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 attending: chief complaint: s/p unwitnessed fall; transferred from for eval of intracranial hemorrhage and non-st elevation mi major surgical or invasive procedure: - placement and removal of right internal jugular central venous catheter - placement and removal of right femoral central venous catheter - placement of left femoral central venous catheter ivc filter placement bronchoscopy, transbronchial biopsy, bronchoalveolar lavage and brushing stereotactic ct guided brain biopsy ultrasound-guided liver biopsy history of present illness: 68f with htn, copd, etoh abuse, and question of lung ca presented to hospital on , one day after having fallen in the setting of etoh use. . the fall occurred on . pt cannot give much history surrounding the fall but mentions that she was walking towards a chair when she fell. pt denies chest pressure or chest pain, shortness of breath, or palpitations. denies hitting her head. the morning after the fall () pt's daughter called pt, noted that pt seemed confused, with slurred speech, and brought pt to the ed at hospital. in the ed at hospital, pt complained of headache, mild right shoulder pain, and blurry vision. her exam was significant for a left frontal echymosis and some swelling around her left orbit. pt was alert and oriented x 3, with no focal neurologic deficits. laboratory studies were notable for wbc 12.3, plt 644, na 129, troponin 5.1, ck 3319. a head ct revealed right parietal intraparenchymal hemorrhage. . pt was transferred to for further workup. in the , pt was febrile to 103 with bp 89/57. pt was noted to be disoriented and inattentive. finger-to-nose was unstable, l>r. pt received tylenol 1300mg, vancomycin 1g ivx1, levofloxacin 500mg ivx1, flagyl 500mg ivx1, norepinephrine, and dexamethasone. due to hypotension to 79/palp, code sepsis called and pt was started on levophed. a subclavian line was placed but needed to be pulled location of tip of catheter. a r fem line was placed and subsequently was pulled out by pt; a l fem line was placed for access. . does not have any pain now, does not feel thirsty. pt denies recent fevers at home, denies dysuria, cough, abdominal pain, or changes in bowel movements. past medical history: etoh abuse htn r lung mass, possibly malignant, with "spot" in liver - pt due for bx and staging copd anxiety social history: lives alone, has someone help with vacuuming and washing the floors. used to smoke about 1/2ppd x most of her life - > 45 years, quit 3-4 years ago. states that she drinks 3-4 beers/day but family members have suggested more. pt denies having had shakes withdrawal or having h/o seizures. family history: noncontributory physical exam: vs: 97.9 101/67 98 21 99% 4l nc gen: disheveled appearing, slurring speech, nad; c collar in place heent: dentition poor, mm dry neck: could not assess jvp 2/2 c collar in place cv: mildly tachycardic, regular, nl s1/s2, no m/r/g pulm: ctab anteriorly abd: soft, nt/nd, +bs, no masses ext: no c/c/e neuro: cn ii-xii intact; strength 4+/5 bilaterally, sensation intact to light touch, hyperreflexic in patellar and biceps reflexes; toes neither up nor downgoing bilaterally; has difficulty following commands; oriented to person, hospital in , not to year (says ) pertinent results: ct head: hemorrhagic foci in l cerebellum and r frontal lobes with surrounding vasogenic edema, concerning for metastatic foci . ct c spine: no acute fracture . micro: blcx x 2 negative . ekg: 115bpm, nsr, nl axis, no st/t wave changes . bronchial washings, : negative for malignant cells. pulmonary macrophages and rare bronchial cells. . cxr, : no evidence of pneumothorax status post transbronchial biopsy. 2. hazy increased opacity throughout the right upper lobe could be suggestive of a postobstructive process, likely secondary to right hilar adenopathy, better appreciated on recent ct. 3. rounded nodular opacity in the medial right upper lobe correlates with mass seen on recent ct. . echo : the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50%) secondary to hypokinesis of the basal half of the inferior and posterior (inferolateral) walls. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valveleaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. suboptimal image quality -patient unable to cooperate. impression: inferior posterior hypokinesis . ct chest/abdomen/pelvis, : 1. right upper lung nodule concerning for lung carcinoma until proven otherwise. 2. partially occlusive intraluminal filling defects inferiorly from the right upper lobe nodule as well as separate left lower lobe fourth order branch filling defect is better visualized on cta of , but likely still present. 3. 5.4 x 4.0 x 5.0 cm heterogeneously enhancing liver mass as described. the appearance is more suggestive of a metastatic lesion than primary hepatocellular carcinoma or benign lesion. 4. multiple hypoattenuating lesions in both kidneys too small to characterize. 5. stable bilateral small pleural effusions with compressive atelectasis. 6. atrophic spleen with multiple punctate calcifications indicating prior granulomatous disease. 