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: patient recorded as having no known allergies to drugs attending: chief complaint: nausea, vomiting, sob major surgical or invasive procedure: none history of present illness: 42 f w/ metastatic breast ca (liver, brain, bone, lung) undergoing radiation therapy to the brain (last ), recent chemotherapy (in treated with abraxan), on decadron. she presented to hosp last night with n/v, chills, sob. at ed her initial vitals were significant for- t 99.9 bp 67/52, pulse 143, rr 20, 02sat 85% on ra -> 98% nrb. she was given 3.5l of ns, decadron 8mg, zosyn 3.375mg , vancomycin 1g and started on levophed (bp refractory to 2l of ivf). her cxr showed bilateral hilar infiltrates. her initial labs were significant for a wbc count was 1.1 (60% neut, 30% bands- anc 660), hct 39.2, plts 166. a ua showed some protein but otherwise was unimpressive. in the osh icu, her bp was supported by levophed (4mg/min) and continuous ivf. her 02 sats were 97-100% on an nrb. her abx. were changed to ceftazidine/cipro/vanc for neutropenic sepsis. she was continued on dex 4mg po q6hrs. a kub was done n/v, which showed a lack of bowel gas. a her family req. transfer to . she was intubated for airway protection and a r subclavian central line was placed (). past medical history: - metastatic breast cancer dx'ed 13 years ago s/p mastectomy/reconstruction r breast and chemotherapy navelbine and avastin in 8/. poor response to treatment with gemzar. she then had a response to xeloda but did not respond to her most recent therapy, which was doxil. then cmf treatment in . now on abraxane, first dose 10/9. - hypercholesterolemia - adjustment d/o social history: is married. works as a cpa. she denies tobacco, alcohol, or drug use. family history: non-contributory physical exam: vs: temp: 96.6 bp: 122/73 hr: 88 rr: o2sat ac 500/12 fi02 0.50 peep 5 gen: intubated, sedated heent: et tube placed. perrl. resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: nt/nd, bowel sounds are hypoactive, soft abdomne, well healed surgical scar. ext: wwp, 2+ dp skin: no rashes pertinent results: 04:00am blood wbc-1.4*# rbc-3.26*# hgb-8.3*# hct-26.7* mcv-82 mch-25.5* mchc-31.1 rdw-19.9* plt ct-52*# neuts-57 bands-27* lymphs-9* monos-5 eos-0 baso-0 atyps-0 metas-2* myelos-0 nrbc-1* 04:01am blood wbc-2.5*# rbc-3.44* hgb-8.8* hct-28.2* mcv-82 mch-25.6* mchc-31.2 rdw-19.7* plt ct-66* pt-18.8* ptt-30.7 inr(pt)-1.7* fibrino-676* fdp-40-80 04:01am blood gran ct-2160* 04:01am blood glucose-121* urean-17 creat-0.3* na-138 k-3.8 cl-111* hco3-20* angap-11 04:00am blood alt-243* ast-985* alkphos-489* amylase-68 totbili-0.8 04:01am blood calcium-9.9 phos-1.5* mg-2.9* 03:44pm blood type-art temp-35.8 rates- tidal v-450 peep-5 fio2-50 po2-147* pco2-23* ph-7.44 caltco2-16* base xs--5 -assist/con intubat-intubated 08:13am blood type-art temp-37.2 tidal v-350 peep-5 fio2-50 po2-172* pco2-25* ph-7.43 caltco2-17* base xs--5 intubat-intubated vent-spontaneou 03:44pm blood lactate-2.0 brief hospital course: 43 yo f w metastatic breast ca undergoing radiation therapy. transferred from an osh where she presented with hypotension, hypoxia, fever c/w septic shock that resolved quickly with ivf and broad spectrum abx. . # septic shock: unclear source. pt. had bilateral infiltrates on cxr. was treated with broad spectrum abx given trend towards neutropenia, now resolved. also given stress dose steroids as had been on dexamethasone in the past for brain mets. hypotensive in micu requiring 2l ns. her anc was 666 at time of transfer concerning for functionl neutropenia. per family pt. mounted a fever to 99.8 on decadron. has difficulty with swallowing recently and may have aspirated. prelim sputum gram stain was positive for gpcs and patient was started on vancomycin. however subsequent culture revealed oropharyngeal flora. patient improved quickly, including respiratory status, supporting aspiration pneumonitis picture. patient stabilized and was transferred to omed service. repeat cxr improved over course of 1 day, supporting aspiration diagnosis and all antibiotics were discontinued. all cultures remained negative. . # neutropenia: resolved. most likely differential includes medications, viral illness (ebv, cmv?), bacterial illness, ards. also be manifestation of depressed marrow response to sepsis given chemotherapy 3 weeks ago. counts recovered over hospital course without intervention. . # respiratory distress: presented to osh with sob. required a nrb to maintain 02 sats. she was intubated for airway protection for transport as well as for ongoing respiratory distress. her cxr was significant for diffuse bilateral