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: vicodin attending: chief complaint: lower extremity weakness major surgical or invasive procedure: c7-l10 fusion history of present illness: 67f presented to osh () for progressive lower extremity weakness, now pod#4 from c7-l10 fusion. in early the pt had severe in the thoracic spine pain while lifting a 20lb . pain described as sharp pain, radiating bilaterally anteriorly in a band like fashion below her breasts. the pt took ibuprofen for the pain and later took hydrocodone( which made her nauseous) . on , pt noted to have "rubbery legs", unable to walk. bladder and bowel intact. went to osh were ct scan revealed t5 and l1 compression fractures, thoracic spinal cord compression, and subsequently transferred to . . at , pt noted to have mild lower extremity weakness, sensory loss below t5 and and bilateral upgoing babinski. mri showed pathologic compression fracture at t5, with diffusely abnormal signal intensity involving vertebral body, pedicles, and laminae. also noted was severe spinal cord compression from epidural soft tissue component. also a prevertebral soft tissue component and several scattered lesions of increased signal intensity in the spine, including the sacrum, representing metastatic lesions. . on , pt underwent fusion of the c5-l2 vertebrae with bx and lymph node sent for immunophenotyping and pathology. pt subsequent sent to tsicu for care following laminectomy during which received 5000ml lr, 631ml prbcs for 2500 ebl. pt was seen by the pain service post-operatively. . per report the pathology preliminary has revealed sheets of plasma cells consistent with plasmacytoma/multiple myeloma. past medical history: 1. osteopenia. 2. history of engorged turbinates status post sinus procedure. 3. removal of a ruptured epidermal cyst on right buttock and a dermatofibroma from the left buttock in . 4. history of cystic breast lesions, evaluated by ultrasound. 5. mammogram wnl social history: single and lives alone. previously married, now divorce. she has no children. lived briefly in the phillipines. formerly worked as a clinical educator. lives in , . she enjoys gardening. she smoked briefly in college. she does not drink alcohol regularly. family history: mother: died from acute leukemia in her 60s. father: alcoholism, died in his 50s brother: 66 hx of hodgkin's. brother: 63 brother: 60 hx of pulmonary emboli, s/p vats maternal aunt: diagnosed with colon cancer in 70s maternal uncle: diagnosed with colon cancer in 70s physical exam: (on transfer to bmt service pod#4) vitals: t: 99.2 bp: 125/70 hr: 70 rr: 16 96 o2sat: gen: aox3, nad, well-nourished heent: perrl, eomi, sclera anicteric, mmm, op clear neck: no jvd, no bruit card: s1 s2, no m/g/r, radial pulses +2, minor decrease in sharp sensation along t5 distribution pulm: lungs ctab, no w/r/r, tenderness to palpation left suprascapular area. no focal masses appreciated abd: soft, nt, nd, +bs, no hsm, no masses ext: no c/c/e, no palpable cords neuro: cn ii ?????? xii grossly intact. moving all 4 extremities. strength 5/5 in upper and lower extremities. patellar dtr +1. equivocal babinski tests bilaterally. back: vertical wound dressings c/d/i skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses rectal: normal tone pertinent results: admission labs: 08:45pm wbc-6.3 rbc-3.72* hgb-12.4 hct-34.9* mcv-94 mch-33.4* mchc-35.6* rdw-13.4 08:45pm neuts-74.1* lymphs-20.3 monos-4.3 eos-1.0 basos-0.2 08:45pm plt count-231 08:45pm pt-14.7* ptt-25.7 inr(pt)-1.3* 08:45pm urine color-straw appear-clear sp -1.004 08:45pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-15 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg . . pertinent labs/studies: . hct: ranged from 24.7 and 31.1 on this admission. ldh: 115 -> 251 - > 263 -> 299 -> 332 -> 270 spep: igg 280, iga 748 igm 8 . ecg: : sinus rhythm. borderline low qrs voltage in the limb leads. diffuse non-diagnostic repolarization abnormalities. cannot exclude prior septal myocardial infarction. . mr c,t,l spine w& w/o contrast - 1. severe pathologic compression fracture of t5 vertebra, with diffusely altered areas of signal intensity involving the vertebral body as well as the pedicles on both sides and the laminae on both sides, with significant amount of epidural soft tissue component, overall resulting in severe compression of the cord. there is also prevertebral soft tissue component, with some enhancement. 2. several scattered focal lesions of increased signal intensity on the stir sequence and enhancement on the post-contrast images in the spine, including the sacrum, representing metastatic lesions. 3. as the primary malignancy is not known, further workup, to evaluate for primary malignancy is recommended. ct torso can be performed for this reason; evaluation for bony details for the spine can be better performed with sagittal and coronal reformations on the same. otherwise, ct of the spine- thoracic, and if necessary, cervical and lumbar regions can be considered for better evaluation of bony details. 4. small bilateral pleural effusions, with collapse/consolidation of the adjacent portions of the lung, which can be better evaluated with ct chest. 5. small 0.8 cm t2 hyperintense lesion, in the left kidney, may represent a cyst but can be better evaluated at time of ct torso. . l- spine: : in comparison with the previous study of this date, an extensive surgical procedure has been performed with multiple rods and hooks extending from c6 through l2. . skeletal survey : there is marked loss of height of the l1 vertebral body. several areas of lucency are seen in the posterior aspect of the calvarium. although these could merely represent venous lakes, the possibility of metastases cannot be excluded. ct or mr would be necessary to exclude this possibility. the views of the appendicular skeleton show no definite lytic lesion. . pathology t5 and lipoma of left hip: 1) soft tissue, left hip, excision: mature adipose tissue consistent with lipoma. 