7. diverticulosis without evidence of diverticulitis. 8. ivc filter. . stereotactic brain biopsy, +6 mm (smear #15 only): reactive brain, numerous cells with small, pyknotic nucleus and red cytoplasm, and single, microscopic, poorly-preserved fragment of atypical cells, suggestive of metastatic carcinoma. note: the only tissue suggestive of metastatic carcinoma is a single tiny cluster of poorly preserved cells in the final smear. that tissue contains nuclei tightly clustered together and partially molded around each other. the remaining tissue is either air dried, necrotic and partially mineralized, or contains blood with frequent nucleated red blood cells. the latter cells are the predominant preserved cell in the deeper biopsies. nucleated red blood cells are abnormal and make the diagnosis of carcinoma suspect, especially given to poor preservation of the small cluster of suggestive cells. given that this patient has a small, calcified spleen, other diagnoses aside from carcinoma should be considered (e.g. granulomatous disease, extramedullary hematopoiesis, bone marrow emboli, chronic infections). the current material alone should not be the basis of treatment for metastatic carcinoma. confirmation of carcinoma elsewhere should be sought (e.g. reviewing outside pathology, additional biopsies of suspect sites). a bone marrow biopsy to determine the cause of the nucleated red cells may be warranted. . liver biopsy: positive for malignant cells, consistent with metastatic small cell carcinoma. . 09:25pm wbc-13.2* rbc-4.01* hgb-12.9 hct-36.6 mcv-91 mch-32.2* mchc-35.3* rdw-13.2 09:25pm neuts-87.5* bands-0 lymphs-8.3* monos-3.5 eos-0.6 basos-0.1 09:25pm ck-mb-28* mb indx-1.1 09:25pm ctropnt-0.45* 09:25pm lipase-28 09:25pm alt(sgpt)-43* ast(sgot)-111* ck(cpk)-2519* alk phos-59 amylase-33 tot bili-0.4 09:25pm alt(sgpt)-43* ast(sgot)-111* ck(cpk)-2519* alk phos-59 amylase-33 tot bili-0.4 09:25pm glucose-145* urea n-16 creat-0.6 sodium-129* potassium-4.0 chloride-93* total co2-20* anion gap-20 09:46pm lactate-1.8 03:40am ctropnt-0.24* 03:40am ck(cpk)-* 03:40am ck-mb-21* mb indx-1.1 07:57am ck-mb-18* mb indx-1.2 ctropnt-0.18* 07:57am ck(cpk)-1517* brief hospital course: ms. is a 68 year old female with a history of alcohol dependence who was admitted to an osh after a fall in the setting of alcohol intoxication. she was found to have an intracranial hemorrhage and was transferred to micu for further management. during this admission, she was found to have a lung nodule, liver nodule and several brain nodules. she was also found to have multiple pulmonary emboli. . # intracranial hemorrhage/lesions: the patient experienced a fall in the setting of alcohol intoxication. she was found to have an intracranial hemorrhage and multiple lesions on head imaging. despite also having a non-st segment elevation mi, aspirin was held to avoid further intracranial hemorrhage. she was started on dilantin for seizure prophylaxis and it was titrated according to serum levels with adjustment for a low albumin. the patient was also started on dexamethasone for reduction of brain edema per neurology and neurosurgery recommendations. the patient was also seen by by neuro-oncology and radiation oncology. sterotactic brain biopsy was performed which demonstrated metastatic poorly differentiated carcinoma, histologically similar to the tumor in the patient's subsequent liver biopsy. the patient's case was discussed at a tumor conference and it was agreed that she should receive outpatient whole brain xrt. radiation oncology follow up is scheduled with dr. at hospital (). oncology follow-up is scheduled with dr. in (). the patient will follow up with dr. should follow up with neuro-oncology at () one month after completion of whole brain irradiation. dexamethasone should be tapered by 25% per week after completion of whole brain radiation. . # metastatic small cell lung cancer: a lung nodule was identified on chest ct. a bronchoscopy was performed by interventional pulmonary in an attempt to gain tissue. however, the lesion was not proximal enough for biopsy. bronchial washings performed were negative for malignant cells. a ct chest/abdomen/pelvis revealed a large superficial lesion in the liver which was amenable to biopsy by ultrasound and demonstrated metastatic small cell carcinoma. . # pulmonary embolus: the patient was noted to be tachycardic to the 130's on the day after admission. differential included alcohol withdrawal versus pe. cta performed showied intraluminal filling defect arising inferiorly from the right upper lobe lung nodule with extension into a second-order right upper lobe pulmonary artery branch. additionally, fourth-order partially occlusive filling defects in the left lower lobe consistent with pe were found. no anticoagulation was initiated given the patient's ich. an ivc filter was placed. the patient's hr and o2 saturation were monitored closely during this hospitalization. she was found to be 95% on ra at rest, but did desaturate to 86% while ambulating with physical therapy. . # elevated troponin: the patient denies any chest pain during this episode or