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: naprosyn attending: chief complaint: lower extremity weakness major surgical or invasive procedure: paracentesis history of present illness: ms. is a 69 year old woman with metastatic hcc who was transferred from ed to with slowly progressive weakness. she was found to have acute renal failure and hyponatremia. she was transferred to the icu for hypotension in the ed. she has failed several chemotherapy trials and is currently on avastin/erlotinib (although obtaining erlotinib has been problem due to insurance issues). she has known metastatic disease throughout the chest, abdomen and pelvis with extensive adenopathy and pulmonary metastases. she has significant ascites, last para was 2 weeks ago. the patient reports feeling progressively more weak, particularly in her legs for the past several weeks. she started off using a cane, then walker, and now is even having trouble with that. initially she thought her arm strength was normal, then thought that she was having some trouble with her handwriting. she denies incontinence of urine or stool. her appetite has been poor and she has been hopeful to try an appetite stimulant. she has felt queasy on occasion but no persistent nausea and no emesis. no diarrhea. she reports a "tickle" cough for the past couple of days but no fever, chills, sweats, or sputum production. . in the ed her vs were t 97.4 bp 113/69 hr 97 rr 18 o2 100% on 2l. she had back pain (chronic) and was given 4mg iv morphine and sbp dropped to high 80s. she was given a total of 3l of ivfs which maintained sbps in 90s-100s. given concern for possible pneumonia, she received levaquin 750mg iv, and cefepime 2g iv x 1. past medical history: oncologic history: - this 69-year-old female was initially diagnosed with hepatocellular carcinoma in 09/. at that time, she had pain in her right upper quadrant and underwent an ultrasound to evaluate for potential gallstones. the ultrasound showed a mass. she went on to have a ct scan, which also showed a very suspicious looking mass concerning for hcc. she had an afp of 112,000. - she was started on sorafenib, which she was on from until 05/. - she had progression by afp and imaging and was changed over to a clinical trial on rad001 in 06/. - she continued on rad001 for some time; however, developed a rising afp and worsening disease on ct scan on and was taken off of the study. - she was started on trial 08-243 on of gc33. she had a ct scan which showed progressive disease so she was taken off of the trial. - she was started on avastin and tarceva. . past medical history: 1. nonalcoholic steatohepatitis (nash) with subsequent cirrhosis. 2. type 2 diabetes for 16 years. 3. status post total right hip replacement in . 4. status post total knee replacement in . 5. status post d&c in . 6. hypertension. 7. hidradenitis of the labia. 8. arthritis. social history: married with 4 children. worked as a bookkeeper for . no alcohol. quit cigarette smoking 39 years ago. 15 pack year history. family history: not contributory physical exam: -- on admission -- vitals: t 96.6 hr 98 bp 108/59 rr 16 o2 97% on 3l general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: distant breath sounds. no wheezes or crackles cv: regular rate and rhythm, normal s1 + s2, 3/6 sem > rusb, no rubs, gallops abdomen: distended but soft, nontender, no guarding or rebound tenderness, normoactive bs gu: + foley ext: warm, well perfused, 2+ pulses, no clubbing, trace pedal edema. neuro: a+ox3, cnii-xii intact, strength in upper extrem , lower extrem: (r), 4-/5 (l), sensation intact throughout. pertinent results: 03:12am blood wbc-4.4 rbc-3.90* hgb-10.7* hct-32.9* mcv-85 mch-27.3 mchc-32.3 rdw-15.5 plt ct-161 12:39pm blood neuts-87.2* lymphs-6.6* monos-4.9 eos-0.9 baso-0.4 03:12am blood pt-13.6* ptt-27.6 inr(pt)-1.2* 12:39pm blood glucose-94 urean-49* creat-1.5* na-128* k-5.6* cl-93* hco3-22 angap-19 03:12am blood glucose-86 urean-43* creat-1.3* na-129* k-4.8 cl-99 hco3-17* angap-18 04:12pm blood glucose-77 urean-38* creat-1.2* na-134 k-4.3 