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: no known allergies / adverse drug reactions attending: chief complaint: displaced nephrostomy tube, hyponatremia major surgical or invasive procedure: nephrostomy tube placement history of present illness: ms. is a 52 y/o f with a h/o stage iv appendiceal adenocarcinoma recently complicated by pseudomonal urosepsis from bilateral hydronephrosis requiring the placement of bilateral nephrostomy tubes who presents from home after one of the tubes has been displaced. she was recently discharged from on , at which time she was found to have pseudomonal urosepsis and was discharged on ciprofloxacin 400mg iv bid to complete a 14 day course, during that hospital stay she was also found to be hyponatremic with a sodium in the high 120's, thought to be due to siadh. today when her family was helping move her from the couch her right nephrostomy tube got caught on something and was accidentally pulled out so her family brought her to the er to have the tube replaced. she currently feels weaker than her baseline but has trouble describing how she feels, denies any fever/chills, cp, sob, n/v/d, ha or changes in her vision, denies any changes in her ostomy output. . in the ed, initial vs were: 98.7, 76, 92/72, 16, 98% ra. the initial plan had been to have ir replace the nephrostomy tube tonight, however when her labs returned this was put off. her labs were notable for a white count of 33.7, na of 114, k of 6.4, lactate of 3.8, and a bun of 35. her ekg was nsr at 97bpm, no peaked t-waves or pr prolongation, poor r wave progression. she was given 10 units of iv insulin, 1 amp of d50, calcium gluconate, her scheduled dose of ciprofloxacin, along with cefepime and vancomycin for her leukocytosis. a repeat k after treatment was 5.4 and her sodium was 116. while in the er it was noted that her left sided nephrostomy tube was not draining anymore either. by report, after multiple discussions in the er she refused kayexelate and placement of a peripheral iv, although she would like the nephrostomy tubes replaced for comfort, as she is no longer seeking treatment for her underlying cancer and is dnr/dni on home hospice. vs on transfer were: 106, 104/74, 10, 100% on ra. . on arrival to the icu her initial vs were: 95.8, 99, 101/75, 9, 99% on ra. she says that her pain is improved after the pain medication, she has no other complaints. also on arrival to the icu it was noted that her left sided nephrostomy tube was not draining or flushing. . review of systems: (+) per hpi and for anorexia (-) denies fever, chills, night sweats. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation or changes in bowel habits. past medical history: stage iv appendiceal adenocarcinoma (pt3 nx pm1b); k-ras mutation confirmed - : presented to ed for progressive abdominal/pelvic discomfort. ct demonstrated "marked abnormal distention of the endometrial cavity measuring up to 6.5 cm" which was filled with high-density fluid. there was a possible mass within the cervix as well as a 2.2 x 3.2 cm cystic lesion within the right adnexa. of note, the appendix was described as normal. tvus revealed an enlarged right ovary with a complex cyst thought to be hemorrhagic, as well as an abnormal endometrial cavity containing a heterogeneous lesion with mixed solid and cystic elements, thought to be concerning for neoplasm. she was recommended to follow up with gyn. - : endometrial biopsy demonstrated adenocarcinoma, endometroid type, grade i. - : re-presented to ed with continued lower abdominal pain as well as about a month's worth of vaginal bleeding. - : ca-125 elevated at 113 - : went to the operating room with dr. for a planned hysterectomy, bilateral salpingo-oophorectomy, and staging procedure for presumed endometrial adenocarcinoma. intraoperatively, her appendix was noted to be "pulled down in towards the right adnexa." the right adnexa itself was completely adherent to the pelvic side wall and right fallopian tube. there was evidence of gross tumor on the anterior surface of the uterus. the left fallopian tube and ovary were also replaced by hemorrhagic mass. there was also a 2 cm nodularity on the omentum, worrisome for metastasis. intraoperatively, she underwent rigid proctoscopy which showed no evidence of intralumenal tumor. peritoneal washings were