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: patient recorded as having no known allergies to drugs attending: chief complaint: rle pain major surgical or invasive procedure: . s/p ivc filter placement s/p l3 biopsy s/p liver biopsy . history of present illness: . hpi (per floor/micu notes, confirmed w/pt): briefly, 26 y/o f, flew from for medical care, who presents with severe hip pain, low back pain and 4 weeks of urinary incontinence and fevers since , although increasing in frequency over the past few weeks. also with occasional night sweats, denies weight changes or change in appetite, +intermittent nausea. recent progression of urinary incontinence, also associated with sensation changes in rle. she notes that for the past month she has been unable to feel when she is having a bowel movement. . she denies known exposure to tuberculosis. . in ed, performed pan-spine mri, which demonstrated collapse of the superior and inferior endplates at l3, along with mild enhancing epidural soft tissue changes posterior to the vertebral body. in the right sacrum, there was a large area of signal abnormality with adjacent soft tissue mass from s1 to s3 level, extending to the right iliacus muscle and ilium. there also appeared to a thrombus in the ivc. cxr also suggested bilateral lower lobe pulmonary nodules. she was also found to have elevated lfts, with alt 48, ast 57, alk phos 548, ggt 248, tbili 0.8. she was admitted to the floor for further work-up. . past medical history: -r ovarian cyst-she affirms increasing abdominal girth , feeling increased bloating, presented to the ed found to have a right ovarian cyst, was resected. - (7yrs old) hospitalized for 6 months for fever/cough, weakness, unclear source of infection, did require blood transfusions. - gyn- no menstrual periods for the past year social history: social history: had ovary removed secondary to cyst at 19 years old - denies any history of ovarian cancer. lives with her sister and brother. recently relocated from - speaks creole and portugese. 2 live time sexual partners, denies stds, denies etoh, ivdu, smoking family history: 1 sister age 27, with question of r leg mass resected 4 yrs ago denies other cancer history physical exam: vs: temp: 96.7 bp:98/54 hr: 89 rr:18 100 o2sat gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, epigastric mass ~2 inch diameter, firm, nontender, no hepatomegaly detectable, ? splenomegaly, lower abd well healed scar ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii intact. lle , rle , sensation decreased to light touch, rle toes down going in r leg, upgoing in l leg pertinent results: . ekg: q-waves, st depressions and twi in iii. lad, tachycardic, normal intervals. . micro: urine cx with burkholderia cepacia . imaging: . pan-spine mri: cervical spine: impression: no significant abnormalities on mri of the cervical spine. thoracic spine: impression: no significant abnormalities on mri of the thoracic spine. no evidence of disc herniation, bony metastasis or epidural abscess. 1.2-cm nodular opacity in the right lower lung. lumbar spine: impression: the signal changes and associated soft tissue extension at l3 level and within the sacrum are suggestive of metastatic disease. the central post-gadolinium low signal seen within the sacral mass appears to be due to central necrosis within a tumor than an area of abscess. probable thrombus within the inferior vena cava. further evaluation with abdominal and pelvic ct recommended. . ct torso: impression: 1. massive aggressive tumor involving the entire left and mid scarum, right iliac bone, l3 and symphysis pubis which most likely represent metastatic spread. 2. marked involvement of the liver by large masses most likely due to metastatic spread of unknown primary. for precise evaluation of spinal involvement please review the mri from 3. multiple pulmonary metastases. 4. dermoid cyst, most likely in left ovary . chest cta: impression: 1. bilateral massive central pulmonary embolism as described above, involving right main, right ascending and descending, left descending and their branches. 2. multiple pulmonary nodules in lower lobes, representing metastasis as seen on the prior study. 3. partially visualized heterogeneous masses in the liver representing metastasis as seen on the prior ct scan. for complete assessment of the abdomen and pelvis, please refer to the official report of ct study performed a day earlier. . tte: conclusions: the left atrium is normal in size. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). the right ventricular cavity is moderately dilated. right ventricular systolic function is normal. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is moderate to severe pulmonary artery systolic hypertension. there is no pericardial effusion. impression: right ventricular cavity enlargement with preserved systolic function. moderate pulmonary artery systolic hypertension. . lenis: grayscale and doppler ultrasound of the bilateral lower extremities: normal flow, compressibility, and augmentations are seen in bilateral common femoral, superficial femoral, and popliteal veins. there is no evidence of dvt. impression: no evidence of dvt. . mrv : 1. focal inferior vena caval thrombus at the l2 level. the thrombus appears to be bland, superior in location to the tumor-infiltrated l3 vertebral body. 2. multiple masses consistent with the patient's history of metastatic disease. 