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: confusion, dysphasia/dysarthria, bradyphrenia major surgical or invasive procedure: wxrt history of present illness: 79y russian speaking woman w/ atypical carcinoid tumor, metastatic to liver and hylum c/o of headache for over 48 h (started in the occipital region, spreading to frontal area). per patient while having her dinner on she became drowsy. she then developed imbalance c/o of left arm pain. mrs did not complain of nausea or diplopia associated with her headache but was noted to be dysarthric. however, she did complain of "vertigo." and symptoms consistent with tinnitus. this was a sudden change. she was brought to hospital. hospital course obtained from fellow's note: "evaluation at revealed a left thalamic hemorrhagic infarct, and the patient was transferred to the nsicu for further management. she was given 1g of dilantin and 10mg of decadron prior to transfer to . on arrival here, her neurologic symptoms had resolved with the exception of an inability to ambulate, which the patient attributes to generalized weakness and exhaustion rather than to a focal weakness of the lower extremities. she is transferred to the omed service for initiation of whole brain radiation therapy" as of today (), patient has received two radiation treatments which she has tolerated well. she appears in no acute distress with stable vital signs. pt denies fevers, chills, ha, diplopia, dysarthria, dysphagia, localized weakness, paresthesias or tremors. her major c/o has been constipation (no bm x 5 days) and generalized weakness. she denies wt loss, sweats, sob, cp, pnd, abdominal pain, n/v, cough, hematemesis, diarrhea, melena, brbpr. the remainder of the review of systems is negative in detail. . onc hx. - per fellow note: "the patient was diagnosed with atypical carcinoid tumor in late when a hepatic mass was identified, with fna showing low-grade neuro-endocrine carcinoma. she underwent a right middle lobe wedge resection of a lung mass on , with pathology revealing a 2cm atypical carcinoid tumor with satellite lesions. in , a ct showed disease progression with an enlarging right upper lobe mass, a stable right hilar mass, and a liver mass that had increased in size. the patient was treated with carboplatin/etoposide followed by four cycles of pemetrexed with evidence of further disease progression. her most recent ct scan on demonstrated a small increase in the size of her right lung mass with an increase in both the size and number of her hepatic metastases. she is now considering treatment with rad-001 plus a novel on a clinical trial which is expected to open this summer. in the meantime, she is taking temozolomide 250mg, with an initial 5-day course given from . follow-up with dr. is planned for ." past medical history: 1. glaucoma affecting b/l 2. hypertension hx 3. hypothyroidism (synthroid stopped by her oncologist). 4. inflammation of the arachnoid at 20 yo (direct translation) social history: lives with daughter in . was independent in adls prior to admission. distant history of tobacco use, occasional etoh use, no illicit drugs. family history: noncontributory physical exam: pe examination on admission: temperature 97.6 f, hr 84 bpm, bp 111/56, saturating 96% on room air, respiratory rate 14 neurological examination cranial nerves i and viii not formally tested ii: peripheral vision constricted bilaterally, presumed to be due to her glaucoma. optic discs were pale and large bilaterally. pearl in tact. iii, iv, vi: normal eye movements va, b, c : no sensory deficits noted. ix, x: good palatal movements and a strong cough : power in both the sternocleidomastoid and trapezius muscles xii: no tongue deviation. upper and lower limb examinations demonstrated normal tone, power and reflxes, apart from the l2,3 group where power was reduced to bilaterally. no fasciulations were noted, no clonus was observed. gait was not formally assessed. cerebellar signs were negative. however, proprioception appeared to be reduced on the prominences of her hallux bilaterally. pinprick sensation appeared to be reduced in her right leg, her trunk was not assessed, but the sensation in her arms were in tact. cardiovascular system: heart sounds were normal, jvd was not elevated, +1 edema up to her ankles bilaterally