negative for malignant cells. surprisingly, the pathology from this operation revealed the primary source of her cancer to actually be the appendix with a 1.5 cm histologic grade ii primary lesion invading through the muscularis propria and into the subserosa/mesoappendix (pt3). this stained positive for cytokeratin 7, cytokeratin 20, er, and cdx2, confirming this as an appendiceal primary. the same adenocarcinoma was found to be involving the right fallopian tube and ovary, uterus, cervix, omentum, and the serosal surface of the bowel wall (pm1b). there was no perineural invasion. k-ras mutation confirmed. - : began cycle 1 of folfox; required 20% dose reduction of all medications after cycle 1 due to neutropenia; oxaliplatin stopped after 4 cycles due to neuropathy; completed sixth cycle on - : presented to ed with small bowel obstruction, thought to be due to intraperitoneal relapse. pet ct confirmed fdg-avidity of multiple peritoneal/pelvic implants and several liver masses. - : underwent evaluation by dr. at for hyperthermic intraperitoneal chemotherapy (hipec). underwent debulking of intraperitoneal carcinomatosis by hipec was deferred given obvious hepatic metastases. - : began cycle 1 of palliative folfiri and bevacizumab; on day 27, was admitted to the hospital with a colovaginal fistula after complaining of stool per vagina - : underwent a complicated surgical takedown of the enterovaginal fistula, diverting ileostomy, and repair of a bladder perforation with dr. . - : presented to the ed with abdominal pain and leukocytosis. found to have diffuse enteritis with new bilateral obstructive hydronephrosis and progression of peritoneal and hepatic metastases. eventually discharged on home hospice on . social history: she is married. she denies tobacco, drug, or alcohol use. she lives with her husband and son. she reports feeling safe at home. family history: she denies any family history of breast cancer, ovarian cancer, uterine cancer, or colon cancer. physical exam: physical exam on admission: vitals t 95.8 bp 101/75 hr 99 o2 99% on 2l nc general appearance: anxious, cachetic eyes / conjunctiva: perrl cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: clear : throughout ) abdominal: soft, bowel sounds present, distended, tender: throughout extremities: right lower extremity edema: 4+, left lower extremity edema: 4+ musculoskeletal: muscle wasting skin: not assessed neurologic: attentive, follows simple commands, responds to: verbal stimuli, oriented (to): person, place, time , movement: purposeful, tone: not assessed . physical exam on disharge: vitals t 96.1 bp 94/67 hr 96 o2 100% on 2l nc general appearance: anxious, cachetic eyes / conjunctiva: perrl cardiovascular: (s1: normal), (s2: normal) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: clear : throughout ) abdominal: soft, bowel sounds present, distended, tender: throughout extremities: right lower extremity edema: 4+, left lower extremity edema: 4+ musculoskeletal: muscle wasting skin: not assessed neurologic: attentive, follows simple commands, responds to: verbal stimuli, oriented (to): person, place, time , movement: purposeful, tone: not assessed pertinent results: labs on admission: . 10:42pm urine hours-random urea n-640 creat-93 sodium-35 potassium-40 chloride-37 10:42pm urine osmolal-486 10:00pm urine color-yellow appear-cloudy sp -1.016 10:00pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-mod 10:00pm urine rbc-21-50* wbc-* bacteria-few yeast-none epi- 10:51pm lactate-3.8* na+-116* k+-5.4* 08:05pm glucose-95 urea n-35* creat-0.8 sodium-114* potassium-6.4* chloride-87* total co2-18* anion gap-15 08:05pm osmolal-258* 08:05pm wbc-33.7* rbc-3.82* hgb-10.5* hct-32.6* mcv-86 mch-27.5 mchc-32.2 rdw-17.5* 08:05pm neuts-90.7* lymphs-5.5* monos-2.0 eos-1.9 basos-0 08:05pm pt-19.8* ptt-35.5* inr(pt)-1.8* . micro: blood cx: pnd urine cx: pnd . imaging: . cxr: impression: increased right moderate right effusion and right basilar pneumonia. (unchanged from ) . ekg: nsr at 97bpm, no peaked t-waves or pr prolongation, poor r wave progression brief hospital course: ms. is a 52 y/o f with a h/o stage iv appendiceal carcinoma who presented after her right nephrostomy tube had dislodged, found to be hyponatremic and hyperkalemic, with a cr above her baseline on labs. . #) dislodged nephrostomy tubes: