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: abnormal gait and numbness on his b/l his lower extremities for two days major surgical or invasive procedure: 1. revision t2, t3, t4, t5, t6 bilateral laminectomy, medial facetectomy, foraminotomies for removal of intraspinal extradural mass, most likely renal cell carcinoma. 2. removal of posterolateral instrumentation and re- instrumentation t2 to t7. 3. primary t7 bilateral laminectomy, medial facetectomy and foraminotomy for removal of intraspinal extradural mass, most likely renal cell carcinoma. 4. application of local autograft as well as allograft. history of present illness: a 65-year-old gentleman with a history of metastatic renal cell carcinoma to spine presented with abnormal gait and numbness on his lower extremities for two days. because of the metastasis in the spine, the pt underwent t2-t6 bilateral laminectomy in , he initially felt fine. however, in the morning of yesterday, he suddenly had difficulty in walking, which progressively worse over the past 24 hours. he denied weakness, but he had numbness on his b/l lower extremities. he denied urine or fecal incontinence although he had constipation that he attributed to pain medications. he denied fever, chill, but he still had back pain around his surgical site, which had not gotten worse. in the ed, orthopedics did consult and recommended " npo after midnight, no anticoagulation, consider iv dexamethasone. needs discussion between radiation vs. surgery in am" in an osh , pt had already received one dose of dexamethasone at 10 mg. review of systems: (+) per hpi. (-) denies fever, chills, night sweats. denies blurry vision, diplopia, loss of vision, photophobia. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations, lower extremity edema. denies cough, shortness of breath, or wheezes. denies nausea, vomiting, diarrhea, abdominal pain, melena, hematemesis, hematochezia. denies dysuria, stool or urine incontinence. denies arthralgias or myalgias. denies rashes or skin breakdown. all other systems negative. past medical history: oncology history: oncologic history: : lower back pain and hematuria &#; ct: 8-cm mass from the upper pole of the right kidney and compressing the ivc. : right radical nephrectomy&#;rcc, grade , clear-cell type with clean margins and no lymphatic invasion. (stage t2n0m0) and : ct scan: 4-cm right lower lobe nodule suspicious for metastatic disease. bronchoscopy and biopsy : nondiagnostic. pet : nodule was intensely fdg avid&#; open thoracotomy and wedge resection of the lung nodule surveillance ct scan in : 2.6 x 1.5-cm right paratracheal lymphadenopathy. bronchoscopy and ebus-guided biopsy: renal cell carcinoma. : vats-assisted mediastinal lymph node dissection by dr. at . ct: progression of disease located in the mediastinum, right hilum, and in the lung parenchyma bilaterally. a small pericardial effusion was also noted on this report. - :completed il2 therapy : torso ct: decrease in size of mediastinal and hilar lymphadenopathy. increase in size of right upper lobe pulmonary nodule compared to prior. :new stable adrenal lesion, likely metastatic : left laparoscopic adrenalectomy - present with back pain - thoracic spinal met, resection at other pmh: hyperlipidemia recent hypothyroid after il2 psh; t3 to t5 laminectomy and posterior fusion from t2 to t7 on left laparoscopic adrenalectomy on social history: lives with his wife and 3 children in , . his children are 18, 20 and 21 years of age. he never smoked and drank alcohol only occasionally. family history: non-contributory physical exam: vitals - t:97 74 118/75 18 99% ra general: nad, lying comfortably on bed skin: warm and well perfused, no excoriations or lesions, no rashes heent: at/nc, eomi, anicteric sclera, pale conjunctiva, patent nares, mmm, nontender supple neck, no lad, no jvd. cardiac: rrr, s1/s2, no mrg lung: ctab abdomen: nondistended, +bs, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly m/s: he was able all extremities, no cyanosis, clubbing or edema, no obvious deformities pulses: 2+ dp pulses bilaterally neuro: 4/5 strength bilaterally throughout. sensation intact and symmetric throughout. eomi. the reflex was hyperactive in the b/l lower extremities . loss of proprioception in ble. . pertinent results: 04:33pm lactate-1.4 04:20pm glucose-134* urea n-22* creat-1.0 sodium-134 potassium-4.7 chloride-99 total co2-24 anion gap-16 04:20pm wbc-7.8 rbc-4.67 hgb-12.6* hct-39.1* mcv-84 mch-27.0 mchc-32.3 rdw-13.3 04:20pm neuts-94.1* lymphs-4.9* monos-0.5* eos-0.3 basos-0.1 04:20pm plt count-318 mri of the spine: t2-t7 posterior fusion with postop artifact in spinal canal which obscures evaluation. within surgical bed, there is heterogeneous appearnce within spinal canal which may represent susceptilibity +/- residual/recurrent tumor or postsurgical fibrosis. canal and foramina patent in lower t- and l/s-spine. cord has normal signal at these levels. brief hospital course: patient was transferred from omed to the spine surgery