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: clindamycin / morphine / tetracycline / penicillins attending: chief complaint: shortness of breath major surgical or invasive procedure: r pleurodesis with chesttube placement history of present illness: 53 year-old female with metastatic breast cancer with known pulmonary, liver and bone metastases admitted from home with increasing shortness of breath at rest and with exertion. pt recently admitted to with sob and dyspnea at the time underwent left sided thoracentesis with improvement in sympotms. states she felt better (no sob, no cough) for ~ days and since than has progressively felt worse. specifically sob with lying flat and doe. denies any chest pain. has also had a cough but denies fevers, chills, nausea, vomiting. denies sick contacts or recent travel. of note patient was scheduled for a mri as an outpatient for monitoring of known bony metastases, however, did not feel like she would be able to lie flat for it. . currently she has minimal symptoms of sob while sitting up in a chair. + cough. ros had episode of diarrehea after a ct scan ~1 week ago, however, states this is improved now. denies any worsening of her baseline back pain. denies any numbness, tingling or bladder or stool incontinence. past medical history: 1. breast cancer: diagnosed with post-menopausal infiltrating carcinoma with ductal and lobular features in , er positive and pr negative, her-2 negative. status post right-sided modified radical mastectomy with combined sentinel lymph node and lymph node dissection. 2 sentinel ln positive as well as 3 nonsentinel ln for a total of 5 out of 30 sampled lymph nodes positive. lymphovascular invasion was present as well. the tumor was grade . she completed dose-dense adriamycin and cytoxan followed by 4 cycles of dose-dense taxol with dr. . following this, she underwent xrt to the chest wall, followed by arimidex in 11/. in , she began to feel a sensation of a muscle pull between the shoulders of the mid to upper back. imaging ultimately revealed recurrent disease in the spine. she started xeloda , and received xrt to t2. had been receiving taxotere and avastin, stopped in . 2. hypertension 3. seasonal allergies social history: she lives with her husband in , . non-smoker. family history: not reviewed with patient. physical exam: vitals: t 96.2 bp 119/76 hr 102 rr 24 o2 95%ra . gen: middle aged female in nad, pleasant. heent: anicteric, mmm, perrl resp: good air movement with slight decreased bs at left base. no crackles or wheezing. cvr: rrr. normal s1, s2. no r/m/g abd: soft, obese, nt ext: no edema neuro: a&o x 3, cn ii-xii intact, strength 5/5 upper and lower ext and symmetrical. pertinent results: pleural fluid: positive for malignant cells; consistent with metastatic adenocarcinoma. . complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 12:00am 6.0 3.45* 10.4* 33.0* 96 30.1 31.4 15.4 200 12:00am 4.5 3.37* 10.3* 32.4* 96 30.6 31.9 15.6* 158 03:28am 8.6 3.75* 11.5* 35.8* 96 30.6 32.0 15.9* 147* 12:15am 12.1*# 4.16* 12.8 41.0 99* 30.7 31.2 15.7* 255 12:30am 5.5 3.95* 12.0 37.5 95 30.3 32.0 15.9* 216 . renal & glucose glucose urean creat na k cl hco3 angap 12:00am 95 25* 1.5* 140 3.6 109* 23 12 12:00am 89 31* 1.6* 137 3.6 106 22 13 12:00am 101 39* 2.2* 140 3.9 108 21* 15 04:26pm 124* 37* 2.2* 139 4.1 107 21* 15 12:30am 90 15 0.7 140 4.0 106 24 14 . admission cxr in comparison with the study of , there is little change in the bilateral pleural effusions, more prominent on the left. the area of increased opacification at the right base has not progressed and may well have represented only fortuitous superimposition of vascular structures. some atelectatic change is seen in the retrocardiac region. brief hospital course: assessment/plan: 53 yo f with metastatic breast ca and known bilateral pleural effusions admitted with dyspnea for pleurodesis. . # dyspnea: initially admitted with dyspnea due to bilateral pleural effusion, underwent l pleurodesisi with chesttube placement. also underwent r thoracentesis to drain off pleural fluid. respirations improved however pt did not feel that she could lay flat due to fear of dyspnea as well as pain for mri lumbar area that had been scheduled to evaluate for mets to spine. ct was d/c'ed without incidence - no pneumothorax. pt was weaned off oxygen prior to discharge home. . # respiratory distress: developed acidemia and hypoxia after overdose on dilaudid pca pump. pt was started on narcan drip. hypercarbic respiratory failure improved without intubation, however required bipap. all pain medications were held except tylenol. pt was continued on supplemental o2 and weaned to off and aggressive incentive spirometry. at discharge, pt had adequate sats on room air. . # uti: pt with complaint of dysuria, per ua, urine culture with lactobacillus. pt completed a 3 day course of ciprofloxacin. . # acute renal failure: pt developed acute renal failure while in the intensive care unit. fena < 1%, cr.levels improved daily with gentle rehydration. cr. was 1.5 at discharge. . # t/l spine metastasis: although no worsening of symptoms currently, she was scheduled for outpt mri, however was unable to lay flat due to orthopnea related to l pleural effusion. after b/l pleural effusions had been drained, pt was reluctant to undergo the mri in house in part due to fear of orthopnea when flat and pain. she is to undergo mri as an outpatient. . # hypertension: was well controlled on home regimen metoprolol 100mg daily. . # pain: from l pleurodesis and s/p ct placement/removal, had been placed on dilaudid pcp for pain control however overdosed and had stay. upon return to the floor, pt was fearful of overdose and used minimal pain meds. oxycodone as needed as well as acetaminophen scheduled. . pt reached maximal hospital benefit and was discharged home to follow up with pcp and oncologist. medications on admission: 2:2:2 solution - benadryl, maalox and viscous lidocaine metoprolol 100 mg daily oxycodone prn protonix 40mg daily tessalon perle prn. famciclovir 500 mg (started 1 wk ago for ?oral hsv) * allergies: she reports allergies to pcn (rash), clindamycin (rash) and tetracycline (rash). discharge medications: 1. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 2. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days. disp:*4 tablet(s)* refills:*0* 5. lidocaine-diphenhyd--mag- 200-25-400-40 mg/30 ml mouthwash sig: five (5) ml mucous membrane prn. discharge disposition: home with service facility: discharge diagnosis: bilateral pleural effusions metastatic breast ca hypertension discharge condition: good, o2sats 95% ra discharge instructions: you were admitted with shortness of breath, we have drained the fluid from around your lung. . we have not made any changes to your home regimen. please take cipro for 2 additional days. . please come to the ed or call your pcp if you develop chestpains, worsening shortness of breath, fevers or any other worrisome symptoms. followup instructions: stitch removal: please come to interventional pulmonology on , to have your stitches reomved. . please call your oncologist to make an appointment within 2 weeks of discharge . you will need to have mri of lumbar spine rescheduled after visit with your oncologist md, procedure: insertion of intercostal catheter for drainage thoracentesis other incision of pleura injection into thoracic cavity diagnoses: acidosis malignant neoplasm of liver, secondary urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified secondary malignant neoplasm of pleura personal history of malignant neoplasm of breast accidental poisoning by other opiates and related narcotics acute respiratory failure poisoning by other opiates and related narcotics secondary malignant neoplasm of lung 

Answer: The patient is high likely exposed to