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: aspirin attending: chief complaint: spinal cord transfer from hospital major surgical or invasive procedure: : t2-t5 lami for tumor resection and biopsy history of present illness: 88-year-old male with penile scc s/p hemiresection c/b blastic spinal cord disease (c2-4) who presented to hospital 1 day ago with difficulty walking x1 week. . the patient was in his usual state of health until 1 week ago (patient states 1 day ago). at that time he developed difficulty walking and urinary incontinence. he denies any back pain, saddle or lower extremity anasthesia. he presented to hospital. he had an mri showing a large mass encompassing t2-t5 compressing the spine. neurosurgery evaluated the patient, felt that he was not at acute risk for compression when supine so no steroids. he was transferred to for neurosurgical evaluation and biopsy lesion to see if responsive to radiation therapy. . currently, feels well. denies fevers, headache, back pain, leg pain, leg weakness, numbness, stool incontinence. he does endorse urinary incontinence. past medical history: medical & surgical history: - htn - mild dementia - penile scc in , s/p hemi-resection - hearing loss - chronic kidney disease - anemia - gout - bph - b12 deficiency - skin cancer - gerd - hypothyroidism - hld - s/p left hip replacement - s/p tonsilecomy social history: no smoking. no etoh or illicits. in . family history: cad, ca physical exam: admission exam: vs - temp 98.4 f, bp 126/68, hr 80, r 16, o2-sat 97% ra general - elderly male, tanned, no apparent distress heent - dry mmm, op clear neck - supple, no jvd heart - rr, nl rate, no mrg lungs - ctab, no r/rh/wh, anterior exam abdomen - soft/nt/nd extremities - wwp, no c/c/e, 2+ peripheral pulses neuro - awake, a&ox2, cns ii-xii grossly intact, muscle strength throughout (including bilateral lower extremities when supine), sensation grossly intact throughout including saddle area, gait deferred, rectal tone normal . discharge exam: patient is awake and alert, oriented to self and place, on and off to date he has 5/5 strength with his right lower extremity, and trace weakenss in the left lower extremity secondary to hip surgery. full strength in bilateral upper extremities. pertinent results: admission 07:20am blood wbc-7.2 rbc-2.74* hgb-8.8* hct-26.0* mcv-95 mch-31.9 mchc-33.7 rdw-14.3 plt ct-317 07:20am blood pt-13.3* ptt-29.1 inr(pt)-1.2* 07:20am blood glucose-98 urean-36* creat-2.4* na-141 k-3.8 cl-107 hco3-27 angap-11 07:20am blood calcium-9.2 phos-2.6* mg-2.2 ct tspine : findings: there are sclerotic lesions in the vertebral bodies of t2 through t5 with involvement of the posterior elements and the spinous processes. the left lamina and pedicle of the t6 vertebral bodies are also involved. sclerotic foci are also seen in the posterior ribs and costovertebral junctions at the levels of t3 through t6. there is extensive paravertebral soft tissue tumor spread from the levels of t2 through t5 with extensive epidural and neural foramina, better demonstrated on the mr of the thoracic spine from . extensive atherosclerotic calcifications of the thoracic aorta, as well as atelectatic changes and small bilateral effusions are seen in the lungs. the partially visualized kidneys demonstrate hypoattenuating lesions, likely cysts, but incompletely characterized. impression: 1. sclerotic metastases involving the vertebral bodies of t2 through t6 (with involvement of the posterior elements and the spinous processes) and the posterior ribs and costovertebral junctions at the levels of t3 through t6. 2. extensive paravertebral soft tissue involvement and epidural tumor extension better assessed on the mr of the thoracic spine from . ct cspine : impression: 1. sclerotic focus of the left pedicle of c4 might represent a blastic metastasis, less likely a bone island. 2. multilevel moderate degenerative changes, most pronounced at c3/c4, c4/c5, and c5/c6. ct lspine : impression: 1. levoscoliosis, and moderate-to-severe degenerative changes of the lumbar spine, most pronounced at l4/l5 with severe spinal canal narrowing. 2. there are no suspicious bony lesions in the lumbar spine. mri c/t/l- spine : again noted are sclerotic metastases involving t2 through t5 vertebral bodies and spinous processes. there is also involvement of the left aspect of the body and pedicle of t6. there are degenerative endplate changes at t12-l1. there is circumferential epidural neoplasm from t2 through t5 with compression of the cord and cord myelomalacia, worse at t2-t3. pre- and paravertebral soft tissue is also noted at these levels with extension into the neural foramina bilaterally. multiple ribs also demonstrate metastatic lesions bilaterally. evaluation of the cervical spine demonstrates multilevel djd. a small sclerotic focus at c4 on the left pedicle at c4 may represent a metastatic focus. there are multilevel disc osteophyte complexes with canal narrowing and foraminal