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: hypotension major surgical or invasive procedure: none history of present illness: 53f with a history of gastric bypass and metastatic carcinosarcoma of the uterus s/p chemotherapy with /taxol, most recent treatment six weeks ago, who presented to about one month ago and was diagnosed with spontaneous splenic rupture. she is now s/p exploratory laparotomy and splenectomy. she was reviewing the pathology slides today with her oncologist in clinic and was told that there was evidence of metastatic disease in the spleen. they checked her blood pressure and noted systolics in the 80's so transported her to the ed. in the ed she complained of mild luq pain. fast was performed and noted to be positive so surgery was consulted. past medical history: oncologic history: mrs. is a 53-year-old woman who noted some vaginal discharge and followed up with her gynecologist when the discharge became bloody. she underwent endometrial biopsy, which revealed high-grade malignant tumor concerning for carcinosarcoma and a pelvic ultrasound revealing an echogenic area within the cavity measuring 4 x 4 x 4 cm. she was referred to dr. . -- on , she underwent robotic assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy, bilateral pelvic and paraaortic lymph node dissection and washing. pathology revealed carcinosarcoma (malignant mixed mullerian tumor) and cervix with squamous metaplasia. tumor 5.5 x 3.5 x 2.5 cm grade 3. cytology of washings negative. pt1a (stage ia) 10% myometrial invasion, cervix negative, ovaries and fallopian tubes negative, tn0, 0 out of 9 pelvic lymph nodes, and 0 out of 4 paraaortic lymph nodes positive for metastasis. no definitive foci of lymphovascular invasion identified. - on , started carboplatin auc 5 and taxol 175 for cycle 1 which was complicated by taxol-associated myalgias and orthostatic hypotension (brief hospitalization, without loc). - on seen by dr. regarding vaginal spotting, thought to be secondary to healing at suture site. - on , continued auc 5 and decrease taxol to 150mg/m2 for cycle 2 for c1d15, anc 730 - on received cycle 3 4 and taxol to 135mg/m2 with neulasta on day 3 after deferred 4 week due to persistent neutropenia - c4d1 taxol/ - c5d1 /taxol past medical history: hypertension, osteoarthritis, history of urate and calcium stones, status post multiple lithotripsy, thyroid cancer in with recurrence status post radical neck dissection (of note, she had an mssa surgical wound infection in the setting of her radical neck dissection) and complicated by thoracic duct injury status post clip placement, negative colonoscopy (history of polypectomy in ). past surgical history: gastric bypass in at with 135-pound weight loss (a 40-pound weight gain since menopause), thyroidectomy (), radical neck dissection for recurrent disease (), left total knee replacement in complicated by bacteremia and joint infection with recurrence after six weeks of antibiotics resulting in spacer placement and replacement of the joint again in , tonsillectomy at age 5, carpal tunnel bilaterally in , cholecystectomy, umbilical hernia repair social history: denies tobacco and drug use. married and lives with her husband. she works in retail and has 6 grandchildren family history: noncontributory physical exam: on admission: vitals: 98.1 74 94/64 16 97 ra gen: a&o, nad heent: no scleral icterus, mucus membranes moist cv: rrr, no m/g/r pulm: clear to auscultation b/l, no w/r/r abd: soft, mildly tender to palpation in the luq, no hernias or masses, well-healed midline incision ext: no le edema, le warm and well perfused pertinent results: cxr : new left-sided effusion with possible underlying atelectasis or airspace disease ct abd/pel : enlarging complex ascites, hemorrhage without clear source of bleed; rapid progressive metastatic disease in pelvis, liver, splenectomy bed, stomach, mesentery, peritoneum cta : no active extravasation, loculated fluid, large complex masses in splenectomy bed, pelvis, omentum, peritoneum abdominal xr : no e/o obstruction, contrast in colon, pleural effusion cxr : substantial l pleural effusion, compressive atelectasis, low lung volumes cxr : no ptx, substantial decrease in l pleural effusion gib study : no evidence of active bleeding within the splenic resection bed cta : acute pulmonary emboli in rll and rul, new nodular opacity in r apex concerning for early pna. extensive metastatic dz in abd, perihepatic ascites cxr : picc in place, l effusion returned cxr : l effusion brief hospital course: ms. is a 53yo woman with a history of metastatic uterine carcinosarcoma who was admitted from the emergency room to the icu for hypotension secondary to hemorrhage into splenectomy bed lesion. she was then transferred to the gynecologic oncology service on hospital day 2. she was discharged on home hospice on hospital