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: penicillins / sulfamethoxazole/trimethoprim attending: chief complaint: shortness of breath, productive cough major surgical or invasive procedure: ultrasound-guided paracentesis liver biopsy history of present illness: -- per admitting resident -- ms. is a 46 year old lady with a history malignant thymoma (full onc history below) who presents here due to dyspnea and cough, which has been progressive over many months. patient states that her breathing is getting worse, and that her oxygen requirement at home has increased from 2.5lpm to 3lpm. she has also had a worsening cough productive of thick, yellow sputum. patient denies fevers, chest pain, headache, abdominal pain, nausea, vomiting, diarrhea, or brbpr. she does report darker colored urine of late and a 30 lb. weight loss ove the past 2 years. . one day prior to admission patient called into the pulmonary clinic to report worsening eye and leg edema and was instructed to taper her prednisone over 2 weeks. she says she now comes to the ed to seek help with shortness of breath, as well as to receive further treatment for her cancer. . in the ed, initial vs: 97.5 110 112/72 rr 19, sp02 97% @ 3-4lnc. patient received levofloxacin 750mg/vanc 1gram for questionable pneumonia due to worsening lul cxr findings. she also received 20meq of potsasium and was continued on oxygen. an 18 gauge iv was placed. vs prior to transfer: 99 126/80 24 98 % 4.5l nc . on arrival to the , patient's vitals were r: 99.8, hr: 105, bp: 119/84, sp02: 97%. patient complains of shortness of breath but denies any pain. past medical history: --malignant thymoma: initially presented in with diplopia and lid droop. she was diagnosed with myasthenia . subsequently, found to have a thymoma with evidence of metastases to the pleura. treatment history: 1. neoadjuvant cytoxan/adriamycin/cisplatin--small response 2. resection of mass and pleural stripping 3. external beam radiation 4. 1 cycle of carboplatin/paclitaxel with carboplatin infusion reaction 5. 8 weeks of weekly taxol completed in . developed pulmonary nodules 6. tarceva 7. prednisone 8. plasmapheresis for myasthenia flare 9. alimta 10. xeloda 11. doxil , then observation . other past medical history: # myasthenia - treated with cellcept since # chronic bell's palsy # allergies # combined restrictive/obstructive lung disease # malignant thymoma: initially presented in with diplopia and lid droop. she was diagnosed with myasthenia . subsequently, found to have a thymoma with evidence of metastases to the pleura. treatment history: 1. neoadjuvant cytoxan/adriamycin/cisplatin--small response 2. resection of mass and pleural stripping 3. external beam radiation 4. 1 cycle of carboplatin/paclitaxel with carboplatin infusion reaction 5. 8 weeks of weekly taxol completed in . developed pulmonary nodules 6. tarceva 7. prednisone 8. plasmapheresis for myasthenia flare 9. alimta 10. xeloda 11. doxil , then observation . other past medical history: --myasthenia --treated with cellcept since --chronic bell's palsy --allergies --combined restrictive/obstructive lung disease --mild pulmonary hypertension social history: married and has two young children. originally from southern . ms. used to work overnight at a bank, but is currently unemployed. her husband works in a restaurant. she denies use of tobacco, ethanol, or other drugs. family history: no history of cancer, myasthenia , diabetes, ms, sle, or other autoimmune diseases. physical exam: -- per admitting resident -- t: 99.8, hr: 105, bp: 119/84, sp02: 97% on 4 liters/minute general: jaundiced, thin, short of breath heent: sclera are jaundiced, eomi, no lad cardiac: holosystolic murmur best heard at left sternal border; normal s2, sinus tachycardia lungs: diffuse crackles bilaterally abdomen: +bs, soft, non-tender, non-distended, no obvious organomegally extremities: 1+ edema bilaterally; +pedal pulses skin: circular ecchymotic lesions on back and abdomen, which patient attributes to "circulation" machine she uses at home. neuro: a&ox3. appropriate. some trouble hearing. belly's palsy with mild paralysis of right side of face. pertinent results: 09:56pm urine hours-random urea n-336 creat-22 sodium-less than potassium-24 phosphate-9.5 09:56pm urine osmolal-236 09:56pm urine color-yellow appear-clear sp -1.007 09:56pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-lg urobilngn-neg ph-7.0 leuk-tr 09:56pm urine rbc-1 wbc-5 bacteria-few yeast-none epi-1 trans epi-<1 12:29pm lactate-2.0 12:25pm glucose-235* urea n-10 creat-0.3* sodium-130* potassium-3.1* chloride-81* total co2-44* anion gap-8 12:25pm alt(sgpt)-273* ast(sgot)-200* alk phos-480* tot bili-20.9* dir bili-15.0* indir bil-5.9 12:25pm lipase-75* 12:25pm ammonia-111* 12:25pm wbc-33.6*# rbc-4.67 hgb-13.0 hct-41.0 mcv-88 mch-27.8 mchc-31.6 rdw-16.6* 12:25pm plt count-255 12:25pm plt count-255 12:25pm pt-18.0* ptt-38.9* inr(pt)-1.6* cxr stable opacification of the left lower and mid lung, attributed to the patient's known pleural metastatic disease. interval patchy opacities noted at the left lung apex could represent pneumonia versus progression of metastatic disease. correlation with clinical history and possible ct of the chest may be helpful in further evaluation. . ruq u/s: 1. no intra- or extra-hepatic biliary ductal dilatation. 