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: altered mental status major surgical or invasive procedure: lumbar puncture history of present illness: 30 yo woman with h/o metastatic ca with recent treatment with 6 cycles chemo and ams at home. nortryptiline recently switched to prozac. yesterday had sob/anxiety while at mall and this resolved at home. per husband, mom and dad felt nauseous overnight but awoke at 2am with vomiting/nausea. at 8:30 am she was sleeping and she opened her eyes for her husband but at 9:30 mom found her altered, repeating same word again and again. was on coumadin but this was discontinued on tuesday nose bleeds. takes immodium, 8 lomotil, tincture of opium, nortryptilene recently switched to prozac. valium at home. acute shortness of breath yesterday. gets dexamethasone for chemo. had 6th cycle of chemo recently. staffed with dr . patient will need an lp, mri of her brain w/wo contrast, eeg. need to discuss dispo of patient. acute encephalopathy with concerning features of increased tone in both legs, upgoing toes with couple of beats of clonus. . in the ed, initial vs were: t:97.1 hr:90 bp:111/69 rr:16 o2sat:100. she was awake but would only say "yuck" to everything. pupils were 8mm and reactive bilaterally. increased reflexes and clonus in bilateral lower extreities. head ct negative. cxr negative. labs notable for inr 1.5, hct 33 and stable. hypernatremic at 146 with lactate at 5.1. neuro was consulted and they recommended mri, lp, adn eeg. lp is pending - was done in er. patient was given 2 mg ativan, 10mg dex, 2gm ctx, 1gm vanc shortly before lp, and 4mg zofran. lfts and repeat lactate pending. since in ed has become a little less confused knows her name now. . recent vs: hr 62, bp 121/72, 16, 99ra. no seizure activity noted but another resident may have seen seizure activity in ed. past medical history: past medical history: 1. spontaneous familial polyposis syndrome (with possible accompanying extracolonic manifestations suggestive of syndrome). 2.stage iiib cancer (t3n1): s/p proctocolectomy, ia j pouch, ileostomy on . is day#: 17 of cycle 3 of folfox chemotherapy (oxaliplatin, flurouracil, leucovorin--treatments given on days 1 and 15, every 4 weeks). 2. gastric polyps (fundic gland polyps) and duodenal polyps (adenomas) noted on egd 3. s/p ct guided drainaged of pelvic abcess . . psh: l ankle growth plate fusion, excision l neck and popliteal fossa masses (benign pathology) , total proctocolectomy w/ ileoanal pouch and diverting ileostomy , reversal of ileostomy . social history: she is married, does not smoke cigarettes and rarely drinks alcohol. family history: paternal grandfather with cancer (older than 60), mother and father with benign polyps, but there is no family history of familial polyposis syndrome. physical exam: vitals: t:97.7 bp:127/65 p: 70 r:16 18 o2: 1002lnc general: alert, nad heent: sclera anicteric, dry mm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: well healed surgical scars, soft, slight ttp on right with deep palpation, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: alert, oriented only to person, asterixis, pupils 8mm equally reactive to light -> after one hour patient a+ox 3, able to recall details of last few days and her medical course to date, still with asterixis though pertinent results: 05:18pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 04:15pm cerebrospinal fluid (csf) protein-24 glucose-68 04:15pm cerebrospinal fluid (csf) wbc-1 rbc-1* polys-4 lymphs-52 monos-44 12:32pm glucose-104 lactate-5.1* na+-146 k+-4.0 cl--109 tco2-19* 12:32pm hgb-12.0 calchct-36 12:30pm glucose-107* urea n-18 creat-0.8 sodium-146* potassium-4.1 chloride-112* total co2-19* anion gap-19 12:30pm alt(sgpt)-22 ast(sgot)-26 alk phos-97 tot bili-0.5 12:30pm lipase-26 12:30pm calcium-9.1 phosphate-3.8 magnesium-2.9* 12:30pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 12:30pm wbc-5.7 rbc-4.42 hgb-10.8* hct-33.9* mcv-77* mch-24.5* mchc-32.0 