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: dyspnea. major surgical or invasive procedure: inferior vena cava filter placement. history of present illness: mrs. (aka "") is a 59 year old lady with a history of breast cancer (s/p mastectomy) and pes in who presented to an osh ed on unresponsive after having a productive cough for five days. in the field, she had an o2 sat of 47%. in the osh ed, cxr showed lul pna with t of 100.3. initial labs were notable for ck 49, ckmb 12, tropi 0.06, abg 7.31/78/19. she was started on ctx/azithro for cap and put on bipap and transferred to . in the ed, she was weaned to an nrb and maintained her mental status. she had hemoptysis but was guiac negative. ct showed large bilateral pes. she received asa 325mg po x1, heparin iv, 1lns, and albuterol and ativan for respiratory distress. mrs. was transferred to the micu with vs 99.5, 94, 121/86, 12, 92%nrb. she was awake and responsive, but lethargic. she reported feeling fine but was unclear why her husband brought her to the hospital. in the icu, on , her oncologist dr. , was emailed about the possibility of mrs. ' letrozole being responsible for her pes. he wrote back saying ok to hold letrozole for now but that it was unlikely the etiology. her iv heparin was changed to lovenox, and her diet was advanced, given her hemodynamic stability. she was nervous and sleepless most of the night, and called her sister repeatedly (who then called the unit). the patient appeared to be in opiate withdrawal, so oxycodone was increased but remained below her total home dose. on , mrs. still required 6l of nc to maintain o2 sat in low 90s. she remained very anxious about her narcotic regimen, so oxycontin 20 mg was added. metoprolol was held in the setting of r heart strain; captopril 6.25mg tid was started because sbp increased to 160s. her husband asked for narcotics for himself, and the house officer refused. on she was going to be called out but was still requiring 5-6l o2. she also had a mechanical fall. she was very anxious about leaving the icu. she improved overnight and was called out on . vitals on transfer were: hr: 91, bp: 159/106, o2sat: 91-97% on 2-3l nc. past medical history: breast ca s/p left mastectomy in chemotheraphy neuropathy, and resultant narcotics addiction nephrolithiasis chronic pain depression/anxiety pulmonary emboli in social history: drinks ~6 oz vodka daily smokes: cigarettes daily for many years lives with husband in narcotics abuse (prior to admission her pcp was prescribing 40mg po qid) family history: mother had bilateral breast cancer. no other breast or ovarian cancers father died at age 69. he had a history of arrhythmia she denies any other history of clotting disorders her maternal mother died at age 69 of a brain aneurysm her paternal grandmother died at age 45 from stomach cancer physical exam: (on admission) vs: 96.9 102/58 94 14 95% nrb; 91% 5l nc gen: tearful, alert and oriented, intermittently pausing during speech, overall comfortable appearing. skin: red skin, worse with coughing heent: no jvd, neck supple, no lymphadenopathy appreciated chest: wheezes in all lung fields, l sided rhonchi. cardiac: s1 & s2 regular without murmur, left mastectomy abdomen: tender with guarding but not tense or rigid. bowel sounds present. extremities: tender l calf, bilateral edema, warm without cyanosis neurologic: alert and appropriate, tearful. cn ii-xii grossly intact. . (on discharge) gen: nad. skin: some bruising on abdomen and upper extremities from enoxaparin injections. chest: ctab with no adventitious sounds. cv: rrr without murmurs. abdomen: +bs, soft, nontender, nondistended (bruising as above). ext: resolving ecchymoses on left medial thigh/groin and posterior right leg. no edema, warm, well perfused. neuro: a&ox3, grossly intact. psych: anxious at times, but overall positive affect and goal directed thinking. pertinent results: admission labs: wbc-8.3 hgb-14.7 hct-45.0 neuts-78.5* lymphs-13.0* monos-7.6 eos-0.6 basos-0.2 glucose-141* urea n-13 creat-1.0 sodium-139 potassium-4.1 chloride-96 total co2-31 . discharge labs: wbc-8.3 hct-36.2 plt ct-412 pt-19.4* ptt-102.6* inr(pt)-1.8* glucose-134* urean-11 creat-0.7 na-138 k-3.8 cl-101 hco3-26 alt-15 ast-29 ld(ldh)-220 alkphos-46 totbili-0.8 . relevant studies: echo - right ventricular cavity enlargement with free