cl-101 hco3-21* angap-16 12:39pm blood alt-27 ast-92* alkphos-171* totbili-0.7 12:39pm blood albumin-3.3* calcium-9.3 phos-4.2 mg-2.4 03:12am blood triglyc-115 04:49pm blood lactate-1.4 02:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-15 bilirub-neg urobiln-neg ph-5.0 leuks-neg 02:00pm urine hours-random creat-116 na-less than 02:00pm urine osmolal-515 03:46pm ascites wbc-367* rbc-8250* polys-pnd lymphs-pnd monos-pnd 03:46pm ascites totpro-2.1 creat-1.1 ld(ldh)-75 amylase-22 albumin-1.4 triglyc-275 08:06am blood wbc-8.9 rbc-4.56 hgb-12.6 hct-38.3 mcv-84 mch-27.7 mchc-33.0 rdw-15.6* plt ct-137* 07:55am blood glucose-207* urean-38* creat-1.0 na-129* k-5.4* cl-97 hco3-25 angap-12 03:10pm blood creat-0.9 na-129* k-5.9* cl-98 08:06am blood glucose-222* urean-62* creat-1.2* na-131* k-5.4* cl-97 hco3-21* angap-18 12:39pm blood alt-27 ast-92* alkphos-171* totbili-0.7 08:06am blood alt-43* ast-67* ld(ldh)-221 alkphos-166* totbili-0.8 08:06am blood calcium-9.9 phos-4.4 mg-2.2 03:46pm ascites wbc-367* rbc-8250* polys-12* lymphs-63* monos-9* macroph-16* 03:46pm ascites totpro-2.1 creat-1.1 ld(ldh)-75 amylase-22 albumin-1.4 triglyc-275 . microbiology blood cultures negative ascites fluid negative . imaging lle u/s no evidence of left lower extremity dvt. . cxr: 1. bilateral right greater than left pleural effusions, essentially unchanged in cross-modality comparison to the ct from . 2. opacity at the right lung base likely represent atelectasis, however, early pneumonic infiltrate cannot be ruled out. . ascites fluid negative for malignant cells. . impression: small acute infarcts as described above. left parietal 1.5cm lesion suspicious for metastasis. gadolinium enhanced study recoomeded . mr impression: 1. technically limited study. no intravenous contrast given, precluding evaluation for leptomeningeal metastatic disease. 2. no obvious change in extensive multilevel spondylosis. severe spinal canal stenosis with compression of the cauda equina at l2-3. moderate spinal canal stenosis at l1-2 and l3-4. . echo the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. significant aortic stenosis is present (not quantified). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: poor technical quality due to patient's body habitus. left ventricular function is probably normal, a focal wall motion abnormality cannot be fully excluded. the right ventricle is not well seen. there is probably mild aortic stenosis but the severity cannot be accurately determined. . cxr 1. decrease in bilateral pleural effusions with improved lung aeration bilaterally. no new opacities in the lung parenchyma. 2. stable bilateral hilar and mediastinal masses brief hospital course: ms. is a 69 year old woman with metastatic hepatocellular carcinoma. she was initially admitted to with hypotension, hyponatremia and acute renal failure. she was called out to the floor, but had progressive weakness from severe spinal stenosis, agitation, and respiratory difficulties. extensive family discussions were held regarding goals of care given extensive tumor involvement. she died . # arf - ms. presented with an acute elevation in cr (1.5 on arrival, ~1.0 at baseline). fena < 0.1%. given history of decreased po intake and physical exam, thought to be consistent with hypovolemia and prerenal failure. she was given ivf + albumin challenge to attempt to improve renal function, as well as rule-out/treat hrs. she showed improvement by discharge from the icu to the floor. on the floor, she was given another challenge of albumin and her creatinine normalized. her creatinine again worsened when she had severely decreased po intake. she was given several boluses of normal saline. # weakness - ms. initially had some focal weakness in her lower extremities, left greater than right. this was initially thought to be secondary to a metabolic processes. after stabilization of those processes the patient was called out to the floor. on the floor, initial exam showed marked weakness. neurology was consulted and an mri of the spine was attempted, which was complicated