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: penicillins / iodine; iodine containing attending: chief complaint: back pain, elevated inr major surgical or invasive procedure: surgical fasciotomy right internal jugular central line placement left subclavian line placement history of present illness: pt is a 77 year old male with hx of metastatic follicular thyroid cancer with known vertebral mets admitted with elevated inr. the patient reports that his visiting nurse checked an inr on (last dose of coumadin) which was elevated to >4. his coumadin was held, and when it was checked again today it was elevated >5 and he was instructed to come to the ed. incidentally he reports that he has had worsening back pain for the last week, describes pain which is usually controlled on percocet to . the pain is sharp, constant, and is in a band along the beltline between his hips. it does not radiate. he has no pain, numbness or tingling in his legs. no change in bowel or bladder function. he reports that it is usual for him not to be able to lie flat due to pain, but this is much worse than usual. in addition, he has been taking more percocet than usual - 6-8 tabs daily and subsequently began having nausea and vomiting x this week. he states that he feels well right up until the time that he vomits (usually right after a meal). he denies bleeding - mucosal or otherwise. . ros: decreased appetite, denies sob, cp, no fever or chills, but reports cold intolerance. no change in bowel habits, with regular bm daily. . in the ed his vitals were t 98.1 hr 104 bp 141/86 o2 - 98% on ra. he was given percocet for pain. ct scan was done showing no evidence of rp bleed. nuerosurgery was contact and recommended no need to reverse inr at this point. past medical history: - history of hairy cell leukemia diagnosed in , status post splenectomy without further treatment. - metastatic follicular thyroid cancer (summary below) - history of paroxysmal atrial tachycardia - benign prostatic hypertrophy - dm type 2 on oral hypoglycemic agents - hypercholesterolemia - hypertension - status post left hip replacement - recent dvt and pe () - status post electrophysiology ablation of avnrt focus - status post fluoroscopic guided placement of ivc filter . brief onc summary per last endocrine note: "the patient was diagnosed in with follicular thyroid carcinoma affecting his lungs, lumbosacral spine and left hip. he suffered a fracture of his left hip for which he had a left replacememt and was found to have extensive bony lesions at the l5-s1 invading his spinal canal, this causing severe spinal stenosis. he received external beam radiation for spinal metastases but suffered dvt complicated by coronary embolus while in rehab. he eventually had a total thyroidectomy on . because he had been on amiodarone for paroxysmal atrial fibrillation, he could not immediately be treated with radioactive iodine for his metastatic disease. his amiodarone was stopped in and with aggressive therapy, his iodine level eventually dropped in . he was treated with thyrogen twice as his tsh could not be increased adequately due to topic production of thyroid hormone by metastatic thyroid carcinoma. this allowed him to receive 200 mci of radioactive iodine treatment . he was treated with decadron around the time of the therapy due to known spinal metastases and concern for cord compression." social history: he lives in with his wife and son. has four children, 2 sons, 2 daughters. denies tobacco or alcohol use. he used to work in heavy glass manufacturing. his son and one of his daughters live with him. family history: he reports that his mother had breast cancer and died at 82y/o. his father died of a stroke at 86y/o. his sister has lung cancer. physical exam: vitals: t 98.4 bp 129/94 hr 88 rr 17 o2 100% ra gen: elderly man in mild distress - appears uncomfortable sitting upright in bed heent: mmm, no op lesions - no mucosal bleeding, eomi, pupils dilated (s/p b/l cataract surgery) neck: supply, no lad, no jvd heart: rrr, nl s1/s2, no s3/4, no murmurs lungs: cta b/l, no wheezes or rales abdomen: soft, nt/nd, +bs, no masses, no hsm, no guarding or rebound tenderness msk: approx 4cm mass over vertebrae around level t10-l1 - tender to tough, not fluctuant, non-erythematous. otherwise generally tender to lumbar/sacral region extrem: 2+ pitting edema b/l, compression stockings in place, skin smooth and hairless. no erythema or calf pain. pertinent results: labs on admission: na 139 k 4.1 cl 101 hco3 28 bun 12 creat 0.8 glucose 130 ca 8.6 mg 1.6 p 2.5 . alt 14 ast 20 ap 119 tbili 0.4 alb 4.3 amylase 65 lipase 18 . wbc 5.8 hgb 10.9 hct 33.5 plt 439 mcv 106 n 74.4% l 17.2% . pt 48.4 ptt 82.2 inr 5.7 . u/a: trace ketones, otherwise negative . --> blood, urine and tissue cx --> pan-sensitive klebsiella . mr lumbar spine (): 1. since the previous mri the soft tissue changes at t12-l1 level have decreased. signal changes indicative of metastatic disease are still noted at this level. on the post-gadolinium images a central area of low signal identified within the t12 vertebral body which could be due to changes from treatment. 