day 10. her hospital course was as follows: # code status: ms. was initially full code and all the measures below were taken. however after two family meetings, her daughter, was named as her healthcare proxy and her code status was changed to comfort measures only on . she was evaluated by hospice and admitted into inpatient hospice. it was decided that she would be receive a fentanyl patch daily and oxycodone as needed for breakthrough pain. her picc line and foley catheter were left in place. her family received teaching about managing her indwelling catheter prior to discharge. # hemoperitoneum: in the icu, she was transfused a total of 3 units of prbcs with hct increase from 25.1 to 32.4. due to concern for bleeding from her splenectomy bed, interventional radiology was consulted and recommended a repeat ct scan in arterial phase to identify potential vessels to embolize. on hospital day 2, after receiving renal-protective bicarb infusion given her cr 1.5, a cta abdomen showed no active extravasation. since a repeat hct was stable at 32.4 and 34.1, she was then transferred to the gynecologic oncology service where hct trended downwards overnight from 34.1 to 30.4 to a nadir of 27. as she was also tachycardic in the 100s and oliguric (10-20cc/hr), she was transfused 2 additional units of prbcs on hospital day 3. during transfusion, her tachycardia improved to the 90s and her urine output improved. her post-transfusion hct was appropriate at 32. however, her hematocrit still continued to trend downwards and per acs recommendations, we did order a tagged red cell scan, which showed no evidence of an acute bleed. we therefore transfused her 2 more units of blood for a hct of 25.7. her hct did not show an appropriate rise and was 27.8 and she received another unit of blood. labs were discontinued after her code status changed. # acute kidney injury: given her creatinine of 1.5 on admission, she received renal-protective bicarb infusion prior to her cta abdomen. after her cta abdomen, her creatinine increased from 1.1 to 1.8, and she was oliguric. a fena was 0.3% consistent with pre-renal acute kidney injury, likely caused by a combination of iv contrast and anemia. her urine output improved slightly and her creatinine decreased to 1.7 after her blood transfusion on hospital day 3. however, she continued to be oliguric (10-15cc/hr) on hospital day 4 with creatinine of 1.8, so she was bolused 500cc crystalloid and her urine output improved slightly. her urine output continued to average 10-20cc during the course of her stay. however, we stopped giving her boluses because there was concern that the fluids were adding to her left lung pleural effusion. urine output monitoring was stopped and her foley discontinued after her code status was changed. # pleural effusion: chest x-ray in the emergency room showed a new left-sided pleural effusion. she was maintained on nasal canula oxygen with acceptable oxygen saturations. given the inability to wean her from oxygen and dyspnea on exertion on hospital day 4, a repeat chest x-ray was performed which demonstrated a substantial l pleural effusion, compressive atelectasis, and low lung volumes. given her symptoms, interventional pulmonology was consulted. on hospital day 5, she underwent an uncomplicated left thoracentesis by interventional pulmonology, with 300cc of fluid removed. post-procedure chest x-ray desmonstrated no evidence of pneumothorax. after the thoracentesis, we attempted to wean her off the oxygen on hospital day 6. however, she had a desaturation to 85%/ra prompting an evaluation with ct scan to rule out a pulmonary embolism. given her poor kidney function and creatinine of 1.8, we pre-hydrated her with sodium bicarbonate to prevent worsening nephropathy. her cta showed acute pulmonary emboli in the right lung vasculature, new nodular opacity in righ apex concerning for early pneumonia. extensive metastatic disease in her abdomen and perihepatic ascites. she continued to require oxygen and was continued on this for comfort. # pulmonary embolism: lovenox 80mg sc daily was started after diagnosis of pulmonary embolism. it was discontinued after her code status was changed. # right apex pneumonia: given the fact that ms. was newly diagnosed with this while in house, it was treated as a hospital acquired infection with intravenous vancomycin, cefepime and levofloxacin. she did have a picc line placed because of her antibiotic requirement and for blood draws. the antibiotics were discontinued per her code status. # nausea: on hospital day 3, she had persistent nausea, for which she received iv zofran, phenergan, and ativan. her nausea then improved and she was able to tolerate small amounts of a regular diet. # e. coli uti: in the icu, she was started on bactrim due to a urinalysis with positive nitrites. on hospital day 4, her final urine