2) soft tissue and bone, t5, excision: plasmacytoma, see note. note: the sections are of multiple fragments of bone and soft tissue infiltrated by sheets of plasma cells with focal areas of necrosis. by immunohistochemistry, cd138 highlights sheets of plasma cells. by kappa/lambda light chain immunostaining, plasma cells are kappa restricted. in the context of appropriate clinical, laboratory and radiologic findings, this is consistent with features of plasma cell myeloma (see also subsequent bone marrow specimen). please correlate with clinical, laboratory and radiologic findings. . tissue: immunotyping, lymph node: non-specific t cell dominant lymphoid profile; diagnostic immunophenotypic features of involvement by a non-hodgkin b cell lymphoma are not seen in specimen. tissue sections reveal sheets of plasma cells. correlation with clinical findings and morphology (see s08-49708h) is recommended. flow cytometry immunophenotyping may not detect all lymphomas as due to topography, sampling or artifacts of sample preparation. . bone marrow biopsy (): cellular marrow with increased plasma cells. note: plasma cells are enumerated at 42% (aspirate). the morphological findings along with the recently diagnosed plasmacytoma (t5) are consistent with a plasma cell dyscrasia/plasma cell myeloma. correlation with clinical, radiologic, and other laboratory studies are needed for definitive confirmation/categorization. immunostains are pending and will be reported as an addendum. . . discharge labs: . brief hospital course: 67 yo female with h/o osteopenia who presented with back pain and lower extremity weakness and was found to have a plasmacytoma and multiple myeloma. . # plasmacytoma: the patient on admission was found to have a large mass at t5, with spinal cord compression. this mass was resected and biopsied and pathology was found to be consistent with a plasmacytoma. radiation oncology was consulted, but it was decided that the patient would undergo medical treatment with with valcade and decadron instead of radiation therapy. the patient received decadron 40 mg iv daily for four days, twice, and she will be followed by dr. for further treatment of her plasmacytoma and multiple myeloma. . # multiple myeloma: the patient has a history of osteopenia and was found to have a plasmacytoma on admission. a spep was then performed which demonstrated an elevated iga level. the patient underwent a bone marrow biopsy on , which demonstrated multiple myeloma. the patient was started on high dose decadron for four days, from through . the patient then underwent another course of high dose decadron from through . the patient tolerated this medication well, and she will follow up with dr. as an outpatient for valcade and decadron therapy. the patient was also noted to have persistent anemia during this hospitalization, yet her creatinine reamined within normal limits. finally, the patient was started on bactrim ds for pcp prophylaxis in the setting of high-dose steroid use. . # c5-l2 fusion: the patient presented to an osh with back pain and lower extremity weakness. she was found to have a large mass compressing the spinal cord. the patient was orginally admitted to the ortho-spine service, under the care of which she had the mass resected and a c7-t10 fusion on . the patient was followed closely by the ortho-spine service during this admission, and she was fitted for a back brace on pod #6. the patient worked with physical therapy and occupational therapy during this admission, and she has a follow-up appointment with dr. on . . # pain control: the patient was evaluated by the pain service on this admission. she was initially placed on percocet, but this was later changed to oxycodone. the patient's pain was well controlled on this medication, and she did not have any acute events during this hospitalization. . # hypophosphatemia: the patient had a phosphate level of 1.2 on admission. she received 30 meq of k phos which increased her level to 2.7. of note the patient received kphos in the setting of a national shortage of po neutraphos. medications on admission: calcium - on occasion discharge medications: 1. bactrim ds 160-800 mg tablet sig: one (1) tablet po every m/w/f. 2. lorazepam 0.5 mg tablet sig: 1-2 tablets po every six (6) hours as needed for insomnia. 3. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day) as needed. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. tylenol 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. 7. percocet 5-325 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: multiple myeloma plasmacytoma secondary: discharge condition: good. patient's vs are stable, and she is able to ambulate with assistance. discharge instructions: you were admitted to the hospital because you were experiencing back pain and lower extremity weakness. while you were here, we found that you had a large mass in your spine, a plasmacytoma, and you bone marrow showed evidence of a condition called multiple myeloma. while you were here, you underwent surgery on your spine with dr. . after this procedure, you were transferred to the bmt service, where you were given 4 days of decadron. you tolerated this treatment well, and you will return to see dr. in clinic upon discharge. while you were here, we made the following changes to your medications: 1. we started you on protonix for gi prophylaxis while on the decadron 2. we started you on senna and colace to regulate your bowel movements while on oxycodone 3. we started you on lorazepam, as you were noticing significant anxiety and difficulty sleeping 4. we started you on bactrim for infection prophylaxis during the time you are taking dexamethasone. please take all medications as prescribed. please keep all previously scheduled appointments. please return to the ed or your healthcare provider if you experience increasing pain in your back, increasing lower extremity weakness, chest pain, shortness of breath, fevers, chills, or any other concerning symptoms. followup instructions: provider: . . date/time: at 9:30 am. phone: provider: , md phone: date/time: 2:00 provider: , : date/time: 2:00 procedure: biopsy of bone marrow other exploration and decompression of spinal canal excision of bone for graft, other bones excision of lesion of other soft tissue biopsy of bone, other bones other cervical fusion of the posterior column, posterior technique fusion or refusion of 9 or more vertebrae percutaneous vertebral augmentation diagnoses: acute posthemorrhagic anemia urinary frequency disorders of phosphorus metabolism other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation multiple myeloma, without mention of having achieved remission kyphosis (acquired) (postural) paraplegia disorder of bone and cartilage, unspecified neoplasm related pain (acute) (chronic) myelopathy in other diseases classified elsewhere pathologic fracture of vertebrae lipoma of other skin and subcutaneous tissue other immunoproliferative neoplasms, without mention of having achieved remission 

Answer: The patient is high likely exposed to