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: diflucan attending: chief complaint: seizure major surgical or invasive procedure: lumbar puncture x2 history of present illness: 76 year old aa woman who was transferred from hospital for management of seizures and possible intracranial mass vs. bleed. she has a remote hx of colon ca (), thalassemia, was recenlty admitted to omed (d/c'd ) for hypercalcemia, acute renal failure in context of new diagnosis of multiple myeloma. her history actually begins approximately six weeks ago. at that time, she began having pain in her chest and her back which became worse over time. she became immobilized by pain. her abdominal area and torso seems to have swelled and she has had weight loss of about ten pounds over the last six to seven weeks with poor appetite. o/p workup revealed multiple lytic bone lesions and an abnormal monoclonal spike that was c/w igd lambda. she was refered to omed for o/p bone marrow bx. during this visit she was found to have acute renal failure (cre 6.8) and hypercalcemia (12.5) and was directly admitted to the omed service. during her admission, she was found to have a monoclonal gammopathy (igd). her arf was thought to be secondary to light chain nephropathy and hypercalcemia. she was treated with decadron and alkaline fluids. she rece'd total of 5 plasmaphareses and continued on steriods. skeletal survey revealed multiple destructive lesions in calvarium and spine with several vertebral body fractures. she was discharged on decadron with bactrim for pcp and prophylaxis. according to her husband, she has been sleepy, but otherwise ok since her discharge on wednesday. she remains in a significant amount of pain and has therefore been taking narcotics on a regular basis for relief thus contributing to her fatigue. he cannot recall her complaining of anything in particular today. when he went to give her medications at 6:00 last night, he found her sitting on the floor next to the bed (as if she had fallen out of bed). she was not responsive to voice or touch. he called ems who apon arriving found her to be responsive to painful stimuli. they transported her to hospital where she was noted to be "confused". as per her husband, she became more awake while in the er there. she was given narcan. later witnessed to have a gtc seizure x 1 min. she was given dilaudid, ativan (1mg) and dilantin (1g). she had a ct scan which showed right para falcine, parieto-occipital hyperdensity c/w acute blood with surrounding edema as well as a left parasagital meningioma. on arrival to the ed, vital signs temp 99.1, hr 63, bp 150/71, rr 18, 97% on room air. rpt head ct showed stable right parietal bleed. patient was lp'd, given ceftriaxone 2gram iv, dilantin 1gram iv, decadron 4mg iv, and ffp for mild coagulopathy (inr 1.4). she had an mri and abdominal/pelvis ct for abdominal distension. patient denies headache, photophobia, nausea, chest pain, shortness of breath or abdominal pain. she said that she had some difficulty with her medications. no bm recently, but can't remember when. past medical history: -recently diagnosed igd myeloma and hypercalcemia -colon ca duke's c2 s/p resection in ; normal c-scope in except for diverticulosis -thalassemia trait, microcytic anemia -htn -gout social history: she is married for the last 14 years. she has two living daughters, though she had one daughter who died because of a cns aneurysm. her daughter had polycystic kidney disease. mrs. does not smoke tobacco or alcohol and has never done so significantly in her life. she is a retired public school administrator. she retired in family history: daughter had cns aneurysm diabetes lung ca physical exam: t 98.8 bp 80's-130's/40's-60's hr60's rr18 o2 sat 94% (on 3l nc) gen: on ed stretcher, minimally responsive neck: +nuchal rigidity, no thyromegaly cv: rrr, nl s1 and s2, 2/6 sem lung: clear to auscultation bilaterally abd: +bs soft, distended, no fluid wave appreciated, +hepatomegaly ext: bilateral pedal edema neurologic examination: mental status: minimally responsive, opens eyes to verbal or tactile stimulation, but immediately closes them. doesn't follow commands. cranial nerves: pupils 2mm bilaterally, sluggish. no blink to threat. fundi could not be visualized secondary to miosis. +corneal bilaterally. +dolls eyes. cannot test gag or pallate elevation as patient will not allow her mouth to be opened motor: normal bulk bilaterally. tone increased bilaterally ue and le. no observed myoclonus or tremor. withdraws to pain in all 4 extremities, slightly more briskly on the right. sensation: withdraws and localizes pain in ue reflexes: b t br pa ach right 2 2 2 3 2 left 2 2 2 3 2 brisk throughout toes were upgoing on left, mute on right coordination: unable to assess physical exam today pertinent results: 08:25am ck(cpk)-250* 08:25am