rdw-20.1* 12:30pm urine rbc-0 wbc-0 bacteria-0 yeast-none epi-0 brief hospital course: #. ams: pt admitted with ams unable to communicate. she was without leukocytosis or fevers to suggest infectious etiology and preliminary csf studies negative. eeg was suggestive of seizure activity however source of seizures remains unclear. differential includes toxic-metabolic from polypharmacy, fluoxetine (new med for her), or chemo versus new seizure disorder. paragoric, fluoxetin and lomotil were held as it was felt that these could contribute to ams. metastatic disease to the brain and air embolus less likely given normal ct/a and mri. pt initially started on broad spectrum antibiotics however these were discontinued on hd2. keppra was also initially started and dilantin was added after pt noted to have concerning eeg findings on keppra alone. after the addition of dilantin on , there was improvement both clinically and on eeg. symptomatically, pt began to be able to communicate on hd1. however, pt had very poor concentration and was speaking very slowly. this improved drastically upon appropriately dosed dilantin and pt was able to do moyb and serial 7s by hd4. she was transferred to neurology service on for further clinical observation. her mental status and neurologic exam was normal. she was dishcarged home on on dilantin and keppra. her discharge exam neurologic exam was normal. . # sob: pt had sob 2d prior to admission but this had resolved by admission. given pt had recently been on coumadin (for ppx of port thrombosis), pt had cta chest which was negative for pe. pt did not c/o sob throughout admission. . # orthostatic hypotension: pt getting ivf for orthostatic hypotension. got 2l yesterday and still tachycardic and hypotensive while standing -will give addl 1l ivf today . # ca: currently on 5fu and followed by and dr. . - follow up onc recs - continue home anti-emetics - continue loperimide - defer to outpt onc re:treatment of ca . # anemia: hct at baseline 29-34 likely acd given ca may also be slow gib and iron deficiency. pt's iron was increased from once daily to . medications on admission: aprepitant 125 mg (1)-80 mg (1)-80 mg (1) capsule daily dexamethasone 4 mg twice a day diphenoxylate-atropine 2.5 mg-0.025 mg tablet tablet(s) by mouth every 2 hours as needed as needed for diarrhea fluoxetine 10 mg capsule once a day loperamide 4mg qid prn ondansetron hcl 8 mg every 8 hours as needed as needed for nausea ferrous sulfate 300 mg (60 mg iron)/5 ml liquid 5 ml twice daily discharge medications: 1. loperamide 2 mg capsule sig: two (2) capsule po qid (4 times a day) as needed for diarrhea. 2. ferrous sulfate 300 mg (60 mg iron)/5 ml liquid sig: five (5) nl po twice a day. 3. dilantin extended 100 mg capsule sig: three (3) capsule po at bedtime: 300 mg po qhs. disp:*90 capsule(s)* refills:*2* 4. keppra 1,000 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 5. ondansetron hcl 8 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. discharge disposition: home discharge diagnosis: seizures discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: you were admitted with a change in your mental status. you underwent eeg monitoring which revealed seizure activity. you were started on the following anti-seizure medications: keppra (levetiracetam) and dilantin er (phenytoin). please take all medications as prescribed. please follow-up with neurology and oncology as listed below. should you develop any symptoms as listed below or any other concerns, please call your doctor or go to the emergency room. followup instructions: neurology: provider: , md phone: date/time: 8:00 oncology: provider: , md phone: date/time: 10:00 procedure: spinal tap incision of lung diagnoses: acidosis other convulsions encephalopathy, unspecified hyperosmolality and/or hypernatremia benign neoplasm of colon anemia in neoplastic disease orthostatic hypotension malignant neoplasm of rectosigmoid junction 

Answer: The patient is high likely exposed to