2. metastatic disease to l4, l5 and s1 again noted unchanged in extent. 3. no evidence of new bony metastatic disease or epidural mass. 4. multilevel degenerative changes and a small arachnoid cyst at the posterior aspect of the thecal sac at t12-l1 level are unchanged from previous study. . ct lumbar spine (): multilevel metastatic disease within the visualized lower thoracic and lumbar spine as described above. specifically, marked destruction and loss of vertebral body height of the l1 vertebral body with appearance suggesting soft tissue infiltration extending posteriorly with an epidural component. additionally, marked destruction and soft tissue infiltration of the l5 and s1 vertebral bodies. these findings suggest a hemangioma of the l4 vertebral body with superimposed metastasis, recommend further evaluation with an mri of the thoracic spine. approximately 2.7 x 2.5 cm low-attenuation lesion within the interpolar aspect of the right kidney likely representing a renal cyst, recommend further evaluation with ultrasound. further findings as described above. . ct abdomen/pelvis (): impression: 1. no evidence of retroperitoneal or intraperitoneal bleed. 2. diverticulosis. 3. multiple lungs nodules, likely representing metastases, smaller in size since ; however, the evaluation is limited on this abdominal ct. 4. multilevel thoracolumbar spinal metastasis with soft tissue and indentation into the spinal canal, which has been described in detail on recent mri and ct of the lumbar spine. 5. lymphadenopathy along the left iliac chain, increased in size. . x-ray l hip: views of the left hip show an unchanged appearance of the left femoral hemiarthroplasty. no acute fracture is identified. degenerative changes are seen in the lower lumbar spine. ivc filter is seen. degenerative changes are seen in the right hip. impression: stable appearance of the left femoral prosthesis. no acute change. brief hospital course: pt is a 77 yo man with metastatic follicular thyroid cancer with known vertebral metastases presenting with hypotension, elevated lactate, hypoxia concern for sepsis or bleed. . he was initially treated for worsening lower back pain, and started a chronic pain regimen and restarted xrt to l hip and lumbar spine. he spent over 1 week in the hospital when he was transferred to icu for hypotension and placed on pressors & antibiotics. he was found to have a rapidly spreading infection of both legs to the hip. surgery immediately evaluated and took patient to or for fasciotomy which revealed a diagnosis of necrotizing fasciitis. he was unstable in the or, so only his anterior legs were debrided. he has undergone aggressive fluid resuscitation and remained intubated with relative pulmonary edema after his surgery. blood, urine, and tissue cx all showed klebsiella. he was intially treated with cefepime, vancomycin, and clindamycin as well as aggressive pressor support and ventilation. however, family meeting was held and family felt that given very poor prognosis they did not wish to proceed with another surgery. their goal was to maintain the patient's comfort as much as possible including extubating him, and placed on comfort measures. he died at 9:57 pm on . family wished to proceed to autopsy. medications on admission: calcitrol .25 mcg po daily. calcium carbonate 1250 mg five times daily. finasteride 5 mg qd. levothyroxine sodium 350 mcg po qthursday, other days 175 mcg. metformin 1000 mg po bid. pravastatin 20 mg po qd. vitamin d 800 units daily oxycodone w/ apap 5/325 1-2 tabs q4-6 hours as needed for pain discharge medications: none discharge disposition: expired discharge diagnosis: necrotizing fasciitis, sepsis hip pain metastatic thyroid cancer discharge condition: deceased discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified fasciotomy transfusion of packed cells transfusion of other serum other radiotherapeutic procedure diagnoses: abnormal coagulation profile pure hypercholesterolemia malignant neoplasm of liver, secondary acute kidney failure with lesion of tubular necrosis unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled severe sepsis hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) septic shock long-term (current) use of anticoagulants other septicemia due to gram-negative organisms personal history of venous thrombosis and embolism anticoagulants causing adverse effects in therapeutic use secondary malignant neoplasm of lung secondary malignant neoplasm of bone and bone marrow hip joint replacement anemia in neoplastic disease pathologic fracture of vertebrae personal history of malignant neoplasm of thyroid necrotizing fasciitis leukemic reticuloendotheliosis, unspecified site, extranodal and solid organ sites 

Answer: The patient is high likely exposed to