wall hypokinesis c/w pulmonary embolism. . echo - compared with the prior study (images reviewed) of , right ventricular cavity size is smaller and free wall motion is more vigorous. . ecg - sinus rhythm. there are non-diagnostic q waves in the inferior leads. non-specific st-t wave changes. compared to the previous tracing these findings are new. . ct chest - 1. bilateral, multifocal segmental pe, with significant clot burden resulting in right heart strain. emboli are seen in vessels supplying the right upper, middle and lower lobes, and the lingula, with extension of embolic material into multiple peripheral vessels supplying both lungs. there are prominent subsegmental pe in vessels supplying the posterior left lower lobe. 2. enlarged right ventricle and straightened intraventricular septum consistent with right heart strain. no pulmonary infarct at this time. 3. heterogeneous peribronchovascular nodules in the left upper lobe, could reflect hemorrhage or infectious etiology. unlikely to represent infarct. recommend re-imaging after treatment for pe. . cxr - portable ap chest radiograph was compared to chest ct from . the current study demonstrates known opacities in the left perihilar area consistent with known infection. cardiomegaly is unchanged. mediastinal position, contour and width are stable. there is no interval development of appreciable pleural effusion and there is no pneumothorax. brief hospital course: mrs. is a 59 year old woman found unresponsive found to have large bilateral pes and a lul pna. she was transferred from another hospital to where she was admitted to the micu on . she was transferred to the general medicine floor for several days and was discharged on . . # pulmonary emboli/left thigh hematoma: the patient had extensive bilateral pes with hypoxia intially requiring 5l nc. she remained hemodynamically stable throughout her admission. underlying contributing factors include obesity, smoking, history of pes, and malignancy. she may also have a hereditary coagulopathy. heparin gtt was started in the icu. lenis were negative for dvt. echo showed evidence of right heart strain and rv hypokinesis. when hemodynamics remained stable for several hours, heparin was switched to lovenox. oxygen requirement improved to 3l nc prior to call-out to the medical service. on the medicine floor, mrs. remained stable and she no longer had an oxygen requirement by the week before discharge. around the patient developed a large left groin/thigh hematoma. on ultrasound on thigh u/s showed the hematoma to be 8 x 5 x 8 cm. she had a point hematocrit drop, that intially remained stable but on , her hematocrit droppeed from 29 to 25. her thigh was re-ultrasounded and at the time the hematoma measured 14 x 7.6 x 6.4 cm. because of the hemaocrit drop and increasing size of hematoma, her lovenox was stopped. she had an ivc filter placed. upper extremity ultrasound showed dvt in the distal left brachial veins. ct angiogram of the thigh showed no active extravasation of blood. from she was off anticoagulation. her hct was stable over these 3 days, so on she was started on a heparin drip, intially with low goal ptt of 50-70, her hct was stable, and goal was increased to 80. she was started on coumadin on 7.5mg the first day and then , she recieved 5mg coumadin. her inrs: 7am: 1.8 6am: 2.2 12pm: 2.6 she recieved 1 lovenox injection prior to leaving the hospital in order to completw 24 hour of overlap between therapeutic pt with heparin/lovenox. she was discharged with plan for 4mg coumadin until she ses her pcp on tuesday . given her bleeding earlier in the hospital course, her goal inr is 2-2.5, and she was instructed to return to the hospital with any bleeding, lightheadedness, new hematoma formation. we have also made f/u appointments for ms. with pulmonary in to follow up the pe and with interventional radiology to remove the ivc filter (also in ). . # pneumonia: the patient had evidence of a lul pna on outside hospital cxr, positive sputum. she was afebrile with no leukocytosis. torso ct at confirmed lul pna. courses of ceftriaxone (7 days) and azithromycin (5 days) were completed. blood and sputum cultures were negative. on monday, , mrs. had a fever of 101 degrees. she then had a nebulizer treatment and incentive spirometry to see if this reduced her temperature. she