by the patient`s inability to lay flat. scout films that were obtained were able to demonstrate severe spinal stenosis but no evidence of malignancy causing cord compression. the patient was started on decadron 4mg q6h. she was not a surgical candidate. she was continued on decadron, but her weakness progressed. # hyponatremia - ms. has chronic hyponatremia in low 130s and presented with a sodium of 128. this improved with fluid and albumin challenges and was likely hypervolemic hyponatremia secondary to the patient`s known cirrhosis and nash. . # hypotension - resolved after initial fluid challenge in the icu. likely in the setting of receiving morphine. . # cirrhosis - liver enzymes at baseline on admission. on review of old medical records, patient noted to have 2 cords of grade 1 varices. significant ascites with recent, rapid accumulation. no history of encephalopathy. given symptoms and patient presentation, patient was tapped in the icu for 3l to rule out sbp, as well as provide some comfort from symptoms. volume on initial tap was limited given possibility of sbp as well as ongoing arf. ascites labs were consistent with a portal hypertensive etiology. of note, triglycerides were elevated in the ascitic fluid, consistent with chylous ascites; this is strongly associated with malignancy, consistent with patient's h/o hcc. . # hcc: ms. and her family had extensive discussions about treatment for her hcc. her disease had progressed to include new met to the brain and significant disease burden in the mediastinum and lungs. she and her family met extensively with the primary oncology team to discuss the rapid decline and the role of cancer directed therapy. further chemotherapy was not considered to be beneficial given her overall rapid decline and poor performance status. . # hypoxia: ms. developed a new oxygen requirement of 4 l while in the hospital. she was initially started on antibiotics for concern of pneumonia. however, these were eventually stopped when there was no evidence to suggest pneumonia. her oxygen requirement was thought related to her extensive disease. . # goals of care: palliative care, chaplains, and the primary team had extensive conversations with ms. and her family regarding her goals of care. on admission, she was a full code. however, as her prognosis worsened, her code status was changed to dnr/dni. she developed significant agitation and pain. as her status declined, the treatment focus changed to maximize comfort measures. her pain regimen was changed to include iv morphine. she was initially given ativan for anxiety, but became more agitated. she had a good response to zyprexa. her family was at her bedside when she died. medications on admission: avastin fentanyl 25 mcg/hour patch q72h + fentanyl 100 mcg/hr patch q72h metformin 500 mg po bid omeprazole 40 mg po bid oxycodone 5 mg tabs, 1-2 tabs q3-4h prn pravastatin 80 mg daily vitamin c - not taking ca-vit d - not taking colace iron - not taking mvi om3fa - not taking discharge medications: none discharge disposition: expired discharge diagnosis: primary diagnosis 1. hepatocellular carcinoma 2. spinal stenosis 3. cauda equina compression 4. cirrhosis 5. acute renal failure discharge condition: expired discharge instructions: expired followup instructions: expired procedure: percutaneous abdominal drainage diagnoses: hyperpotassemia other iatrogenic hypotension unspecified essential hypertension cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hepatorenal syndrome hyposmolality and/or hyponatremia portal hypertension other opiates and related narcotics causing adverse effects in therapeutic use secondary malignant neoplasm of brain and spinal cord other ascites malignant neoplasm of liver, primary secondary malignant neoplasm of lung cerebral artery occlusion, unspecified with cerebral infarction secondary and unspecified malignant neoplasm of intrathoracic lymph nodes lumbosacral spondylosis without myelopathy cauda equina syndrome without mention of neurogenic bladder 

Answer: The patient is high likely exposed to