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: codeine / vicodin / rowasa / ciprofloxacin / requip / depakote / nsaids / duragesic / pregabalin / latex attending: chief complaint: back pain major surgical or invasive procedure: t6 vertebrectomy and posterior fusion t2-9 transfusion for blood loss anemia post-op history of present illness: 56yo female with newly diagnosed metastatic cancer of unknown primary (likely lung) was admitted with back pain likely related to cord compression and destructive metastatic lesions. unfortunately patient does not have any medical records at and is somewhat poor historian herself. she was reportedly diagnosed with metastatic cancer (no pathologic diagnosis but thought likely primary lung) over the last several weeks. she has had chronic back pain, which has worsened over the last several weeks. she was diagnosed with multiple vertebral compression fractures and was scheduled for outpatient kyphoplasty at . she then presented to on the day prior to admission with increased back pain. ct t and l spine demonstrated findings concerning for cord compression at t6. due to the concern for cord compression, she was transferred to for further evaluation. upon arrival in the ed, temp 97.6, hr 68, bp 132/68, rr 14, and pulse ox 98% on room air. exam was notable for marked back pain and rhonchorous bilateral breath sounds. she received total of 5mg iv dilaudid (2mg, 2mg, and 1mg) and zofran. neurosurgery was consulted in the ed who recommended mri t spine. review of systems: (+) per hpi. back pain, 3 weeks of night sweats, 20 lb weight loss over the last 2 months, chronic loose stools related to her colectomy, occasional shortness of breath, anterior rib pain diffusely, bilateral hip pain, occasional palpitations, nausea, muscle aches (-) denies fever, chills, headache, sinus tenderness, rhinorrhea, congestion, cough, vomiting, constipation, abdominal pain, change in bladder habits, dysuria, arthralgias, or myalgias, urinary incontinence, fecal incontinence past medical history: 1. metastatic cancer, presumed primary lung 2. hyperlipidemia 3. depression / anxiety 4. seasonal allergies 5. s/p total colectomy for collagenous colitis 6. fibromyalgia 7. h/o alcoholism 8. emphysema 9. h/o prescription drug abuse social history: - home: lives in and rents room in sister's home - occupation: has not worked for the last ~15 years, previously employed as a mental health worker at state school in - etoh: history of marked alcohol abuse, drinking several cases (24 cans) of beer daily but reportedly stopped > 20 years ago; does still drink ~several times a month at social functions - drugs: history of remote marijuana use, history of remote prescription drug abuse including with valium and percocet - tobacco: reportedly quit yesterday, 60-80 ppy history ( ppd x 40 years) family history: sister - history of cancer, unsure what kind father - died of emphysema in his 70s mother - died of unknown causes at age 82 physical exam: t 97.9 / bp 155/99 / hr 80 / rr 28 / pulse ox 99% ra gen: uncomfortable appearing, lying on her right side, no acute distress, very pleasant, very thin heent: clear op, dry mucous membranes neck: supple, no lad, no jvd cv: rr, nl rate. nl s1, s2. no murmurs, rubs or gallops lungs: cta, bs bl, no w/r/c abd: soft, nt, nd. nl bs. no hsm ext: no edema. 2+ dp pulses bl skin: no rash neuro: a&ox3. appropriate. cn 2-12 intact. preserved sensation throughout. 5/5 strength in right lower extremity / right upper extremity / left upper extremity; 5-/5 in left lower extremity secondary to pain; normal coordination. gait assessment deferred; intact rectal tone on exam in the ed psych: listens and responds to questions appropriately, pleasant exam upon discharge: motors full, sensation intact, no clonus, wound cdi with staples pertinent results: osh labs: wbc 21.5 / hct 44.6 / plt 426 n 59 / bands 1 / l 31 / m 7 inr 1.1 / ptt 23.5 na 139 / k 3.7 / cl 98 / co2 30.7 / bun 10 / cr 1 / bg 78 ca .9 / tp 6.5 / alb 4.3 / tuberculosis .7 / trop t < .01 ast 11 / alt 8 / alk phos 67 wbc 15.3 / hct 37.8 / plt 325 n 52 / l 31 / m 16 / e 1 / b 1 na 138 / k 3.2 / cl 102 / co2 27.6 / bun 10 / cr .9 / bg 68 ca 9.3 ua - yellow, clear, 1.021, 2+ le, negative nit, neg prot, neg gluc, 1+ ket, neg urobili, neg blood, 80-90 wbcs, rbcs, 3+ muc, 1+ bact, 1+ epi osh studies: cxr - right lung mass compatible with neoplasm ct thoracic and lumbar spine - - findings are compatible with right middle lobe primary lung cancer with metastatic disease to the t2 and t6 vertebral bodies. there