prior to this episode. her troponins were found to trend downward (0.45 -> 0.24 -> 0.18 in the setting of negative ck-mbs; ck was elevated most likely secondary to patient's fall and being immobilized for a period of time). it was unclear if the troponins were secondary to pe or nstemi. echocardiogram showed evidence of posterior inferior wall motion abnormalities, raising concern for possible nstemi. medical management with a beta-blocker and statin was initiated. heparin, aspirin and plavix were contraindicated in the setting of the intracranial hemorrhage. . # possible sepsis: the patient became hypotensive shortly after admission requiring levophed for a brief period. given fever and elevated wbc, aspiration pna resulting in possible sepsis was a concern. it was unclear if her oxygen requirement was at baseline given a history of copd. levophed was quickly weaned and the patient remained hemodynamically stable for the remainder of her hospitalization. broad coverage antibiotic therapy for pneumonia/sepsis was initiated and completed during her stay. . # copd: the patient had good air movement on admission without rales or wheezes. she was continued on albuterol and atrovent nebulizers as needed. . # etoh dependence: the patient was placed on the ciwa scale with ativan as needed upon admission to the micu. she was given a multivitamin, folate, and thiamine. she was seen by social work and expressed a desire to stop drinking. . # htn: metoprolol was briefly held when the patient was hemodynamically unstable. it was restarted and should be continued. nifedipine and enalapril were also discontinued, but may be restarted as indicated. medications on admission: enalapril nifedipine toprol albuterol (pt does not know doses) discharge disposition: extended care facility: rehabilitation and nursing center - discharge diagnosis: primary: 1. stage iv small cell lung cancer - metastasis to brain/liver 2. traumatic right parietal intraparenchymal hemmorhage 3. aspiration pneumonia - sepsis 4. pulmonary embolism s/p ivc filter placement 5. non-st elevation inferior myocardial infarction 6. steroid induced adrenal suppression 7. steroid induced diabetes mellitus 8. etoh abuse - withdrawal . secondary: 1. chronic obstructive pulmonary disease 2. hypertension 3. alcohol dependence discharge condition: stable. afebrile. ambulates with assistance. tolerating po. discharge instructions: you were admitted to the hospital because you experienced a fall. you were found to have small cell lung cancer that has spread to your liver and brain. there is was evidence of bleeding around the masses in your brain. you were also found to have blood clots in your lungs. please return to the emergency room or call your doctor if you experience any of the following symptoms: fever > 101.5, severe shortness of breath, headache not controlled with medication, intractable nausea or vomiting, severe pain or any other concerning symptoms. . you should not take any medications that contain aspirin or ibuprofen. please take all medications as prescribed. . please follow up with all appointments as scheduled. followup instructions: 1. dr. , radiation oncology, hospital. monday, at 2pm. . . 2. dr. , oncology, in . friday, at 2:30pm. . . 3. dr. , neuro-oncology, hospital. . dr. office should arrange for this appointment 1 month after you complete whole brain radiation. . 4. mri with and without contrast prior to your appointment with dr. . this study has been ordered at . you should call to make an appointment for the study to be done. . 5. please check albumin and dilantin level check every monday and thursday. prescription for labwork is included in paperwork. . 6. please check fingerstick blood glucose qid while on dexamethasone. cover with sliding scale as needed. . 7. cranial removal on . this may be done by rn or md. removal, keep wound dry. no dressing should be placed. . 8. please continue dexamethosone as prescribed. it should be decreased by 25% per week after completion of whole brain irradiation therapy. . 9. please follow up with your pcp within one month after discharge. you can make an appointment by calling . procedure: venous catheterization, not elsewhere classified interruption of the vena cava closed (percutaneous) [needle] biopsy of liver closed [endoscopic] biopsy of bronchus closed endoscopic biopsy of lung closed [percutaneous] [needle] biopsy of brain diagnoses: subendocardial infarction, initial episode of care malignant neoplasm of liver, secondary unspecified essential hypertension other specified disorders of pancreatic internal secretion adrenal cortical steroids causing adverse effects in therapeutic use unspecified septicemia chronic airway obstruction, not elsewhere classified other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness unspecified fall sepsis pneumonitis due to inhalation of food or vomitus secondary malignant neoplasm of brain and spinal cord malignant neoplasm of upper lobe, bronchus or lung other pulmonary embolism and infarction other and unspecified alcohol dependence, continuous alcohol withdrawal 

Answer: The patient is high likely exposed to