2. mildly increased echogenicity of the liver is a nonspecific finding. this is most likely due to fatty infiltration, although more advanced liver disease such as cirrhosis or fibrosis cannot be excluded. 3. new ascites. . ct chest/abd/pel : 1. multiple lobulated pleural-based masses on the left, which are unchanged in size and appearance compared to the prior study. 2. consolidation and bronchiectasis in the left upper lobe in addition to diffuse tree-in- opacities, ground-glass opacities, and more focal nodules within the right lung, all of which are highly concerning for an infectious process. however, malignancy cannot entirely be excluded and clinical correlation is recommended, as well as follow-up imaging surveillance. the appearance includes a new right basilar consolidation with bronchiectasis, and apparently superimposed on nearly confluent pleural masses in the left hemithorax are patchy consolidations, most confluent at the left apex, with bronchiectasis, probably due to infection, or potentially radiation if such therapy has been recently performed. . 3. no focal liver lesions or intrahepatic biliary dilatation to explain the patient's lft abnormalities. . 3. marked intra-abdominal ascites. . 4. stable-appearing deep pleural metastases noted extending into the deep pleural surfaces on the left. . tte : the left atrium is normal in size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 70%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , no major change is evident. impression: no obvious vegetations seen . mr liver: 1. heterogeneous, predominantly subcapsular delayed hepatic enhancement, most consistent with hepatitis. there are no focal mass-like areas of enhancement to suggest metastatic disease. there is no biliary dilatation. 2. moderate ascites and enhancement along the right peritoneum. correlate with history of paracentesis; if there has been none, findings could be infectious or malignant in nature. 3. numerous enhancing soft tissue masses in the left pleura and peritoneum, unchanged from recent ct and increased in size from the remote prior mri. . peritoneal fluid cytology: peritoneal fluid: atypical. atypical cells of undetermined significance, see note. note: recommend submission of additional fluid for cell block preparation and additional studies . liver, needle core biopsy: 1. moderate portal and periportal mixed inflammation including lymphocytes and neutrophils, with predominantly centrivenular and bridging necrosis and parenchymal collapse involving 20-30% of the core biopsy, confirmed by reticulin stain. 2. no malignancy identified in this sample. 3. bile ductular proliferation with associated neutrophils. 4. moderate canalicular and intracellular cholestasis with focal bile plug formation. 5. trichrome stain shows no increase in fibrosis. 6. iron stain shows no stainable iron. note: the findings are consistent with an active hepatitis with parenchymal collapse, bile ductular proliferation, and cholestasis. given the provided clinical information, a drug/toxin-mediated injury is favored, however, clinical/serologic correlation is required. brief hospital course: # bacteremia - bcx grew out listeria. the patient was known to consume homemade and potentially unrefrigerated food products which could have been a potential source. pt presented with significant leukocytosis with wbc > 30k. as patient is allergic to pcn, was started on iv bactrim . pt defervesced early in hospitalization but remained with significant leukocytosis. tte showed no evidence of endocarditis and blood cultures promptly cleared after initiation of treatment. after discussion with id, since patient without neurologic/cardiac involvement, ok to treat with three weeks of antibiotics. patient tolerated iv bactrim poorly several days into her course, developing sob and flushing. she was switched to iv meropenem. she developed a mild arm/leg rash to this antibiotic, but the decision was made to treat through the possible allergy given that it was felt that this was the last good option to treat listeria. patient finished her antibiotic course in-house and remained stable. . # pna/bronchiectasis - completed 5 day course of levofloxacin. patient back to baseline oxygen requirement with no additional sob. . # edema - patient developed asymmetric lue edema and ble edema intermittently throughout hospitalization. preference of lue > rue edema likely partly due to decreased hydrostatic pressure as seen on ultrasound (dampened subclavian waveform), possibly from extrinsic compression from thyroid cyst, coupled with low oncotic pressure from depressed albumin. hypoalbuminemia is likely liver failure, although nutrition may be playing a role as well. was effectively treated with lasix/aldactone to improve edema but this was limited by the patient developing hyponatremia. the patient was discharged on a short supply of lasix/aldactone as she was c/o some edema at time of discharge. . # hyperbilirubinemia - the liver consult service followed this patient during her time in-house, during which her workup included a liver mri, which showed diffuse hepatitis with no nodules, a tap, which suggested hepatic ascites. cytology showed possible atypical cells that could have been worked up with more fluid (>1l) but there was not enough left to tap. an ir-guided liver biopsy was performed, which demonstrated zone 3 necrosis consistent with a toxic hepatitis. as the patient had been taking unspecified herbal medications, it