culture returned showing e.coli resistant to bactrim. she was then started on ceftriaxone for her urinary tract infection. her final blood cultures were negative and her ceftriaxone was discontinued on # metastatic uterine carcinosarcoma: in the emergency room a ct abdomen/pelvis demonstrated enlarging complex ascites, hemorrhage without a clear source of bleeding, and rapid progression of metastic disease in pelvis, liver, splenectomy bed, stomach, mesentery, and peritoneum compared to a ct scan performed a week prior. she was seen by the atrius palliative care consult on hospital day 2, who provided recommendations for pain control. on hospital day 5, a team meeting with representatives from the gynecologic oncology, medical oncology, and palliative care teams met with the patient and her family and we discussed the plan of care for her. patient wishes to remain full code. she was told that the prognosis of her disease was not good and palliative chemotherapy with doxil outpatient was discussed once the patient becomes stable and is discharged from the hospital. however, after the 2nd family meeting, it became apparent to the patient and her family that she would not get better and wold not be a candidate for palliative chemotherapy. her code status was therefore changed to comfort measures only. # 1st degree heart block: while in the icu, her troponin increased from 0.05 to 0.18. ekg showed 1st degree av block without any st changes. serial troponins decreased to 0.06 and 0.03 and cpks were within normal limits. she was maintained on telemetry on the floor with no events. telemetry was therefore discontinued. # prophylaxis: given her bleed risk, she did not receive subcutaneous heparin dvt prophylaxis. she did have sequential compression devices and received intravenous pepcide for stress ulcer prophylaxis. she also received an aggressive bowel regimen for constipation and this has continued for comfort measures. medications on admission: allopurinol 100mg daily, levothyroxine 62.5mg daily, ativan 0.5 q8 prn, paxil 80mg daily, mvi, vitamin b6 discharge medications: 1. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 2. paroxetine hcl 30 mg tablet sig: two (2) tablet po daily (daily). 3. docusate sodium 100 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*2* 4. senna 8.6 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed for constipation. disp:*30 tablet(s)* refills:*0* 5. oxycodone 5 mg/5 ml solution sig: one (1) po q3h (every 3 hours) as needed for pain. disp:*10 bottle* refills:*0* 6. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. disp:*20 tablet(s)* refills:*0* 7. fentanyl 75 mcg/hr patch 72 hr sig: one (1) transdermal q72h (every 72 hours). disp:*20 * refills:*0* 8. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for oral discomfort. 9. oxygen please provide oxygen with flow of 2l 10. prochlorperazine 25 mg suppository sig: one (1) suppository rectal q12h (every 12 hours) as needed for nausea. disp:*30 suppository(s)* refills:*1* 11. lorazepam 2 mg/ml concentrate sig: 0.5-1 mg po every six (6) hours. disp:*30 ml* refills:*2* discharge disposition: home with service facility: hospice and palliative care discharge diagnosis: metastatic uterine carcinosarcoma pulmonary hospital acquired pneumonia coagulopathy urinary tract infection concern for intraabdominal bleed. acute renal failure. discharge condition: level of consciousness: lethargic but arousable. mental status: clear and coherent. activity status: bedbound. discharge instructions: you were admitted to the gynecology oncology service for concern for bleeding from your splenectomy bed and you were found to have metastatic uterine carcinosarcoma. *) please take your pain medication as scheduled. *) please continue your bowel regimen *) please continue oxygen for comfort followup instructions: none do 16-adl procedure: venous catheterization, not elsewhere classified thoracentesis diagnoses: pneumonia, organism unspecified malignant neoplasm of liver, secondary unspecified pleural effusion urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified depressive disorder, not elsewhere classified candidiasis of mouth pulmonary collapse hemorrhage complicating a procedure removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other and unspecified coagulation defects knee joint replacement other pulmonary embolism and infarction personal history of antineoplastic chemotherapy hemoperitoneum (nontraumatic) first degree atrioventricular block secondary malignant neoplasm of other digestive organs and spleen secondary malignant neoplasm of retroperitoneum and peritoneum bariatric surgery status postsurgical hypothyroidism personal history of malignant neoplasm of thyroid other and unspecified escherichia coli [e. coli] malignant neoplasm of uterus, part unspecified 

Answer: The patient is high likely exposed to