnosed with adenocarcinoma to left shoulder of unknown primary. pt received further eval for primary site including ruq us, upper and lower endoscopy, and thin sliced ct abd/pelvis with no primary source of cancer identified. pt received bone scan which revealed extensive uptake of tracer to left scapula, and also to right iliac , left acetabulum, and right sixth rib which possibly represents osseous metastases. mammogram pending to evaluate for possible breast cancer. pt also with left upper extremity swelling which has been unchanged over weeks and is likely secondary to tumor. past ultrasound of left arm revealed no dvt. beacause of severe pain to scapula, pt has been getting daily to site for pallative pain management. pain control has been managed with dilaudid (? allergy to oxycodone) and (pt started with session 1 of 5 on ). she has severe lymphedema in the left arm tumor in the shoulder and this has worsened over hospital course. lue us showed non-occlusive thrombus, not getting anticoagulation. pt will tried lymphedema wrapping and she received ice/ heat packs prn. she also received aggressive pain regimen as well. she received 5 days of and started chemo on despite that primary has not yet been discovered. her small bowel is the only area that has not been adequately investigated for cancer. # difficulty ambulating: xray of hip showed left iliac bone suspicious lytic lesion with cortical disruption pointing more to mets for cause of pain in hips. bone scan confirmed this suspicion. pt also has lower extremity chronic lymphedema that may be contributing to decreased mobility. pt's right ventricular cavity is dilated with normal free wall contractility. edema is likely not from chf given pt's normal ef. lenis showed no dvt. tte showed normal ef with dilated right ventricle. pt had compression stockings (teds) and ace bandages placed to help with lower extremity edema # acute on chronic hyponatremia: low sodium has been a chronic issue for patient with baseline of approximately 130. on admission na was 134. over the course of three says starting , pt's na dropped to 119. at first this was though most likely due to hypovolemia (as pt as npo with bowel prep over days) therefore pt was given aggressive iv fluids over one day and na improved initially to 123 and then dropped again to 119. there was most likely a component of siadh and pt was fluid restricted and sent to micu for treatment with hypertonic saline. pt spent two days in for correction with hypertonic saline for level of 120 with ms changes. her mental status improved. renal followed pt and recommended salt tabs, fluid restrition, laisx prn, and high osmolarity food/diet. the thought is that siadh is the predominant feature of her hyponatremia but was likely confounded by hypovolemia earlier in hospital course. she appeared intravascularly euvolemic but is total body overloaded. she was discharged with a sodium level of 127 on sodium chloride tabs 1mg po bid. she will have blood drawn as an outpatient to check her sodium (in addition to post-chemotherapy cbc). micu course: the patient was admitted to the micu for administration of 3% saline at 25cc per hour based on renal recommendations. this was started on the evening of transfer and sodium levels were checked q4hrs. on transfer, sodium was 123. the next morning after 15 hours of hypertonic saline infusion, her sodium rose to 128. hypertonic saline was discontinued and normal saline was initiated. sodium remained stable at 126 so saline was then stopped per renal recommendations. her mental status has improved somewhat from the time of initial transfer. # : creatinine rise to 1.5 up from .6- .8 prior to . this increase correlated to when pt received iv contrast for ct scan therefore cin suspected. however also on the ddx pt was started on high dose ibuprofen on to help with pain. and pt had been on ace i (both of which have since been discontinued because of nephrotoxicity). fena from was .05% pointing more to prerenal process. # atrial fibrillation s/p ppm on pradaxa at home. pacemaker is located on the left side, the same side of pt's scapula tumor and is in the radiation field. pt received pacemaker evaluation which indicated approx 20% pacemaker dependent. pt continued home sotalol and pradaxa was held while in house as pt needed procedures for cancer workup. # htn: normotensive. continued home lisinopril. # primary biliary cirrhosis: continued home urodiol transitional issues: ======================= pt remained full code while hospitalized medications on admission: preadmission medications listed are correct and complete. information was obtained from patientwebomr. 