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: erythromycin base / percocet attending: chief complaint: fevers, malaise major surgical or invasive procedure: placement of right ij line, now removed. placement of right arm picc line. history of present illness: briefly, ms. is a 57-year-old woman with history of metastatic neuroendocrine pancreatic cancer s/p whipple, pancreatic ductal stent, octreotide, cyberknife to pancreatic head, tace to the liver, and streptozocin and doxorubicin, who was admitted to with fever and malaise. she was febrile on admission with a wbc of 7 trending up to 15. abdominal ct revealed erosive duodenal metastasis invading through duodenal wall and into portal vein. surgery recommend aggressive medical management as the patient's surgical options are very limited. the patient was started on cefepime, vancomycin, and metronidazole on admission. micafungin was then added on the second day. she initially required pressors for hypotension but was quickly weaned off and, by the time of floor transfer, had been off pressors for over 24 hours with stable hemodynamics. her blood cultures grew out gram positive rods (some preliminary identification of corynebacterium) and budding yeast. initially gnrs were also reported but later corrected to gprs. on transfer, she was asymptomatic with stable vitals. past medical history: -neuroendocrine tumor of the pancreas - initially presented in with jaundice and weight loss. ct scan showed a mass in the head, neck, proximal body of the pancreas invading the smv as well as multiple enhancing liver lesions. she underwent staging laparoscopy with biopsy and ultrasound in . pathology of the liver lesion revealed pancreatic endocrine tumor. in , she underwent palliative roux-en-y hepaticojejunostomy with placement of stent fiducials in the pancreatic head. an octreotide scan in , showed variable uptake and tumor markers were normal. the patient was started on octreotide treatment in . ct torso in , there was marked interval enlargement of a pancreatic head mass with invasion of adjacent structures. she had interval increase in the size of hepatic metastatic foci, all doubled in size since , with a left lower lobe pulmonary nodule of 5 mm. has had cyberknife but with increasing lesions. -hypertension -depression. -recent hernia repair social history: etoh, no smoking, no illicits. lives with husband in . she has three children. family history: nc physical exam: vitals: t 97.4, hr 83, bp 135/88, rr 18, 98%ra gen: cachetic woman lying in bed awake, tired-looking but in no acute distress neck: supple cv: no jugular venous distention, normal rate, regular rhythm, normal s1/s2, no murmur lungs: clear to ascultation bilaterally, no crackles or wheezes abd: soft, nontender, nondistended, bowel sounds present ext: warm, well-perfused, no cyanosis or edema neuro: oriented x 3, answering all questions appropriately pertinent results: 08:40pm lactate-1.3 k+-8.5* 08:30pm glucose-245* urea n-32* creat-0.8 sodium-136 potassium-4.4 chloride-110* total co2-19* anion gap-11 08:30pm tsh-0.43 08:30pm cortisol-33.3* 08:30pm wbc-11.9*# rbc-3.14* hgb-8.3* hct-25.9* mcv-83 mch-26.3* mchc-31.9 rdw-19.0* 08:30pm neuts-88.5* lymphs-6.5* monos-3.9 eos-0.4 basos-0.7 08:30pm plt smr-low plt count-90* 06:32pm lactate-1.1 04:06pm po2-95 pco2-43 ph-7.37 total co2-26 base xs-0 comments-green top 04:06pm lactate-1.7 04:06pm hgb-7.4* calchct-22 o2 sat-95 02:50pm urine color-yellow appear-clear sp -1.020 02:50pm urine blood-lg nitrite-neg protein-75 glucose-250 ketone-tr bilirubin-sm urobilngn-neg ph-5.0 leuk-neg 02:50pm urine rbc-* wbc-0-2 bacteria-mod yeast-none epi-0-2 02:03pm lactate-4.0* 01:45pm glucose-276* urea n-38* creat-1.1 sodium-134 potassium-5.9* chloride-97 total co2-24 anion gap-19 01:45pm estgfr-using this 01:45pm alt(sgpt)-50* ast(sgot)-187* tot bili-0.7 01:45pm alt(sgpt)-50* ast(sgot)-187* tot bili-0.7 01:45pm lipase-8 01:45pm tot prot-5.7* albumin-2.2* globulin-3.5 calcium-7.3* magnesium-1.9 01:45pm wbc-7.5 rbc-3.79* hgb-9.9* hct-30.6* mcv-81* mch-26.1* mchc-32.3 rdw-18.8* 01:45pm neuts-88* bands-6* lymphs-3* monos-2 eos-0 basos-0 atyps-0 metas-1* myelos-0 01:45pm hypochrom-2+ anisocyt-2+ poikilocy-1+ macrocyt-normal microcyt-2+ polychrom-normal ovalocyt-occasional schistocy-occasional acanthocy-occasional 01:45pm plt smr-very low plt count-66*# 01:45pm pt-13.3 ptt-26.4 inr(pt)-1.1 micro: blood cx : coag-neg staph, yeast blood cx : corynebacterium blood cx : pending stool : c. diff negative imaging: ct pelvis with contrast: 1. large pancreatic head mass with metastases to peritoneum, third portion of duodenum, and possibly distal cbd. tumor thrombus involving distal portal vein and proximal smv. 2. persistent loculated air and fluid collection in the right mid abdomen, with new air in adjacent portal vein. this is concerning for erosive duodenal metastasis invading through duodenal wall and into portal vein. if feasible, repeat examination with oral gastrografin contrast would be helpful for further characterization. 3. stable-appearing liver metastases post tace. 4. right buttock subcutaneous air and fluid collection, raises concern decubitus ulcer. direct visualization advised. 5. 