infiltrates. however, there was no clear consolidation. was on ards net protocol overnight. patient was extubated without difficulty. repeat cxr following day was clear, pointing toward a diagnosis of aspiration pneumonia. patient did well satting 100% on ra after transfer out of micu. . # altered mental status: patient has baseline abullia secondary to brain metastases. was not responding to questions after extubation. however over the course of several days, patient's mental status improved back to baseline. unclear if this was related to drugs, brain mets, depression. likely a combination of all three. celexa dose was increased. # nausea/vomiting: pt. was recently hosp for n/v/dehydration. per family- she was doing well until the afternoon of when she started to exp. n/v. she has also had poor po intake recently. a kub at was significant for lack of bowel gas. also, this could be a side effect of radiation or due to her metastatic disease- increased intracranial pressure from brain mets. - antiemetics as needed. (compazine/zofran/ativan). . # brain metastasis: diagnosed by mri on . undergoing radiation therapy (last treatment ). patient completed radiation treatment while in house. began steroid taper on day of discharge. . # breast ca: completed xrt for brain metastases whie in house. no other intervention was completed. . # anemia: anemia of chronic disease. hematocrit was followed daily and patient did not require transfusion. . # hypercholesterolemia: continued on simvastatin. # depression: affect appeared flat and concern for underlying element of depression. celexa was titrated up to 30mg po daily. . # code status: changed to dnr/dni per husband's request when patient was nonresponsive. . # communication: husband- (cell) home . . medications on admission: home medications: compazine 10 mg qday citalopram 20mg qday dexamethasone 4 mg dilaudid 2 mg qhs emend 125 mg (1)-80 mg (1)-80 mg (1)--1 capsule(s) by mouth as directed percocet prn lorazepam 1 mg prn protonix 40 mg qdaily tessalon perle 100 mg tid prn tussionex zocor 20 mg qdaily prn zofran 8 mg tid prn . transfer medications: vancomycin 1g iv q12hrs ceftazidine 2g iv q12hrs ciprofloxacin 400mg iv q12hrs dexamethasone 4mg po q6hrs benzanoate 100mg po tid celexa 20mg po qdaily simvastatin 20mg po qdaily zofran 8mg po tid protonix 40mg po qdaily ativan 1mg po qhs prn levophed iv drip compazine 10mg iv q6hrs prn discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. atovaquone 750 mg/5 ml suspension sig: one (1) po daily (daily). 5. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 6. lorazepam 0.5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed. 7. lorazepam intensol 2 mg/ml concentrate sig: 0.5 ml po qhs:prn as needed for insomnia. 8. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 9. citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). 10. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 11. ondansetron 4 mg iv q8h:prn 12. pantoprazole 40 mg iv q24h 13. dexamethasone 2 mg tablet sig: per taper tablet po per taper: on : 4mg po qam, 2mg po qpm; on : 2mg po qam, 2mg po qpm; on : d/c steroids. 14. menthol-cetylpyridinium 3 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed). discharge disposition: extended care facility: east region discharge diagnosis: primary: aspiration pneumonia secondary: metastic breast cancer discharge condition: good, satting 100% on ra, afebrile discharge instructions: you were transferred to this hospital with respiratory distress and shock. you were intubated and in the intensive care unit. you quickly recovered and were transferred to the oncology floor. all antibiotics were discontinued as you were much improved. you completed your radiation treatments. . your dose of celexa was increased to 30mg daily. . please follow up with your regularly scheduled appointments. . please return to the emergency room or call your doctor if you develop any worrisome symptoms such as shortness of breath, chest pain, fever, chills. followup instructions: provider: , md phone: date/time: 9:30 please call dr. at to set up a follow up appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other radiotherapeutic procedure diagnoses: malignant neoplasm of liver, secondary unspecified septicemia severe sepsis personal history of malignant neoplasm of breast acute respiratory failure pneumonitis due to inhalation of food or vomitus secondary malignant neoplasm of brain and spinal cord septic shock secondary malignant neoplasm of lung secondary malignant neoplasm of bone and bone marrow neutropenia, unspecified anemia in neoplastic disease 

Answer: The patient is high likely exposed to