respiratory: poor air entry in the right upper zone anteriorly, otherwise lungs were clear. abdomen: palpable tender liver edge, otherwise soft abdomen with normal bowel sounds. pe on omed transfer (): vs t99.9 p94 bp112/75 r18 95%o2 sat on ra gen-nad, amiable russian speaking woman heent-no ,mmm, no icterus, clear conjunctiva neck-no , full rom cor-s1s2 nl, no g/m/r, rrr pulm-cta bl, decreased snds at r base abd-soft, nt, nd, no organomegaly extrem-no edema, chronic venous statis changes in le, lue antecubital fossa w/ erythematous, macular rash 6x8cm w/ satellite lesions, purulent discharge from site of venipuncuture skin- see above neuro: perrl, iii - xii intact, viii not formally tested, strength 5/5 throughout, sensation intact throughout except medial right leg between ankle and mcl, ftn, hts intact, babinski negative. romberg, gate not assessed due patient weakness. dtrs 2+ . pertinent results: labss on admission and transfer from icu to omed service: 02:45am blood wbc-3.6* rbc-4.22 hgb-13.2 hct-38.8 mcv-92 mch-31.3 mchc-34.0 rdw-13.8 plt ct-232 04:49am blood wbc-6.7# rbc-4.09* hgb-12.7 hct-37.8 mcv-93 mch-31.2 mchc-33.7 rdw-14.2 plt ct-232 02:45am blood neuts-79.6* lymphs-17.6* monos-1.6* eos-0.7 baso-0.4 07:30am blood neuts-86.0* bands-0 lymphs-8.8* monos-4.1 eos-0.9 baso-0.1 02:45am blood pt-13.0 ptt-30.0 inr(pt)-1.1 02:45am blood glucose-167* urean-10 creat-0.8 na-144 k-3.9 cl-109* hco3-26 angap-13 04:49am blood glucose-104 urean-16 creat-0.7 na-143 k-4.1 cl-109* hco3-25 angap-13 07:30am blood glucose-101 urean-14 creat-0.7 na-136 k-3.6 cl-101 hco3-26 angap-13 02:45am blood ck(cpk)-142* 10:30pm blood ck(cpk)-81 03:15pm blood ctropnt-<0.01 10:30pm blood ck-mb-2 ctropnt-<0.01 07:08am blood ck-mb-2 ctropnt-<0.01 07:15am blood ck-mb-2 ctropnt-<0.01 04:49am blood calcium-9.9 phos-3.4 mg-2.1 07:30am blood calcium-9.7 phos-3.0 mg-2.0 imaging: mri : findings: on t1-weighted sequences without contrast there is evidence of multiple hemorrhagic lesions involving both frontal lobes, the largest lesion is located on the left thalamic area measuring approximately 1.5 x 2.1 cm in size in the sagittal projection x 2.2 x 2.0 cm in the axial view. there is no evidence of hydrocephalus, this lesion is protruding partially to the left side of the third ventricle. magnetic susceptibility is demonstrated in these lesions related with hemorrhagic changes. on flair, no significant vasogenic edema is demonstrated. after the administration of gadolinium contrast punctate lesions are also visualized suggesting metastatic infiltration (image #18 series #12). a punctate focus of magnetic susceptibility is noted on the right cerebellar hemisphere (image #6 series #9), mild restricted diffusion is demonstrated surrounding these lesions, there is no evidence of acute ischemic events. normal flow void signal is identified in the major vascular structures. the orbits, the paranasal sinuses and the mastoid air cells appear unremarkable. impression: multiple hemorrhagic brain lesions most of them located supratentorially in both cerebral hemispheres and left thalamic region as described above, given the history of lung cancer the differential include metastatic hemorrhagic lesions. some of these lesions demonstrate magnetic susceptibility including a small focus of low signal on the right cerebellar hemisphere as described above. there is no evidence of hydrocephalus. ct - impression: large hemorrhage within the left thalamus with concern for noncommunicating hydrocephalus. subtle hypoattenuation surrounding the lateral ventricles may reflect transependymal egress of cerebrospinal fluid. note added at attending review: there are other lesions, with surrounding edema in the right frontal lobe (series 2, image 26), and left frontal lobe (series 2, images 21 and 22). these findings are most suspicious for metastatic disease. recommend mr with contrast if these are not known lesions. us ue - impression: superficial thrombus within the left cephalic vein limited to the antecubital fossa consistent with either a partial acute thrombus or partially recanalized chonic thrombus. the left basilic vein was not identified. cxr - impression: no evidence of acute cardiopulmonary process. right infrahilar opacity consistent with lymphadenopathy demonstrated on the outside chest cts as well as the