right tube was completely dislodged and the left tube no longer flushes or drains. went to ir and had tube replaced successfully without any complications. . #) hyponatremia: etiology not completely clear based on her urine lytes or serum osms, likely has a component of hypovolemic hyponatremic, while on exam she appeared total body volume up, her jvd was flat and her mm dry. her urine lytes show a low urine sodium and high osms, consistent with hypovolemic hyponatremia, however she does not appear as sodium avid on labs as one would expect, this could be due to a degree of as her cr is up to 0.8 from her baseline of 0.2-0.3. also likely a component of siadh in the setting of malignancy. with administration of normal saline, na improved from 114 to 117, where it remained stable. further correction with ivf in the hospital setting was discussed with the patient and family, but it was decided to opt in favor of discharge home w/ hospice given current goals of care. she was discharged with some additional bags of ns for use prn until hospice arrives on monday. . #) hyperkalemia: potassium was 6.4 on admission with no ekg changes, improved to 5.4 after calcium gluconate, insulin and d50, possibly related to worsening renal function. patient was monitored on telemetry and did not develop any arrhythmias. . #) leukocytosis: at the time of her recent discharge she had a leukocytosis in the mid-twenties, now elevated to the mid 30's, no evidence of infection on exam. does have right basilar opacity, but chest x-ray appears largely unchanged from . u/a from the er with wbc's, rbc's and bacteria, however since the nephrostomy tubes were not draining well it is not clear where the urine was collected from. continued ciprofloxacin 400mg iv bid to complete prior course for pseudomonas urosepsis, did not continue vanc/cefepime started in the er. urine and blood cultures had no growth to date. . #) : cr up to 0.8 from 0.2 to 0.3 as a recent baseline, given her hypovolemia on exam was likely pre-renal, however may also be partially due to an obstructive picture given dislodged urostomy tube on the right and the left is not draining. she was given ivf and nephrostomy tubes were replaced as above. . #) stage iv appendiceal carcinoma: currently not seeking further therapy and on home hospice. continued oxycodone 5mg q4h prn pain, acetaminophen prn, and ativan prn. medications on admission: oxycodone 5 mg: 1-2 tablets po q4h as needed for pain acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever: max of 3 grams daily. ativan 0.5 mg: one tablet po at bedtime as needed for insomnia ciprofloxacin 400 mg iv every 12 hours to end on discharge medications: 1. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 2. tylenol 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain: maximum of 3g daily. 3. ativan 0.5 mg tablet sig: one (1) tablet po once a day as needed for insomnia. discharge disposition: home with service facility: discharge diagnosis: primary: displaced nephrostomy tube hyponatremia hyperkalemia metastatic appendiceal adenocarcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mrs. , it was a pleasure taking care of you during your admission to medical center. you came into the hospital because one of your nephrostomy tubes was displaced. the interventional radiologists replaced the tube successfully without any complications. you also had some abnormalities in your blood work with low sodium and high potassium. after a discussion with you and your family, we decided that it would be more beneficial for you to go home than for us to keep you in the hospital to correct these abnormalities. . we did not start you on any new medications. you completed your course of ciprofloxacin here, so you can stop the ciprofloxacin when you go home. followup instructions: none procedure: replacement of nephrostomy tube replacement of nephrostomy tube diagnoses: acute kidney failure, unspecified hyposmolality and/or hyponatremia cachexia personal history of malignant neoplasm of large intestine encounter for palliative care hypovolemia secondary malignant neoplasm of retroperitoneum and peritoneum other complications due to genitourinary device, implant, and graft other mechanical complication of genitourinary device, implant, and graft 

Answer: The patient is high likely exposed to