narrowing. there is extensive scoliosis of the lumbar spine to the left. there are extensive degenerative changes at almost all levels with the most significant and severe canal stenosis at l4-l5 from facet hypertrophy and disc bulge as well as ligamentum flavum thickening. no convincing metastatic disease is seen in the lumbar spine. there are degenerative endplate changes at multiple levels. there is severe right foraminal narrowing at l4-l5. there is a schmorl's node at the inferior aspect of l2. incidentally noted there is a mass in the right parotid measuring 1.5 x 1.2 cm. bilateral small pleural effusions are noted. there is a left renal cyst. impression: metastatic disease in the upper thoracic spine with epidural extension and cord compression and cord myelomalacia as detailed above. degenerative sequela in the cervical and lumbar spine with the most severe stenosis at l4-l5. right parotid lesion- primary parotid neoplasm versus metastasis. ct head : negative head ct, no lesions noted. ct torso : impression: 1. no evidence of definite primary or metastatic disease in the abdomen, or pelvis. 2. sclerotic metastatic disease in the upper thoracic spine. epidural extension as described on mri is poorly evaluated on this ct. 3. small bilateral pleural effusions. 4. ascending aortic aneurysm measuring 5.5 cm. extensive atherosclerotic and coronary artery calcifications. 5. enlarged prostate, poorly evaluated on this examination. 6. bilateral simple renal cysts. 7. 6-mm hypodensity in the right lobe of the thyroid gland. this can be further evaluated with a thyroid ultrasound on a non-emergent basis as clinically indicated. bone scan : impression: multifocal osseous metastases involving the t2-t6 vertebral bodies, right anterior fourth rib, left posterior sixth rib, and likely the t9 vertebral body. all lesions with the exception of t9 correspond to sclerotic lesions noted on ct. post operative mri : . postoperative changes in the form of t1 to t5 laminectomies with partial resection of the anterior epidural soft tissue. 2. sclerotic lesion involving t2 to t6 vertebral bodies with associated pre and para-vertebral soft tissue. these likely represent sclerotic metastases. 3. anterior epidural soft tissue at t2 level causing spinal cord compression. hyperintense signal is noted in the spinal cord at this level which likely represents edema. 4. degenerative changes in the thoracic spine which are unchanged since the prior study. brief hospital course: 88-year-old male with penile scc s/p hemi-resection c/b blastic spinal cord disease who was transferred from hospital with large mass encompassing t2-t5 compressing the spine. . acute issues: . # spinal cord compression: mri at osh with t2-t5 compression. while laying flat he had good strength on admission though morning after admission with mew left lower extremity weakness concerning for acute worsening disease. continued to have urinary incontinence. neurosurgery consulted and felt he would benefit from acute neurosurgical intervention for cord decompression. radiation oncology also consulted. felt this may be lymphomatous infiltration rather than solid tumor mets and so requesting biopsy results prior to radiation initiation. neurosurgery aware of need for biopsy felt he would benefit from surgery anyway and so radiation deferred for time being. patient had mri and ct spine to eval for extent of disese and he was started on dexamethasone 4mg iv q6hours. . # cancer: history distant penile cancer though now with blastic disease in spine. rare for penile cancer to metastasize. given chronicity of spinal lesions, blastic in nature and indolent course there is high suspicion for metastatic prostate ca. psa added on to am labs and showed an elevated level at 11.4. # ckd: cr 2.5 on admission. baseline creatinine around 2.5-2.8 per records. . # htn: continued atenolol though would consider switching to alternative since bb inferior for htn management and because of crf . chronic: # gout: chronic, stable, continued allopurinol. . # bph: chronic, stable, continued terazosin . # anemia: chronic, stable, baseline hct around 27. . # gerd: with history of pud/ugib. chronic, stalbe, continued pantoprazole, no evidence of bleed during admission and hct remained stable around baseline . # hypothyroidism: chronic, stable, continued levothyroxine . # hld: chronic, stable, continued simvastatin . transitional issues: - contact: though osh records indicate son is hcp - pcp: . - derm-oncology: dr. - urologist: dr. completed hemi-penectomy urology - radiation oncologist: dr. - dr. ?surgeon - dr. (dermatologist) - consider changing anti-hypetensives to alternative given crf and inferiority of bb transferred to neurosurgery post-operatively on patient was taken to the or with dr for lami and lesion rsxn/biopsy. intraoperatively, patient had cardiac arrhythmias- aflutter/afib and hypertension. because of this, he was taken to the icu post-operatively. he was taken to the icu