1. *nf* (cyclosporine) 0.05 % ou 2. dabigatran etexilate 150 mg po daily 3. lisinopril 5 mg po daily 4. sotalol 80 mg po bid 5. ursodiol 500 mg po bid 6. acetaminophen 500 mg po q6h:prn pain 7. ascorbic acid 250 mg po daily 8. calcium carbonate 600 mg po daily 9. vitamin d 400 unit po daily 10. cyanocobalamin dose is unknown po daily 11. docusate sodium 100 mg po bid:prn constipation 12. ferrous sulfate 325 mg po daily 13. flaxseed *nf* unknown oral prn 14. loratadine *nf* 10 mg oral prn rash 15. systane *nf* (peg 400-propylene glycol) 0.4-0.3 % ou 16. selenium sulfide dose is unknown tp frequency is unknown discharge medications: 1. sotalol 80 mg po bid 2. ursodiol 500 mg po bid 3. acetaminophen 500 mg po q6h:prn pain 4. docusate sodium 100 mg po bid:prn constipation 5. loratadine *nf* 10 mg oral prn rash 6. *nf* (cyclosporine) 0.05 % ou 7. senna 1 tab po bid:prn constipation 8. artificial tears preserv. free 1-2 drop both eyes prn dry eyes 9. ciprofloxacin hcl 500 mg po q12h duration: 9 days stop after dose on . treating uti. rx *ciprofloxacin 500 mg 1 tablet(s) by mouth twice a day disp #*16 tablet refills:*0 10. morphine sr (ms contin) 30 mg po q12h hold for rr<12 or if pt sedated rx *morphine 30 mg 1 capsule(s) by mouth q12hrs disp #*4 capsule refills:*0 11. albuterol 0.083% neb soln 1 neb ih q6h:prn shortness of breath/wheezing 12. simethicone 40-80 mg po qid:prn gas pain 13. sodium chloride 1 gm po bid 14. ascorbic acid 250 mg po daily 15. cyanocobalamin 25 mcg po daily 16. calcium carbonate 600 mg po daily 17. dabigatran etexilate 150 mg po daily 18. ferrous sulfate 325 mg po daily 19. lisinopril 5 mg po daily 20. systane *nf* (peg 400-propylene glycol) 0.4-0.3 % ou 21. vitamin d 400 unit po daily 22. hydromorphone (dilaudid) 2-4 mg po q2h:prn pain do not give if rr<12 or oversedated rx *hydromorphone 2 mg tablet(s) by mouth q2hrs disp #*8 tablet refills:*0 23. sarna lotion 1 appl tp qid:prn itching discharge disposition: extended care facility: senior healthcare of discharge diagnosis: - adenocarcinoma, unknown primary origin - hyponatremia 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: dear mrs. , you were admitted to under the oncology medicine service on for pain in your left hip and difficulty walking following your recent discharge on . your stay was complicated by hyponatremia (low levels of sodium in your blood), which required a brief stay in the icu. you did well in the icu, and your sodium levels rose to a level where it was safe to transfer you back to the floor. during your stay, you completed 5 radiation treatments to your left shoulder tumor. you do not need further radiation therapy and do not need to follow-up with the radiation oncologist. also, you started your first chemotherapy dose on tuesday, . upon discharge, if you develop any of the following, please come to the emergency department or call your doctor immediately at : fever, chills, nausea, vomiting, diarrhea, blood in your stool or darker than normal bowel movements, worsening fatigue, pallor, numbness/tingling, difficulty moving or confusion, chest pain, trouble breathing, abdominal pain, new rash, new bleeding, new bruising, swelling in part of your body, or other symptoms that concern you. followup instructions: department: hematology/oncology when: monday at 8:15 am with: checkin hem onc cc9 building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: monday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: monday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: colonoscopy esophagogastroduodenoscopy [egd] with closed biopsy injection or infusion of cancer chemotherapeutic substance other radiotherapeutic procedure artificial pacemaker rate check diagnoses: urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation personal history of tobacco use pulmonary collapse paralytic ileus cardiac pacemaker in situ other disorders of neurohypophysis other malignant neoplasm without specification of site secondary malignant neoplasm of bone and bone marrow volume depletion, unspecified internal hemorrhoids without mention of complication neoplasm related pain (acute) (chronic) other drugs and medicinal substances causing adverse effects in therapeutic use biliary cirrhosis other lymphedema other and unspecified escherichia coli [e. coli] acute venous embolism and thrombosis of upper extremity, unspecified hereditary edema of legs 

Answer: The patient is high likely exposed to