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: pollen / dogs / perfume/scents attending: chief complaint: pleural effusion, dyspnea major surgical or invasive procedure: pleurodesis, pleurex catheter and chest tube placement history of present illness: 59 year old female recently admitted - for further work up and port placement with metastatic adenocarcinoma unknown primary, with development of a large right pleural effusion. . she has had worsened orthopnea and dypsnea. today she had a thoracoscopy, chest tube, pleurex catheter placed. . she was last on chemotherapy with carboplatin/taxol approximately 4 weeks ago. a ct on showed progression of disease and also showed the development of a large right pleural effusion which has been causing her progressive sob. during the recent admission a thoracentesis revealed malignant pleural effusion. . her procedure today was complicated by a visceral pleural injury, now with pneumothorax on chest x-. . vs on transfer from the pacu: afebrile, 79, 123/63, 20, 99/3l. she reports continued pain at her port site. feels dyspnea improved. notes general stomach upset and diffuclty eating since finishing chemotherapy 4 weeks ago. . review of systems: (+) per hpi, + dry cough (-) denies fever. denied shortness of breath. denied chest tightness, palpitations. denied vomiting, diarrhea, constipation or abdominal pain. past medical history: ?????? hypertension - essential 401.9cs ?????? congestive heart failure, unspec- per pt has now resolved, possibly related to infection. most recent echo without evidence of systolic heart failure ?????? hypercholesterolemia 272.0be ?????? rhinitis - allergic, unspec cause 477.9an ?????? obesity unspec 278.00j ?????? vertebral compression fracture 805.8q ?????? low back pain 724.2a ?????? carcinoma in situ of vulva 233.32b ?????? igt (impair glucose tolerance) 790.22n ?????? pathological fracture of pelvis 733.19l ?????? pulmonary nodules 793.19e ?????? metastatic adenocarcinoma of unknown origin social history: tobacco 1-2ppd x 37yrs, quit 3 yrs ago, now none. quit etoh 3 years ago, married, 5 children. 2 live nearby. used to work multiple jobs, does not specify what. family history: father had lung cancer at age 72 physical exam: at admission: vitals: afebrile, 79, 123/63, 20, 99/3l general: alert, oriented, no acute distress, comfortable appearing heent: sclera anicteric, dry mm, oropharynx clear neck: supple, jvp not elevated lungs: decreased breath sounds right chest wall, no wheezes, rales, ronchi. chest: port-a-cath in place with recent healing incision right chest wall. right chest tube draining serosanguanous fluid, pleurex in place under right breast. + air leak cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, no edema neuro: cns ii-xii, sensation and strength intact pertinent results: admission labs: 08:08pm blood wbc-6.4 rbc-3.37* hgb-10.3* hct-31.7* mcv-94 mch-30.5 mchc-32.4 rdw-17.2* plt ct-328# 05:49am blood neuts-81* bands-0 lymphs-9* monos-9 eos-0 baso-0 atyps-0 metas-1* myelos-0 09:40pm blood pt-13.1* ptt-35.3 inr(pt)-1.2* 08:08pm blood glucose-117* urean-16 creat-0.8 na-134 k-4.7 cl-98 hco3-25 angap-16 08:08pm blood calcium-9.1 phos-4.1 mg-1.7 imaging: lenis : no deep venous thrombosis in either lower extremity. echo : the left atrium is normal in size. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size and free wall motion are normal. the mitral valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a prominent fat pad. impression: very limited study as the patient was unable to cooperate. moderate symmetric left ventricular hypertrophy with hyperdynamic systolic function. could not fully assess for valvular disease or lvot obstruction. chest (portable ap) study date of 4:30 am impression: right hydropneumothorax with decreased air and increased fluid components. stable right lower lung opacification likely a combination of atelectasis and effusion, though cannot exclude pneumonia. chest (portable ap) study date of 3:52 am findings: in comparison with the study of , there is little overall change. chest tube is in place on the right with fluid collecting in the region of previous pneumothorax. port-a-cath remains in place. opacification at the right base is consistent with a fusion plus compressive atelectasis. the left lung is essentially clear. chest (portable ap) study date of 7:23 am the port-a-cath catheter tip is at the level of mid svc. right chest tube is in place. no change in the appearance of the right hemithorax including loculated pleural effusion and most likely presence of loculated pneumothorax is seen. cardiomediastinal silhouette is unchanged. left lung is essentially clear except for interval development of left pleural effusion and most likely secondary atelectasis. cxr: as compared to the previous radiograph, the two right-sided chest tubes have been removed. there is a minimal increase in fluid that fills the lateral pleural partially air-filled space. in unchanged manner, parenchymal opacities are seen in the paramediastinal right lung areas. unremarkable left lung with trace retrocardiac and