intubated as he was taking longer to wake up. he was started on nicardipine for blood pressure management for sbp < 140. he continued to wake slowly, and by late evening was following commands but did not pass spontaneous breathing trials. he was later extubated on at 6am. his exam improved as he became more alert. afternoon, he appeared to be full on lle but slightly weaker on rle. an mri was ordered for post-op evaluation and we continued to assess his strength as he became more alert. the nicardipine was discontinued and his sbp maintained. patient medications on admission: medications on transfer: - allopurinol 100mg po daily - protonix 40mg po daily - folic acid 0.5mg po daily - lavaza 2g po bid - hytrin 2mg po qhs - bicarbonate 650mg - zocor 20mg po daily - synthroid 50mcg po daily - ferrous sulfate 325mg po daily - vitamin d units po daily - pocaltrol 1 mcg po daily - atenolol 50mg po daily - vitamin c 1000mg po daily - norvasc 2.5mg po daily . medications at home: - amlodipine 2.5 mg po daily - atenolol 50 mg po daily - b12 1000 mcg injection - calcitriol 0.5mcg po daily - ferrous sulfate 325mg po daily - fish oil - folic acid 800mcg po daily - furosemide 20mg po daily - kayexalate 15mg po every other day - levothyroxine 50mcg po daily - omeprazole 40mg po bid - sodium bicarbonate 650mg po daily - terazosin 2mg po daily - vitamin c 1000mg po daily - vitamin d 2000mg po daily - simvastatin 20mg po qhs - allopurinol 100mg po daily - aleve 200mg prn discharge medications: 1. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. terazosin 1 mg capsule sig: two (2) capsule po hs (at bedtime). 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 8. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 9. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. polyethylene glycol 3350 17 gram powder in packet sig: one (1) powder in packet po daily (daily) as needed for constipation. 11. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 12. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 15. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 16. senna 8.6 mg tablet sig: one (1) tablet po daily (daily). 17. dexamethasone 1.5 mg tablet sig: two (2) tablet po q8hrs () for 2 days. 18. dexamethasone 2 mg tablet sig: one (1) tablet po q12hrs () for 1 days. 19. dexamethasone 0.5 mg tablet sig: two (2) tablet po q12hrs () for 1 days. 20. dexamethasone 0.5 mg tablet sig: two (2) tablet po q24hrs () for 1 days. discharge disposition: extended care facility: clipper harbour skilled nursing discharge diagnosis: thoracic metastatic lesion cardiac arrythmias discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ?????? you have staples, keep your wound clean and dry until they are removed. ?????? no tub baths or pool swimming for two weeks from your date of surgery. ?????? do not smoke. ?????? no pulling up, lifting more than 10 lbs., or excessive bending or twisting. ?????? limit your use of stairs to 2-3 times per day. ?????? have a friend or family member check your incision daily for signs of infection. ?????? take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. pain medication should be used as needed when you have pain. you do not need to take it if you do not have pain. ?????? do not take any anti-inflammatory medications such as motrin, advil, aspirin, and ibuprofen etc. for two weeks. ?????? increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. we recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? wear your brace when out of bed or when you are not flat. place brace on while flat in bed or head of bed less than 30 degrees. followup instructions: ??????please return to the office in days (from date of surgery) for removal of your staples. this appointment can be made with the physician . please make this appointment by calling paresa at . if you live quite a distance from our office, please make arrangements for the same, with your pcp. were seen by cardiac surgery for your aortic aneurysm, their recommendation is that you have a follow up echo in months to evaluate for growth. md procedure: other exploration and decompression of spinal canal other exploration and decompression of spinal canal biopsy of spinal cord or spinal meninges diagnoses: anemia, unspecified esophageal reflux unspecified acquired hypothyroidism thoracic aneurysm without mention of rupture chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation atrial flutter hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia personal history of other malignant neoplasm of skin secondary malignant neoplasm of brain and spinal cord do not resuscitate status delirium due to conditions classified elsewhere secondary malignant neoplasm of bone and bone marrow hip joint replacement other urinary incontinence myelopathy in other diseases classified elsewhere personal history of peptic ulcer disease personal history of malignant neoplasm of other male genital organs dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to