6 mm left lower lobe nodule. follow-up chest ct in 3 to 6 months can be obtained to assess for interval change, as clinically warranted. cxr : new right lower lobe opacity, consistent with atelectasis or pneumonia, if clinically appropriate. brief hospital course: 57 year-old female with hx of metastatic pancreatic neuroendocrine tumor s/p xrt, whipple, with abdominal mets who presented to onc clinic today after 5 days of decrease po intake and 3 days of fevers with hypotension and a ct concerning for a necrotic mass near her duodenum. # hypotension/fevers: upon presentation to the icu, the patient was started on early goal directed therapy, with broad antibiotic coverage with vancomycin/cefepime/flagyl. later micafungin was added to her antibiotic regimen. her ct was concerning for several findings, including her large pancreatic head mass with presumed erosive duadenal metastses into the portal vein, as well as a right buttock subcutaneous air and fluid collection, raises concern decubitus ulcer. her blood cultures have grown coag-negative staph, corynebacterium species, and budding yeast in her blood in the setting of necrotic mass invading duodenum. she was weaned off pressors, and was afebrile on the floor. off pressors, her blood pressure remained normotensive to hypertensive. upon transfer to the hospital floor on , the patient remained afebrile and hemodynamically stable. the infectious disease team had been consulted. the patient was maintained on vanc/cefepime/flagyl/micafungin. the patient's antibiotic coverage was changed to zosyn alone on with the addition of fluconazole on . the patient was discharged on iv zosyn and po fluconazole. the patient will likely require these antibiotics indefinitely due to the extensive tumor involvement of the portal ducts and vasculature and high risk of repeated bacteremia . # metastatic pancreatic neuroendocrine tumor: s/p xrt, whipple, now receiving chemo. ct abd/plevis concerning for met eroding into the duodenum. final ct read was concerning for tumor thrombi in portal vein and smv, as well as a right buttock subcutaneous air and fluid collection. goals of care discussion was had between, patient, husband and dr. . no decisions were made, but a followup discussion will be arranged in the outpatient setting. medications on admission: medications on transfer: metronidazole 500 mg iv q8h acetaminophen 650 mg po/ng q6h:prn fever micafungin 100 mg iv q24h vancomycin 1000 mg iv q 12h cefepime 2 g iv q12h ondansetron 8 mg iv q8h:prn nausea citalopram 20 mg po/ng daily pantoprazole 40 mg po q24h potassium chloride replacement (oncology) iv sliding scale potassium phosphate iv sliding scale hydrocodone-acetaminophen tab po q4h:prn pain prochlorperazine 10 mg iv q6h:prn nausea insulin sc sliding scale lorazepam 0.5 mg iv q4h:prn nausea thiamine study drug study med 1 dose iv q12h duration: 13 doses (pt to receive thiamine 200 mg or placebo in 50 ml d5w q12h for 7 days or until hospital discharge, whichever is first. pt. received first dose at 1800 in er, please continue with next dose at 0600 (), and q12 thereafter.) magnesium sulfate replacement (oncology) iv sliding scale discharge medications: 1. zosyn 4.5 gram recon soln sig: 4.5 grams intravenous every eight (8) hours. disp:*90 doses* refills:*0* 2. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever. 3. fluconazole 200 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*2* 4. lexapro 20 mg tablet sig: one (1) tablet po once a day. 5. lorazepam 0.5 mg tablet sig: 1-2 tablets po every six (6) hours as needed for nausea/vomiting, or anxiety. 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. zofran 8 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. 8. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea/vomiting. 9. outpatient lab work please check cbc, chem 7 (na, k, hco3, cl, bun, cr, glucose) and ast, alt, ldh, alkphos, tbili weekly. please send results to infectious disease clinic at office phone:( office fax:( 10. loperamide 2 mg tablet sig: one (1) tablet po four times a day as needed for diarrhea. discharge disposition: home with service facility: critical care systems discharge diagnosis: primary diagnosis: 1. sepsis secondary diagnosis 1. metastatic neuroendocrine tumor discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital with abdominal pain and fevers. we found you had an infection, with bacteria in your blood. you were initially treated in the icu, and needed medications you keep your blood pressures normal. you improved with iv fluids and antibiotics. a ct scan of your abdomen showed that the bacteria is likely getting into your blood from inflammation caused by the tumor. . you were seen by the infectious disease team, and they recommend that you should be on two medications called zosyn and fluconazole. you will have weekly labs checked, and the infectious disease team will determine if these medications need to be changed. you will also follow-up with them in clinic in several weeks. . you should also follow up with you oncologist dr. . she is looking into other oncologists on , who may be able to participate in your care as well. . please monitor your blood sugars at home, and if they are very high you should call your primary care physician to discuss if you need to be on a different insulin medication. . please take medications as directed. we stopped your diovan (blood pressure medicine) because your blood pressure had been low. your primary care doctor may decide to restart this. . please keep follow-up appointments as scheduled. followup instructions: pcp : tuesday, at 12:20 with ,np, she is dr. reeds nurse location: medical center address: ., , phone: you also have the following appointments: department: hematology/oncology when: monday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: monday at 3:00 pm with: , rn building: campus: east best parking: garage department: infectious disease when: tuesday at 4:00 pm with: , md building: lm campus: west best parking: garage md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: acidosis thrombocytopenia, unspecified unspecified essential hypertension unspecified septicemia severe sepsis depressive disorder, not elsewhere classified septic shock other abnormal glucose anemia in neoplastic disease malignant carcinoid tumor of other sites secondary neuroendocrine tumor of liver secondary neuroendocrine tumor of other sites 

Answer: The patient is high likely exposed to