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: history of present illness: this is a 48 year old african american female with a history of multiple myelomas being admitted for respiratory distress. the patient has been recently discharged one week ago from outside hospital () for respiratory distress. back at , she was given nebulizer, antibiotics and steroids. she also had elevated inr and was given medication to lower inr although there was no evidence of bleeding. last night, she reports having increased difficulty with breathing. she has also had a cough. she denies any fever or chills. the patient admitted to decreased p.o. intake but has been recently sedimentary. she denies any swelling of the legs. the patient had noted some wheezing but then took her albuterol inhaler without any effect. she has been on a prednisone taper but reports that she has been coughing up thick sputum. she went to her primary care provider today but could not say a sentence so was sent to the emergency department. in the emergency department, she was tachypneic and wheezing with heart of 120 and blood pressure of 127/82. she received solu-medrol and continued with nebulizer treatment. she improved, but seemed to be tiring. her abg was done and showed ph of 7.41; pco2, 40; po2, 92. she can speak in full sentences but still just making wheezing. she is requiring continued nebulizer treatment but denies any chest pain, nausea, vomiting, diarrhea or abdominal pain. she feels weak in general. past medical history: 1. multiple myeloma diagnosed in , with increase protein in bone marrow biopsy. she is to receive decadron 40 mg q d every other week. 2. pulmonary embolism, . 3. asthma. no pfts ..................... 4. history of steroid psychosis. 5. pneumonia requiring intubation in . medications upon admission: 1. coumadin 2.5 mg p.o. q d. 2. serevent two puffs q.i.d. 3. albuterol inhaler one to two puffs q 6 hours prn. 4. dexamethasone 10 mg p.o. q d. allergies: no known drug allergies. social history: socially, she lives with her children and works at home as a home health aid. she has twenty years of two pack a day smoking history but quit in . she drinks an occasional alcohol. family history: family history shows father died of an myocardial infarction. sister with ovarian cancer. physical examination upon admission: temperature, 96.6; heart rate, 122; blood pressure, 127/82; respiratory rate, 24; o2 saturation, 99%. head, eyes, ears, nose and throat, pupils are equal, round, and reactive to light and accommodation and extraocular movements intact. no accessory muscles are being used. neck is supple without lymphadenopathy. pulmonary, diffuse wheezing with bibasilar crackles with the left greater than right. cardiac, regular rate and rhythm with normal s1 or s2. no murmurs or thrills noted. abdomen is soft, nontender, nondistended with normal active bowel sounds. extremities, no edema, cyanosis or clubbing noted. neurologically, the patient is somnolent but oriented x 3. no focal defects are noted. laboratories upon admission: white count, 9.6; neutrophils, 66%; lymphocytes, 5%; bandemia, 21%; monocytes, 1%. sodium, 131; potassium, 4.4; chloride, 92; bicarbonate, 24. bun, 14; creatinine, 0.8. glucose, 131. inr, 1.3. ptt, 29.1. abg, 7.41; pco2, 40; po2, 92. hospital course: 1. pulmonary - dyspnea secondary to chronic obstructive pulmonary disease/emphysema under this hospital course. briefly, the patient received bipap, ...................., intravenous solu-medrol, nebulizer treatment and inhaler treatment while in the intensive care unit. she was able to be weaned off of the oxygen back to room air, sating to about 93 or 94 percent. though her chest x-rays show hyperinflation and no signs of infection, she was given five days worth of zithromax. an echocardiogram was to rule out any cardiac wheezes which then showed an ejection fraction of greater than 55%, mild right ventricular dilation and mild pulmonary arterial pressure. pulmonary function tests were performed showing obstructive pattern with fec of 2.56 which is 93% of the predicted and fev1 of 0.9 which is 43% of the predicted in fev1 to fec ratio of 46%. when the patient was transferred to the medical floor, a ct was performed showed no evidence of a pulmonary embolism but did show signs of emphysema. sputum cultures were sent and showed no growth of any organism. alpha antitrypsin was sent out but is still pending. 2. pulmonary embolism - the patient was continued on coumadin for an inr between 2 and 3. since she was subtherapeutic, she was started on lovenox until she became therapeutic on the coumadin. 3. psychiatry - anxiety. the patient was quite anxious during the hospital course. psychiatry was called to consult and recommended that she be on risperidone at 0.25 mg q hs. the patient did well on this medication. 4. oncology - multiple myeloma. a protein electrophoresis was done showing a monoclonal igg capa gammaglobulinopathy (60% of the total protein in , but now is 66% of total protein on , despite q weekly dexamethasone treatment. bone marrow biopsy was done revealing 70 to 80 percent plasma cells. given these findings, the patient was then transferred to the for start of chemotherapy with vincristine, ................... and decadron in preparation for bone marrow transplant to be done. , m.d. dictated by: medquist36 procedure: non-invasive mechanical ventilation injection or infusion of cancer chemotherapeutic substance diagnoses: pneumonia, organism unspecified hyposmolality and/or hyponatremia personal history of tobacco use acute respiratory failure multiple myeloma, without mention of having achieved remission personal history of venous thrombosis and embolism chronic obstructive asthma, unspecified tachycardia, unspecified adjustment disorder with depressed mood 

Answer: The patient is high likely exposed to