is destruction of the t6 vertebral body with posterior extension of tumor to cause cord compression. there is what appears to be metastatic disease to the left adrenal gland. , f 56 cytology report bronchial brushings procedure date of report approved date: specimen received: bronchial brushings specimen description: received brush in cytolyt. prepared 1 thinprep slide. clinical data: 56 y/o female with right lung mass and spinal mets suspicious for lung cancer. previous biopsies: tbna-rml mass report to: dr. diagnosis: bronchial brushing: positive for malignant cells consistent with non-small cell carcinoma. note: please correlate with endobronchial biopsy (s09-). diagnosed by: . , ct(ascp) , m.d. brief hospital course: 56f with a history of asthma, copd, r lung mass and metastatic cancer with 8-wk h/o lbp related to cord compression and metastatic lesions. the patient also suffers from spinal stenosis. the lung mass was sampled via broncoscopy and shown to be nsclc. ct is concerning for metastatic disease to vertebral bodies and cord compression at t6. there is an additional met to an adrenal gland. . 1) back pain. etiology likely r/t metastatic disease to spinal cord in background of 6-year h/o spinal stenosis. cxr shows no evidence of pneumothorax. ?????? dilaudid po ?????? fentanyl patch (100 mcg/hr tp q72h) ?????? lidocaine patch (5% 3 daily) ?????? tizanidine (2 mg po qhs) for muscle relaxation - prn bowel regimen in setting of high dose narcotics (note h/o colectomy). ?????? patient allergic to lyrica . 2) cord compression. t-spine mri reveals cord compression at t6 from path comp fracture and circumferential epidural mass. advanced ddd including compressive central disc herniation at c3-4 w/ additional multilevel canal/foraminal narrowing in c/l spine. lytic lesion in anterosuperior r iliac crest, l pelvic side wall. head ct/mri show no acute intracranial processes or masses. bone scan completed, no other mets. - out of bed with brace - lower left weakness improving (), otherwise neurologically intact. frequent neuro checks - neurosurgery and rad onc recs greatly appreciated - continuing dexamethasone 4 mg q6h (stop prednisone). please note: given chronic h/o prednisone use, must start po prednisone taper after dexamethasone is discontinued. - neurosurg took to or where under general anesthesia pt underwent t6 vertebrectomy with cage placement and posterior fusion t2-9. due to prolonged prone position, pt was kept intubated overnight and monitored closely in icu and was extubated pod#1. her motor exam was full. she had jp drain that was monitored for output. it was removed pod#3. her incision was clean and dry. her diet and activity were advanced. she wears tlso when out of bed. she worked with pt/ot and was recommended for rehab. she prefers oncologic follow up closer to home and appt was arranged for her and she was informed. . 3) metastatic cancer - nsclc on preliminary brushings ?????? bone scan () - known thoracic spine t3 lytic bony met, uptake involving right ilium. ?????? social work consulted for coping ?????? (heme/onc) to follow for chemo eligibility - pt prefers to have oncology treatment closer to home . . 4) leukocytosis - likely reactive/secondary to use of dexamethasone. 5) psych: depression, anxiety, current smoking addiction, former substance abuse, restless leg syndrome - on trazodone for insomnia - continue bupropion - social work following - continue clonazepam for now . 5) respiratory issues: - emphysema - stable on ra. - seasonal allergies - stable - continue albuterol nebs, fexofenadine . . 6) gu: pyuria, previous evidence of uti. ?????? ua and culture were negative . . 7) hyperlipidemia - stable. continue statin. . 8) history of chronic steroid use for unclear etiology. ?????? contact dr. (gi) @ (); waiting to hear from pcp (; ) ?????? on pcp (bactrim ss) . fen: regular diet, replete electrolytes prn, ordered sodium polystyrene sulfonate ppx: heparin sc, bowel regimen prn, on ppi code: full code comm: patient; sister , cell ; home medications on admission: home medications: 1.morphine 35mg po qid 2.clonazepam .25mg po bid 3.albuterol nebs q4-6h prn 4.albuterol inh prn 5.simvastatin 20mg po qhs 6.vitamin b12 1000 mcg po daily 7.prednisone 20mg po daily 8.fentanyl patch 75mcg/hour q72h 9.loratadine 10mg po daily 10.trazodone 400mg po qhs 11.bupoprion sr 150mg po daily discharge medications: 1. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath, wheezing. 3. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 4. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). 5. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 6. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po qam (once a day (in the morning)). 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily) as needed for on steroids. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation: hold for loose stool. 9. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). 10. trazodone 50 mg tablet sig: four (4) tablet po hs (at bedtime) as needed for insomnia. 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation: hold for loose stool. 12. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 13. tizanidine 2 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 14. fentanyl 100 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 15. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: three (3) adhesive patch, medicated topical daily (daily). 16. nph insulin human recomb 100 unit/ml suspension sig: one (1) subcutaneous asdir (as directed). 17. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical (2 times a day). 18. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily) as needed for pcp . 19. bismuth subsalicylate 262 mg/15 ml suspension sig: 15-30 mls po tid (3 times a day) as needed for constipation. 20. dexamethasone 2 mg tablet sig: 0.5 tablet po q8h (every 8 hours) for 1 days: dose for . 21. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day). 22. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever. 23. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. 24. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for diarrhea. 25. prednisone 20 mg tablet sig: one (1) tablet po daily (daily): start . discharge disposition: extended care facility: hospital - discharge diagnosis: lung mass with t6 mass discharge condition: neurologically stable discharge instructions: ?????? do not smoke ?????? keep wound clean / no tub baths or pools until seen in follow up/ begin daily showers ?????? no pulling up, lifting> 10 lbs., excessive bending or twisting for two weeks. ?????? limit your use of stairs to 2-3 times per day ?????? have your incision checked daily for signs of infection ?????? you are required to wear back brace whenever out of bed. ?????? you may shower briefly without the back brace. ?????? take pain medication as instructed; you may find it best if taken in the a.m. when you wake for morning stiffness and before bed for sleeping discomfort ?????? do not take any anti-inflammatory medications such as motrin, advil, aspirin, ibuprofen etc. for 3 months. ?????? increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation call your surgeon immediately if you experience any of the following: ?????? pain that is continually increasing or not relieved by pain medicine ?????? any weakness, numbness, tingling in your extremities ?????? any signs of infection at the wound site: redness, swelling, tenderness, drainage ?????? fever greater than or equal to 101?????? f ?????? any change in your bowel or bladder habits followup instructions: you have appt with oncologist at 12:30pm dr at cancer center , please return to the office in days for removal of your staples or have them removed at rehab or by visiting nurse by please call to schedule an appointment with dr. to be seen in 6 weeks. you will need xrays prior to your appointment you should also contact your pcp and set up appt to discuss need for continued steroid use (you have been on prednisone long term) procedure: closed [endoscopic] biopsy of bronchus closed endoscopic biopsy of lung excision of intervertebral disc excision of bone for graft, other bones dorsal and dorsolumbar fusion of the posterior column, posterior technique fusion or refusion of 4-8 vertebrae diagnoses: hyperpotassemia tobacco use disorder long-term (current) use of steroids adrenal cortical steroids causing adverse effects in therapeutic use acute posthemorrhagic anemia dysthymic disorder other and unspecified hyperlipidemia osteoporosis, unspecified other emphysema chronic obstructive asthma, unspecified myalgia and myositis, unspecified secondary malignant neoplasm of bone and bone marrow leukocytosis, unspecified malignant neoplasm of middle lobe, bronchus or lung personal history of alcoholism insomnia, unspecified neoplasm related pain (acute) (chronic) restless legs syndrome (rls) myelopathy in other diseases classified elsewhere pathologic fracture of vertebrae acquired absence of intestine (large) (small) allergic rhinitis due to other allergen 

Answer: The patient is high likely exposed to