left basal atelectasis. unchanged size of the cardiac silhouette. unchanged right port-a-cath pathology: pleural fluid : positive for metastatic adenocarcinoma. pleural biopsy : metastatic moderately differentiated adenocarcinoma, see note. note: immunoperoxidase studies performed on a bone biopsy (s11-) suggested a gastrointestinal or pancreatic/biliary origin. microbiology: bcx : negative c diff toxin : ______________ brief hospital course: 59 yo f w/ adenocarcinoma w/ presumed involvement of her bones, uterus and lung but currently of unknown primary s/p planned admission for right pleurodesis and pleurex catheter placement complicated by pneumothorax and new onset atrial fibrillation with rapid ventricular response. she was started on folfiri on , course c/b difficult to control nausea/vomiting and diarrhea. # r pleural effusion with pneumothorax: likely due to injury to pleural viscera and adhesions. patient was initially maintained on chest tube and pleurex catheter to 20 mm hg. her chest tube and pleurex catheter were removed after consecutive days w/o drainage. her respiratory status remained stable afterwards and she was kept on supplemental oxygen to keep her o2 saturations. # atrial fibrillation with rvr: morning of patient developed afib with rvr with heart rates to the 160s-190s. due to hypotension after receiving iv metoprolol and poor rate control with iv diltiazem patient was transferred to the micu. in the micu she was initially placed on a diltiazem gtt then transitioned over to po medications. cardiology was consulted and followed her closely while in the unit. initially patient required po diltiazem and metoprolol in order to achieve adequate rate control. however, as her nausea/vomiting and coughing improved, her hr improved so that metoprolol was taken off. however, as her resting heart rate increased to 90s on diltiazem monotherapy (max daily dose), metoprolol was added back. discussion with patient was had regarding anticoagulation given new onset atrial fibrillation. as her chads2 score is 1 (for hypertension) and she has multiple comorbidities that make anticoagulation more dangerous, it was decided that she should not be anticoagulated. patient was made aware of the slightly increased risk of stroke with this heart rhythm and warning signs of stroke. # side effects from chemotherapy/deconditioning from prolonged hospitalization: patient experienced significant nausea/vomiting with her chemotherapy which was managed with standing dexamethasone, zofran and ativan. patient was ordered prn compazine as well. she also suffered from diarrhea, likely from irinotecan. it was controlled with imodium. as patient was also deconditioned through the prolonged hospitalization, she was evaluated by physical therapy and it was recommended that she be discharged to rehab. however, patient refused screening by rehab facilities and stated that she would like to go home instead with her family members to provide additional help. it was discussed with her that it may be unsafe for her to go home given her deconditioning from the hospitalization, but patient declined rehab placement. on reevaluation by physical therapy, she was cleared for home with home pt. # adenocarcinoma of unknown origin: pt has presumed involvement of bone, lung and uterus from prior scans. outpatient workup for identification of primary tumor has been unsuccessful so far. her outpatient oncologist believes that it is most likely upper gi primary malignancy. tumor board has recommended treatment w/ folfiri and patient was started on the first cycle on . heme/onc administered chemotherapy during this hospitalization. # lower extremity pain/edema: patient was negative for dvt per lenis. she has been experiencing increased sensitivity in le since initiation of chemotherapy. # htn: patient's home lisinopril was held due to hyptension from atrial fibrillation, especially as she was normotensive on her new metoprolol and diltiazem. her blood pressure was well controlled on diltiazem as monotherapy. # gastritis: continued home omeprazole. transitional issues: further monitoring and management of her atrial fibrillation, discussed with atrius cardiology, pt does not need to follow up with cardiology, however, if pt is difficult to treat, pcp can refer as outpatient. medications on admission: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 2. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 3. lisinopril 40mg daily 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 5. tramadol 50 mg tablet sig: 2 pills tid 6. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po bid prn nausea 7. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for anxiety / insomnia / nausea. 8. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. take an extra pill if bp elevated at night. 9. baclofen 10 mg tablet sig: one (1) tablet po three times a day as needed for neck pain . calcium/magnesium/zinc vitamin d 1000 u daily certrizine 10mg daily benadryl prn mvi omega 3/fish oil discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po 30min prior to breakfast, dinner (). 2. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 4. tramadol 50 mg tablet sig: two (2) tablet po three times a day as needed for pain. 5. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po twice a day as needed for nausea. 6. baclofen 10 mg tablet sig: one (1) tablet po tid (3 times a day). 7. lorazepam 1 mg tablet sig: one (1) tablet po bid (2 times a day): please do not drive while taking this medication as it can make you drowsy. disp:*60 tablet(s)* refills:*0* 8. hospital bed please dispense one hospital bed. 9. home oxygen 2-6l continuous pulse oxygen via nasal cannula to keep o2 saturations >92% at home. 10. baclofen 10 mg tablet sig: one (1) tablet po three times a day as needed for pain. 11. diltia xt 180 mg capsule,ext release degradable sig: two (2) capsule,ext release degradable po once a day. disp:*60 capsule,ext release degradable(s)* refills:*0* 12. zofran 8 mg tablet sig: one (1) tablet po three times a day as needed for nausea. disp:*90 tablet(s)* refills:*0* 13. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 14. morphine 15 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain: please do not drive while taking this medication as it can make you drowsy. disp:*60 tablet(s)* refills:*0* 15. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal (2 times a day). disp:*1 bottle* refills:*0* 16. miralax 17 gram powder in packet sig: one (1) packet po once a day as needed for constipation. disp:*30 packets* refills:*0* 17. dulcolax 5 mg tablet, delayed release (e.c.) sig: tablet, delayed release (e.c.)s po once a day as needed for constipation. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 18. lidocaine 5 % gel sig: one (1) application topical once a day as needed for pain: apply to shoulder daily as needed for pain. disp:*1 bottle* refills:*0* 19. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day: please take it at different time from your diltia xl. disp:*30 tablet extended release 24 hr(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnosis: metastatic adenocarcinoma of unknown origin secondary diagnoses: atrial fibrillation with rapid ventricular rate, malignant pleural effusion with talc pleurodesis and pleurex catheter placement discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. , it was a pleasure taking care of you at . you were admitted to the hospital initially after having a catheter placed in your chest to drain the fluid in your lungs. while hospitalized you developed a fast heart rate that required you to be transferred to the icu. we were able to control you heart rate with medications. you also underwent chemotherapy during this hospitalization. your nausea and vomiting were controlled with medications. these changes were made to your medications: change lorazepam to 1 mg by mouth twice daily for anxiety/nausea. please do not drive while taking this medication as it can make you drowsy. stop lisinopril as you are now on diltiazem for your heart rate and blood pressure start diltiazem (diltia xl) daily in the morning for heart rate and blood pressure start metoprolol succinate (toprol xl) daily at night for the heart rate and blood pressure start ondansetron (zofran) every 8 hours as needed for nausea start fexofenadine () twice daily for allergy symptoms start morphine every 4-6 hrs as needed for pain. please do not drive while taking this medication as it can make you drowsy. start fluticasone (flonase) spray for nasal drip/congestion start miralax daily as needed for constipation start bisacodyl (dulcolax) daily as needed for constipation start lidocaine gel - apply daily to your shoulder as needed for pain followup instructions: name: , md specialty: hematology/oncology location: address: , , phone: when: wednesday at 09:00am department: hematology/oncology when: thursday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage name: , md specialty: primary care location: address: , , phone: when: friday at 1:30pm md procedure: insertion of intercostal catheter for drainage injection into thoracic cavity injection or infusion of cancer chemotherapeutic substance thoracoscopic drainage of pleural cavity thoracoscopic pleural biopsy diagnoses: other iatrogenic hypotension unspecified essential hypertension atrial fibrillation hematoma complicating a procedure personal history of tobacco use atrial flutter pulmonary collapse nausea with vomiting other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure iatrogenic pneumothorax antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use diarrhea obesity, unspecified secondary malignant neoplasm of lung other malignant neoplasm without specification of site unspecified gastritis and gastroduodenitis, without mention of hemorrhage secondary malignant neoplasm of bone and bone marrow other specified gastritis, without mention of hemorrhage pain in limb secondary malignant neoplasm of genital organs antirheumatics [antiphlogistics] causing adverse effects in therapeutic use other specified forms of effusion, except tuberculous malignant pleural effusion 

Answer: The patient is high likely exposed to