3. splenomegaly . mri brain: 1. there is no definite evidence of intracranial metastatic disease. 2. prominent pituitary gland with possible microadenoma. attention to this area should be paid on follow-up study. 2. heterogeneous bone marrow signal within the partially imaged cervical spine. this finding may be related to underlying anemia versus an infiltrative process. . repeat ct scan, abd/pelvis w/contrast: 1. thrombus in the ivc 8 cm below the tip of a suprarenal ivc filter, unchanged. 2. no interval change in appearance of innumerable soft tissue and bony metastatic lesions from prior exam dated . 3. new left lung base wedge-shaped opacity most consistent with infarction given the prior history of a left lower lobe pulmonary embolism. . brief hospital course: . a/p: 26 y/o f, from , with h/o ovarian cyst/mass 6 years ago presenting with hip and back pain, decreased ability to ambulate and urinary incontince, found to have widely metastatic disease of unclear primary and bilateral pes with residual ivc thrombus, s/p ivc filter placement . . # initial hospital course: on the floor, ms. a torso ct, which confirmed the presence of soft-tissue density masses, the largest in the left lingula, measuring 7.2cm x 6.5cm. there was also local septal thickening in the subpleural posterior portion of the left lower lobe which could represent focal lymphangitic spread. there was a 1.2cm hypoechoic nodule in the thyroid. there was no mediastinal, axillary, or hilar adenopathy, and no bony lesions in the chest. abdominal cuts demonstrated multiple large heterogeneous masses involving the entire left hepatic lobe up to 6.5 cm in the most distal portion of the lobe and 6 x 7 cm in the more medial and lower portions with marked enlargement of the entire left lobe, depressing the transverse colon and stomach downward and backward. there was retroperitoneal lad up to 3 x 1.8 cm. there was no evidence of bowel obstruction, and kidneys, adrenals, and pancreas were unremarkable. pelvis cuts demonstrated a l 7cm x 6.5cm ovarian lesion consistent with a dermoid cyst. images also confirmed the presence of a 9.5 x 7 x 10 cm heterogeneous mass involving the right and mid portion of the sacrum, the proximal portion of the iliac bone with complete destruction of the above-mentioned bones and invading the spinal canal at the level of the sacrum as well as the spinal nerve foramina. in addition, there was partial destruction of the vertebral body of l3 with soft tissue mass entering into the spinal canal with mild compression. a round area of low density of 1.7 cm in diameter is in the right iliac muscle, series 3 image 87, most likely representing part of the aggressive tumor. there was a lytic lesion of the right part of the symphysis pubis with erosion of the cortex, periosteal reaction and soft tissue component. . the morning of admission, ms. became tachycardic, with ecg showing evidence of right heart strain. a stat chest cta was obtained, which demonstrated massive bilateral central pulmonary embolism. there was a large clot in the right main pulmonary artery, proximally occluding at least 50% of the lumen, distally completely occluding the lumen extending to right ascending and descending arteries, which continues down to the right middle and lower lobe branches. there was also a total occluding clot in the left descending artery and its branches. she was started on heparin drip, and a stat tte was obtained, which demonstrated intact rv systolic function, with moderately elevated pa pressures, and no evidence of clot-in-transit. lenis showed no evidence of clot. she was sent to the micu for further management. . # micu course: in the micu, she had an mri of head which ruled out brain mets and she was begun on a heparin gtt. she had an mrv which demonstrated residual clot in the ivc as well as the left iliac vein. on , she went to ir and had an infrarenal ivc filter placed, and also had a biopsy of her sacral lesion by ir. the next morning (day of transfer to floor) she was switched from heparin to lovenox, given that it was difficult to get her therapeutic on the heparin. her neuro exam remained stable throughout her micu course. she was transferred back to the floor for further management after she was monitored and treated for pe in the micu. . # sacral mass w/widely metastatic disease: concerning for neoplastic disease. pathology obtained from the sacral lesion showed only necrotic material. the patient then had an ir-guided biopsy of a lesion lesion. the pathology from the liver core showed poorly differentiated cells. it was impossible to make a diagnosis based on the tissue morphology along and special staining was sent to help determine what type of primary. the differential included primary ovarian (hx of ovarian "cyst" removed 6 years ago and dermoid noted in left ovary on ct scan) vs yolk sac (given elevated afp) vs lymphoma vs hepatoma (has active hep b) vs osteosarcoma vs breast. a breast exam was performed and the patient was found to have fibrocystic breasts but no fixed masses or lumps, and no discharge from either breast. the patient was