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: delirium major surgical or invasive procedure: none history of present illness: 59 yo f with widely metastatic breast cancer including likely leptomeningeal spread on cycle 2 of taxol and avastan admitted with subacute, progressive unresponsiveness and a hypotensive episode. . the patient has reportedly had 2 weeks of confusion and lethargy. she was admitted to for altered mental status and increasing unresponsiveness within the past week. at that time she was found to be hypokalemic to k of 2.6 and dehydrated. after iv fluid rescucitation and potassium repletion she was discharged home. . on the day of admission, she came to clinic for a scheduled xrt treatment. she was found to be hypokalemic with severely depressed mental status. at that visit she opened her eyes to her name but was not speaking or following commands. she did respond to painful stimulus. on arrival to the oncology floor, the patient had vitals of 96.0 92 108/64 22 97% ra. she was noted to be minimally responsive. out of concern for mass effect and/or seizure activity, the patient received 10mg dexamethasone and 1mg iv ativan. subsequently her blood pressure declined to sbp 80 and then 60. she received a 1l ns bolus with return of sbp to 107. the patient also became bradypneic with this episode. she was transferred to the icu for further care. . after transfer, the patient's primary oncologist had a discussion with the patient and her family. the decision was made for no further invasive tests or imaging studies. the patient will receive iv fluids, antibiotics and other iv medications as well as have lab draws. . ros: unable to obtain. past medical history: - metastatic breast cancer. initially presented in with a lytic lesion in the left leg and a breast mass. biopsy revealed infiltrating carcinoma. her-2/neu negative, er positive. s/p cyberknife radiation therapy to an 8mm left cerebellar lesion. known bony mets. likely leptomeningeal spread on mr brain . received palliative xrt to the thoracic spine. she is on cycle 2 of taxol and avastin. - multiple episodes of severe malignancy associated hypercalcemia and altered mental status. - s/p surgical repair of left tibia on - prior hysterectomy and bilateral salpngo-oophorectomy in for benign causes. - surgery for ectopic pregnancy in . social history: married. previous associate principal in a middle school. 2 daughters in their 40's. lifetime nonsmoker with rare alcohol use. family history: half-sister with breast ca at age 63. no other known cancers in the family. physical exam: pe 79 102/38 6 99% ra gen: unresponsive. moans once. not following any commands. not responding to painful stimulus. heent: perrl. eyes pointing upwards. cv: rrr. normal s1 and s2. no m/r/g. pulm: cta bilaterally. abd: soft, nontender. no distention or organomegaly. ext: trace left lower extremity edema. no right lower extremity edema. neuro: unresponsive to commands or painful stimulus. perrl. flexed right upper extremity slowly improved with movement. unable to ilicit reflexes at the patella. upgoing toes bilaterally. . pertinent results: labs: na 143, k 2.9, cl 110, bicarb 22, bun/cr 5/0.5, ca 9.0, mg 1.7, phos 2.1, wbc 4.3 (76% n, 14% l), hct 32.0, platelets 259. . alt 14, ast 43, ap 339, ldh 539, t bili 0.6, alb 3.1. . cea 97, ca 27.29 pending. . ekg: none available. . micro: blood culture (): no growth. (): pending. urine culture (): no growth. . imaging: mr brain with and without contrast (): 1. new metastatic involvement of the leptomeninges, most notable of the posterior fossa. 2. stable minimal residual enhancement at the site of treatment of the left cerebellar metastasis. no new brain parenchymal lesions. 3. interval slight worsening in calvarial metastases including infiltration of the skull base and upper cervical vertebra. brief hospital course: mr is a 59 yo woman with history of metastatic breast cancer presenting with two weeks duration of confusion and icreasing lethargy. ms. was admitted to the for subacute, progressive unresponsiveness and a hypotensive episode likely due to volume depletion. her unresponsiveness was likely secondary to progression of her widely metastatic breast cancer, including possible leptomeningeael spread. also, considered was seizure activity with post-ictal state and toxic-metabolic mediated altered status in the setting of hypercalcemia and hypocalemia. on admission to the , initially, the goals of care were discussed, and it was decided not to pursue further chest x-rays, mri brain, eeg or lumbar puncture. she was volume resuscitated, and her electrolytes were repleted. the next morning, , both palliative care and social work met with the family to continue to discuss goals of care, which included being able to take her home with comfort (but not cmo). per her neuro-oncologist, however, ct head and mri of head and neck as well as eeg were ordered with agreement from family. she was given a keppra load and will start on maintenance doses on the oncology floor. she was deemed stable for transfer to the oncology floor on . on the floor the patient remained stable hemodynamically and neurolgically. the patient received phenytoin and was continued on levitiracetam on neuro/onc recomendation. the mri showed no evidence of leptomeningeal disase with stable cns disease. continous eeg was obtained which showed evidence of encephalopathy. the patient was noted electrolyte abnomalities suggestive of non anion gap metabolic acidosis which improved on ivf. the patient's discomfort was managed with iv morhine which was transitioned to concerntrated elixir at discharge. after a discusion with the family regarding the goals of care a decision was made to transition care at home with comfort care. palliative care was involved in the management of this patient and family discussions. medications on admission: meds, inpatient: - heparin 5000u subq - pantoprazole 40mg daily . meds, outpatient: - oxycodone prn - compazine - zofran - oxycontin - colace prn - prilosec prn - ativan prn discharge medications: 1. morphine concentrate 20 mg/ml solution sig: 5-20 mg po q1hrs as needed for pain, discomfort, agitation, shortness of breath. disp:*30 ccs* refills:*0* 2. ativan 1 mg tablet sig: 1-2 tablets po q2-4hrs as needed for agitation. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: hospice of vna assoc. of discharge diagnosis: primary: encephalopathy discharge condition: comfortable discharge instructions: you were admitted because of altered mental status. this is probably from progression of your cancer. unfortunately, this was not from a reversible process. followup instructions: none md procedure: electroencephalogram diagnoses: unspecified protein-calorie malnutrition depressive disorder, not elsewhere classified hypopotassemia hypotension, unspecified secondary malignant neoplasm of brain and spinal cord dehydration encephalopathy, unspecified secondary malignant neoplasm of bone and bone marrow malignant neoplasm of other specified sites of female breast 

Answer: The patient is high likely exposed to