area of prior lung resection/biopsy. this area might represent neoplastic involvment and should be further evaluated if this was not obtained previously. labs at discharge: 05:15am blood wbc-4.6 rbc-3.69* hgb-11.3* hct-33.3* mcv-90 mch-30.7 mchc-34.0 rdw-12.6 plt ct-289 06:50am blood wbc-4.2 rbc-3.57* hgb-11.4* hct-32.6* mcv-91 mch-31.9 mchc-35.0 rdw-12.5 plt ct-240 06:35am blood wbc-4.2 rbc-3.58* hgb-11.3* hct-32.3* mcv-90 mch-31.5 mchc-34.9 rdw-12.5 plt ct-248 06:20am blood wbc-4.0 rbc-3.64* hgb-11.6* hct-32.9* mcv-90 mch-31.9 mchc-35.3* rdw-12.5 plt ct-221 05:15am blood glucose-106* urean-9 creat-0.7 na-144 k-3.7 cl-109* hco3-27 angap-12 06:50am blood glucose-102 urean-9 creat-0.7 na-143 k-3.7 cl-108 hco3-26 angap-13 06:35am blood glucose-98 urean-8 creat-0.7 na-144 k-3.6 cl-109* hco3-26 angap-13 06:20am blood glucose-101 urean-9 creat-0.7 na-142 k-3.9 cl-108 hco3-27 angap-11 06:50am blood calcium-9.8 phos-3.7 mg-2.1 06:35am blood calcium-9.6 phos-3.5 mg-2.0 06:20am blood calcium-9.7 phos-3.8 mg-2.0 brief hospital course: 79 yo woman with metastatic atypical carcinoid tumor for which she is treated at dfcc, now presenting with multiple hemorragic brain lesions including a left sided thalamic hemorrhage. patient transferred from icu to omed service on (see hpi for summary of icu care). . #) brain metastases, multiple. there was no evidence of elevated intracranial pressure on exam or hx throughout the admission. the neurologic exam appeared to have returned to baseline. patient underwent wxrt (finished 7 of 10 doses), last tx was is due on friday . the care of patient was discussed with primary oncologist, dr. with whom pt has appt on . patient is to start a steroid taper after completion of xrt per dr. . pt. may resume temozolomide after xrt, but this was deferred to the primary oncologist. there were no changes in the neurologic exam from at discharge. #) l antecubital fossa rash. hospital stay was complicated by l antecubital fossa cellulitis, likely allergic reaction at onset, now cellulitis/thrombophlebitis puncture wound. this was noted on . patient was started on clindamycin po x 3 days with progression of erythema and edema (12 x 18 cm erythematous/edematous area). an u/s showed no loculation or fluid collection, just superficial thrombophlebitis. on patient was started on vancomycin iv 1g q12 hours for mrsa coverage, which was decreased to 750mg q12 due to elevated trough. clindamycin was discontinued. erythema and edema continued to progress, repeat u/s showed no change. by however, progression of erythema and edema was arrested. by the cellulitis nearly resolved. patient remained afebrile throughout the hospitalization and on discharge only minor erythema remained at site of thrombophlebitis. vanco was d/ced on and patient was discharged home on doxycycline 100mg po bid for 5 days. bcx were negative. . #) constipation - patient had bms eod on the following regimen: lactulose, senna, docusate, bisacodyl, miralax. she was discharged home with this regimen. . #) bp control - blood pressure was maintained at 110 to 150 sbp. patient required 1 l of ns on 2 separate occasions to maintain goal sbp 120 - 160. . # lll crackles - noted on exam on . most likely atelectasis, as patient w/o fever, cough, or sob, thus less likely pna. cxr - no evidence of pulm edema, consolidation, effusion. resolved by with spirometry. . #) weakness - likely proximal myopathy of unknown etiology. pt. w/ hitory of hypothyroidism, but pt. is subclinically hyperthyroid (tsh < 0.02). a myopathy work up was initiated: anti-ro, anti-la, ldh, aldolase, a pth, a vitamin d, an anti-sm, anti-rnp as well as anca were obtained. also hepatitis b and hepatitis c. patient's physical function improved over hospital stay. she was able to ambulate independently. per pt reports - patient will benefit from home pt 3-4times per week for balance and daily tasks, she was cleared for home. patient will f/u as outpatient w/ neuro-oncology as above. . #) social situation - pt's insurance does not cover any home serices or rehab. have applied for insurance upgrade, however this will take over 1mo. patient has been cleared to go home w/o services by pt. case manager will continue to work on the case. . #) glaucoma - continued home treatments, no symptoms. . #) code status: full patient was discharged home in a hemodynamically stable condition with balance and ambulation at home. she has appropriate follow up. medications on admission: xalatan alphagan cosopt discharge medications: 1. latanoprost 0.005 % drops sig: one (1) drop ophthalmic (2 times a day). 