seen by neurosurgery who felt the sacral lesion was inoperable. there was concern for cord compression but the patient's neuro exam was carefully monitored and remained stable (patient continued to have urinary incontinence and unchanged slight lower extremity weakness ( lle but normal strength 4/5 rle)). the patient may require pelvic reconstruction in the future. heme/onc also followed the patient and recommended starting steroids for concern of cord compression. the patient was seen by radiation oncology and was simulated for xrt but not treated as her neuro exam remained stable. her pain remained under adequate control with prn oxycodone. upon discharge, pathology results were still pending. the patient will be followed up by her primary care doctor and an outpatient oncology appointment will be scheduled for her by the oncology consult service pending results of her pathology to initiate treatment. . # pe/ivc clot: the patient was switched from a heparin gtt to lovenox after it was difficult to get the patient therapeutic on a heparin gtt. she remained hemodynamically stable and was on ra. there was no evidence of rv collapse on tte. she is s/p ivc filter placement by rij approach . the patient had a repeat ct scan during her hospital course to reevaluate her ivc filter and her ivc clot. the ivc clot was found to be distal to the ivc filter. upon discharge, she was started on a lovenox bridge to coumadin. she will be followed up by her pcp for an inr check on the day after discharge. . #hepatitis b: the patient was found to have labs consistent with chronic hepatitis b. her lfts showed a mildly elevated ast (45), elevated ggt, and elevated ap (400) c/w metastatic bone and liver dx. bilirubin was normal and the patient showed no evidence of acute cholestasis during this admission. . # elevated platelet count: patient was admitted with extreme thrombocytosis given prior values >1000. her platlet could was thought to be most likely reactive thrombocytosis malignancy. her platlet count trended down to 700s-800s. . # ?uti: patient was found to have a mildly positive ua, and urine cx with burkholderia cepacia. she was treated with 3 days of bactrim. . # low hct: there are no prior hct for a baseline hct. fe studies are most c/w aocd. haptoglobin is not depressed. her hematocrit remained stable. . # fen: regular diet . medications on admission: oxycodone discharge medications: 1. oxycodone 5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*20 tablet(s)* refills:*0* 2. dexamethasone 4 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*60 tablet(s)* refills:*1* 3. enoxaparin 40 mg/0.4 ml syringe sig: 40 mg subcutaneous q12h (every 12 hours): please continue lovenox until your inr is between 2.0-3.0. you will need to see your primary care doctor for inr checks (see appointments). disp:*14 * refills:*0* 4. warfarin 5 mg tablet sig: one (1) tablet po hs (at bedtime): please get your inr checked on at your primary care doctor's office. disp:*30 tablet(s)* refills:*0* 5. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* discharge disposition: home discharge diagnosis: . primary: 1) widely metastatic disease (sacral mass, pulmonary nodules, masses in liver) 2) pulmonary emboli - severe 3) dermoid cyst in left ovary 4) microcytic anemia 5) thrombocytosis 6) pseudomonal uti . secondary: 1) chronic hbv infection . discharge condition: good discharge instructions: . 1- please take all medications as prescribed. you were started on the following new medications: - lovenox injections and coumadin to protect you from further clots. you will see your primary care doctor , , for an inr check. if you inr is between 2.0-3.0, you may stop the lovenox injections and continue only the coumadin. - dexamethasone for possible cord compression from the tumor in your sacrum - oxycodone as needed for back pain. . 2- please seek medical attention immediately if you experience worsening lower extremity weakness, decreased sensation in your lower extremities, decreased ability to walk, or inability to have a bowel movement or urinate. . followup instructions: . please followup with your primary care doctor, dr. . you will need to see your primary care doctor , at 2pm at clinic. you will need to have your inr checked during that visit on . . is located at: . , phone: . you will be contact by the oncology department for a followup visit. if you do not hear from them within 2 weeks, please contact ms. at or call the hospital at and have the heme/onc fellow, dr. , page . . procedure: venous catheterization, not elsewhere classified interruption of the vena cava closed (percutaneous) [needle] biopsy of liver biopsy of bone, other bones diagnoses: anemia, unspecified malignant neoplasm of liver, secondary urinary tract infection, site not specified secondary malignant neoplasm of lung other malignant neoplasm without specification of site chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta other pulmonary embolism and infarction secondary malignant neoplasm of bone and bone marrow pseudomonas infection in conditions classified elsewhere and of unspecified site other venous embolism and thrombosis of inferior vena cava benign neoplasm of ovary essential thrombocythemia 

Answer: The patient is high likely exposed to