also had a repeat chest xray and blood cultures and urinalysis sent. all cultures were negative, and the fever was thought to be from the hematoma. . # copd flare: the patient was started on prednisone 60mg daily burst and this was stopped after five days without consequence. she received standing ipratropium nebs q6h and albuterol nebs prn. as an outpatient she will likely need pfts when she recovers from her acute illness. . # alcohol/opiate abuse: the patient has a history of alcohol and opiate abuse to which she readily admits. last drink was the day prior to admission. she was given thiamine/folate. she was on a ciwa scale with lorazepam and did not demonstrate any signs of withdrawal. she was intially given oxycodone 10 mg q4h as needed for pain control given high dose opiate use at home. she later demonstrated symptoms of withdrawal, and this was uptitrated to her total home dose of long- and short-acting opiates. on the medicine floor, she was restated on her home dose of oxycontin 40mg po qid with good effect. on , the patient was found to be unresponsive. she responded to narcan iv. on further questioning, her husband her brought her extra doses of oxycontin from home, which she he had taken earlier that evening. her head ct was negative. the patients oxycontin was held intially. on she showed signs of narcotic withdrawal-- crampy abdominal pain, tremor, diarrhea, nausea; so was started on scale, given 10mg po oxycodone for >10. for the first few days, she required 10mgpo about 3 times a day. after several days on this regimen, she was was switched to 10mg po oxycodone twice daily standing. then, on , this was decreased to oxycodone 5mg three times a day standing. the patient is intersted in detox programs, and is being dicharged with enough 5mg oxycodone pills to last her until her pcp . . # breast ca: history of breast ca, seen by dr. , thought to be without recurrence. letrozole was held given rare side effect of dvt. dr. was contact and agreed with stopping letrozole temporarily. . # depression: patient demonstrated considerable emotional lability. paxil was continued. social work was consulted. . # htn: mrs. received her home dose of metoprolol during her stay. she was also started on lisinopril 5mg po daily. her pressures remained stable throughout admission. . # chemotherapy neuropathy: neurontin was continued. lasix was held given inital concern for hemodynamics. it was later restarted at her home dose without problems. . code status was discussed and patient refused to decide code status. thus, she remained full code. . contact: ; sister medications on admission: medications at home: lasix 20mg po daily neurontin 600mg po qid letrozole 2.5mg po daily ativan 2mg po qid metoprolol xl 25mg po daily oxycodone 40mg po qid paroxetine 20mg po daily asa prn thiamine 100mg po daily discharge disposition: home discharge diagnosis: bilateral pulmonary emboli. discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: you were admitted to from until for evaluation and treatment of your pulmonary embolism. you were in the medical intensive care unit for several days before being transferred to the general medicine floor. you were discharged on monday, . the following addition was made to your outpatient medications: - enoxaparin 150 mg/ml syringe sig: one (1) subcutaneous q12h (every 12 hours). - lisinopril 5mg daily - oxygen followup instructions: please schedule a followup appointment with your oncologist, dr. , within one to two weeks. . please schedule a followup appointment with your primary care physician, . within two weeks. call . procedure: venous catheterization, not elsewhere classified interruption of the vena cava diagnoses: pneumonia, organism unspecified unspecified essential hypertension obstructive chronic bronchitis with (acute) exacerbation personal history of malignant neoplasm of breast opioid type dependence, continuous dysthymic disorder antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use nontraumatic hematoma of soft tissue anticoagulants causing adverse effects in therapeutic use drug withdrawal alcohol abuse, continuous other pulmonary embolism and infarction acquired absence of breast and nipple acute venous embolism and thrombosis of deep veins of upper extremity polyneuropathy due to drugs 

Answer: The patient is high likely exposed to