was felt this was a likely etiology and she was told to stop these medications. her lfts/bili were somewhat improved at discharge but still significantly elevated. . # malignant thymoma - per onc team, pt's current sx not directly attributable to malignancy at this time, no role for chemotherapeutic intervention. no evidence of tumor progression on imaging. medications on admission: medications (per omr) albuterol sulfate q2 prn benzonatate 100 mg po tid calcium carbonate 500 mg po daily cholecalciferol 400 unit po daily cyanocobalamin 100mcg po daily fexofenadine 60mg po bid fluticasone-salmeterol 250/50 inh guaifenesin 600mg po bid montelukast 10mg po daily multivitamin 1 tab po daily mycophenolate mofetil 500mg po qd nystatin suspension 5 times daily prednisone 5mg po qod discharge medications: 1. commode please provide patient with bedside commode. 2. wheelchair please provide patient with standard wheelchair. 3. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*60 capsule(s)* refills:*0* 4. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 5. cholecalciferol (vitamin d3) 400 unit capsule sig: one (1) capsule po once a day. 6. cyanocobalamin 100 mcg tablet sig: one (1) tablet po daily (daily). 7. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 8. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) inhalation twice a day. 9. guaifenesin 600 mg tablet sustained release sig: two (2) tablet sustained release po twice a day. 10. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 11. prednisone 5 mg tablet sig: 1.5 tablets po every other day (every other day). 12. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for itching. disp:*60 capsule(s)* refills:*0* 13. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for pruritic rash. disp:*2 tubes* refills:*1* 14. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation every eight (8) hours as needed for shortness of breath or wheezing. disp:*qs for 30 treatments * refills:*0* 15. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 16. menthol-cetylpyridinium 3 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed) as needed for cough. disp:*30 lozenge(s)* refills:*0* 17. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. disp:*qs for 30 treatments * refills:*0* 18. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 19. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 20. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*60 capsule(s)* refills:*0* 21. furosemide 40 mg tablet sig: one (1) tablet po once a day. disp:*14 tablet(s)* refills:*0* 22. spironolactone 100 mg tablet sig: one (1) tablet po once a day: take with furosemide (lasix). disp:*14 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: 1. acute hepatitis; likely drug-induced 2. pneumonia 3. listeriosis . secondary diagnoses: 1. malignant thymoma 2. myasthenia discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - requires assistance or aid (walker or cane) discharge instructions: you were seen at for pneumonia, liver failure, and a bacterial bloodstream infection. your pneumonia was treated with antibiotics. your bloodstream infection was treated with 3.5 weeks of intravenous antibiotics. you completed this regimen before being discharged. you were also found to have jaundice and liver dysfunction when you came to the hospital. after discussion with our liver specialists, we conducted numerous tests, including an mri and a paracentesis (sample of abdominal fluid). these tests suggested your liver was severely inflamed but did not clearly show what the cause of the inflammation was. a liver biopsy was performed. the preliminary report from this biopsy shows no evidence of cancer. the biopsy results suggests that the liver injury was from a toxic ingestion; we suspect an herbal medication you were taking may have caused this. you will be started on a medication to try to improve your liver function and will follow up with the liver specialists as an outpatient. the following medications were changed during your hospitalization: added benadryl and sarna lotion, medications that can help prevent itching from rash added ursodiol, a medication to try to improve your liver function added benzonatate to help with cough added furosemide (lasix) to help with swelling added spironolactone to be taken with lasix to help with swelling added cepacol lozenges to help with cough added docusate to help with constipation added bisacodyl to help with constipation followup instructions: you have an appointment scheduled with dr. , the liver specialist, at 8am on (this coming friday) at the , on the . you can contact his office at (. provider: , pt, ccs phone: date/time: 9:30 please call dr. at ( for a new oncology provider. will also ask dr. to get in touch with you. md, procedure: venous catheterization, not elsewhere classified closed (percutaneous) [needle] biopsy of liver percutaneous abdominal drainage diagnoses: pneumonia, organism unspecified long-term (current) use of steroids acute and subacute necrosis of liver secondary malignant neoplasm of pleura hypopotassemia bacteremia other ascites other disorders of plasma protein metabolism bronchiectasis without acute exacerbation other drugs and medicinal substances causing adverse effects in therapeutic use myasthenia gravis without (acute) exacerbation listeriosis malignant neoplasm of thymus 

Answer: The patient is high likely exposed to