service and taken to the operating room for the above procedure. refer to the dictated operative note for further details. the surgery was without complication and the patient was transferred to the pacu in a stable condition. teds/pnemoboots were used for postoperative dvt prophylaxis. intravenous antibiotics were continued for 24hrs postop per standard protocol. initial postop pain was controlled with a pca. diet was advanced as tolerated. the patient was transitioned to oral pain medication when tolerating po diet. foley was removed on pod#2. physical therapy was consulted for mobilization oob to ambulate with support. hospital course was otherwise unremarkable. on the day of discharge the patient was afebrile with stable vital signs, comfortable on oral pain control and tolerating a regular diet. patient will require rehabilitation considering his neurological status. he will also need adjuvant therapy for control of local recurrence in the future. medications on admission: lipitor 10 mg tab 1 tablet(s) by mouth daily sutent 50 mg cap 1 capsule(s) by mouth once per day for 28 days, then 14 days off fludrocortisone 0.1 mg tab 1 tablet by mouth daily prednisone 2.5 mg tab 3 tablets by mouth daily and increase if sick or surgery oxycodone-acetaminophen 5 mg-325 mg tab tablet(s) by mouth every four (4) hours as needed for pain levothyroxine 75 mcg tab 1 tablet(s) by mouth daily discharge medications: 1. fludrocortisone 0.1 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 3. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*90 tablet(s)* refills:*0* 4. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever or pain. 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 9. prednisone 2.5 mg tablet sig: three (3) tablet po once a day. disp:*90 tablet(s)* refills:*2* 10. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for indigestion. 11. heparin 5000sc tid discharge disposition: extended care facility: hospital discharge diagnosis: 1. recurrent intraspinal extradural tumor, most likely renal cell carcinoma, t2 to c7. 2. thoracic stenosis. 3. recurrent thoracic myelopathy. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: immediately after the operation: - activity: as tolerated - rehabilitation/ physical therapy: you can walk as much as you can tolerate. limit any kind of lifting. - diet: eat a normal healthy diet. you may have some constipation after surgery. you have been given medication to help with this issue. - wound care: remove the dressing in 2 days. if the incision is draining cover it with a new sterile dressing. if it is dry then you can leave the incision open to the air. once the incision is completely dry (usually 2-3 days after the operation) you may take a shower. do not soak the incision in a bath or pool. if the incision starts draining at anytime after surgery, do not get the incision wet. cover it with a sterile dressing and call the office. - you should resume taking your normal home medications. - you have also been given additional medications to control your pain. please allow 72 hours for refill of narcotic prescriptions, so please plan ahead. you can either have them mailed to your home or pick them up at the clinic located on 2. we are not allowed to call in or fax narcotic prescriptions (oxycontin, oxycodone, percocet) to your pharmacy. in addition, we are only allowed to write for pain medications for 90 days from the date of surgery. - follow up: o please call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. o at the 2-week visit we will check your incision, take baseline x-rays and answer any questions. we may at that time start physical therapy. o we will then see you at 6 weeks from the day of the operation and at that time release you to full activity. please call the office if you have a fever>101.5 degrees fahrenheit and/or drainage from your wound. physical therapy: see discharge instructions. activity as tolerated. no restrictions except for bending forward, and lifting. treatments frequency: see discharge instructions followup instructions: you follow up visit at the spine center is scheduled for the at 1 pm with . please call spine center to confirm appointment. also please schedule an appointment with dr for radiation in the first week of (after the spine center appointment on 3rd). dr office number is please schedule an appointment with dr 4 weeks from the day of the surgery for systemic therapy. procedure: imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges dorsal and dorsolumbar fusion of the posterior column, posterior technique fusion or refusion of 4-8 vertebrae diagnoses: anemia, unspecified spinal stenosis, thoracic region abnormality of gait other and unspecified hyperlipidemia secondary malignant neoplasm of brain and spinal cord antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use personal history of malignant neoplasm of kidney myelopathy in other diseases classified elsewhere other iatrogenic hypothyroidism 

Answer: The patient is high likely exposed to