2. brimonidine 0.15 % drops sig: one (1) drop ophthalmic (2 times a day). 3. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*2* 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 6. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. disp:*2 bottles* refills:*2* 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*60 capsule(s)* refills:*2* 8. prednisone 10 mg tablet sig: as directed tablet po once a day for 25 days: start day after completion of radiation. take 4 tabs x 5 days, 3 tabs x 5 days, 2 tabs x 5 days, 1 tab x 5 days, tab x 5 days then stop. . disp:*53 tablet(s)* refills:*0* 9. doxycycline hyclate 100 mg tablet sig: one (1) tablet po twice a day for 5 days. disp:*10 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: atypical carcinoid with metastases, now to the brain hypothyroidism glaucoma history of hypertension discharge condition: stable discharge instructions: you were admitted to for treatment of a bleeding stroke on the left side of your brain that is most likely due to the metastases of your lung cancer to the brain. you were treated in the intensive care unit at , where you were evaluated by neurosurgery and radiation oncology doctors for further treatment. it was felt that best treatment for you would include whole brain radiation for ten cycles. while in the hospital you received seven of those treatments. you have tolerated those treatments well without any adverse effects, except for transient headaches. your stay at the hospital was complicated by an infection and superficial phlebitis (inflammation of the veins) in your left forearm. you did not have a blood clot inside deep inside your arm (deep vein thrombosis). you were treated with antibiotics (intravenous vancomycin) for seven days. your infection improved significantly and rash resolved. you are being discharged home on additional antibiotic (doxycyline) which you should take as directed (please see below) for the next five days. while you were in the hospital, you were seen by a neuro-oncologist (brain cancer doctor). you were diagnosed with a myopathy (a disease of the muscle). the source of this is unclear at the time of discharge. an appointment with neuro-oncology was arranged for you (please see below). functionally, your mobility improved and you were able to walk on your own. in addition, as you complete your last radiation treatment on friday, , you should promptly start taking a regimen of steroid medication prescribed to you at discharge (prednisone, see below for detailed instructions). should you experience any new pain, confusion, difficulties with balance, weakness, numbness, tingling, double vision, severe headache, chest pain, shortness of breath, leg swelling/pain or any other symptom concerning to you, please contact your primary care provider or go to the nearest emergency room. you were discharged home in stable condition. it is strongly recommended that you should complete your radiation treatments and follow up with your primary oncologist, dr. . followup instructions: please follow up with your primary oncologist, dr. on for your regular appointment. please call ( to confirm your appointment or should you have any questions. please follow up for completion of your radiation therapy. your next treatment is , at clinic. please follow up with dr. , a neuro-oncologist. an appointment will be made for you and you will be contact directly. please call to confirm your appointment or if you have any questions. (. md procedure: other radiotherapeutic procedure diagnoses: malignant neoplasm of liver, secondary unspecified essential hypertension unspecified acquired hypothyroidism intracerebral hemorrhage pulmonary collapse secondary malignant neoplasm of brain and spinal cord cellulitis and abscess of upper arm and forearm malignant neoplasm of other parts of bronchus or lung other vascular complications of medical care, not elsewhere classified phlebitis and thrombophlebitis of superficial veins of upper extremities myopathy, unspecified 

Answer: The patient is high likely exposed to