ctropnt-0.13* 08:25am ck-mb-6 08:25am phenytoin-13.9 08:25am pt-14.9* ptt-28.0 inr(pt)-1.4 06:30am cerebrospinal fluid (csf) protein-82* glucose-60 06:30am cerebrospinal fluid (csf) wbc-5 rbc-* polys-94 bands-1 lymphs-4 monos-1 06:30am cerebrospinal fluid (csf) wbc-5 rbc-2370* polys-93 lymphs-5 monos-2 04:00am pt-15.0* ptt-28.6 inr(pt)-1.4 12:35am glucose-103 urea n-56* creat-5.0* sodium-137 potassium-3.5 chloride-102 total co2-25 anion gap-14 12:35am alt(sgpt)-7 ast(sgot)-30 ck(cpk)-245* alk phos-82 amylase-122* tot bili-1.0 12:35am lipase-90* 12:35am ctropnt-0.23* 12:35am ck-mb-8 12:35am tot prot-5.4* albumin-3.9 globulin-1.5* calcium-8.2* magnesium-2.1 12:35am acetone-positive 12:35am wbc-12.7* rbc-3.19* hgb-8.7* hct-26.9* mcv-85 mch-27.4 mchc-32.5 rdw-15.7* 12:35am neuts-95.1* bands-0 lymphs-2.6* monos-1.9* eos-0.4 basos-0 12:35am hypochrom-1+ anisocyt-normal poikilocy-normal macrocyt-1+ microcyt-normal polychrom-normal 12:35am plt smr-normal plt count-184 12:35am pt-15.1* ptt-28.6 inr(pt)-1.4 12:30am urine color-straw appear-clear sp -1.011 12:30am urine blood-lge nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 12:30am urine rbc-* wbc- bacteria-few yeast-none epi-1 head ct showed: 1) right parafalcine parietal hyperdense areas representing hemorrhage, perhaps into a mass, or related to a vascular process. recommend mri with gadolinium for further evaluation. 2) calcified meningioma in the left parafalcine region. 3) lytic lesions in the skull are consistent with multiple myeloma or metastases. mri w/ gad: extensive areas of t2 signal hyperintensity are evident in the cortex and subcortical white matter. there is no diffusion signal abnormality associated with this finding to suggest infarction. the most likely explanation would be edema related to hypertension, seizure activity, or perhaps drug therapy, the so-called reversible posterior leukoencephalopathy syndrome. abd/pelvis ct without contrast: 1. stable appearance of the abdomen. 2. no evidence of acute intra-abdominal pathology. 3. very limited study due to lack of oral and iv contrast. 4. bone findings consistent with multiple myeloma. 5. stable appearance of liver and renal cysts. 6. large cyst in the upper pole of the left kidney has a more solid appearance, however, ultrasound from demonstrated this lesion to be cystic. ekg: nsr @65bpm, normal axis, qs in v4-v6, i and avl thyroid scan findings consistent with multinodular goiter. renal us 1) complex cyst in the upper pole of the left kidney demonstrating a thickened wall with a 10mm mural nodule. mri is recommended for more definititive characterization. 2) stable appearance of multiple other simple renal and hepatic cysts demonstrating no complex features. 3) increased echogenicity of the renal cortices, consistent with renal parenchymal disease. csf: cytology: negative for malignant cells oligo bands: none present, band present in serum is not present in csf brief hospital course: 76 yo with recent dx of myeloma and arf s/p plasmapheresis who presents with new onset seizures and was found to have a right parietal hemorrhage of unclear etiology. neuro: the patient was admitted to the neuro icu for evaluation of ich and seizure management. her initial ct scan was stable and showed no increase in the size of the hemorrhage. the etiology of the hemorrhage was unclear. (underlying mass (plasmacytoma?) vs infection vs venous infarct vs hypertensive hemorrhage). mri with gado not helpful in further narrowing differential, but did show evidence of posterior leukoencephalopathy which was thought to be due renal failure or hypertension (though she was not hypertensive on admission). mrv was negative for sinus thrombosis. she had an lp which showed 2000rbcs, 5wbcs. she received empiric antibiotic coverage with vanco/ceftriaxone/acyclovir until csf culture negatives. the acyclovir was d/c'd sec to low suspicion for herpes encephalitis. decadron was initially started at 4mg q6 for cerebral edema, but was later increased to 10mg q6 hours for myeloma treatment. for seizure control, she was initially treated with dilantin, but was later transitioned to keppra. she was evaluated by neurosurgery who recommended repeating the mri in weeks. her mental status dramatically improved over first 24 hours of admission and she has had no further seizures. she was transferred to the neurology floor on for further w/u of intracranial bleed. given her history and the location of the bleed, it was felt that her bleed was most likely due to an underlying mass. she had a repeat lp on for cytology and oligoclonal bands. tap again showed 2000rbcs (not traumatic). csf cytology was negative for malignant cells nor was there evidence of paraprotein. there was a question of dural enhancement on the first mri (though this was difficult to determine do to motion artifact). she had a repeat mri with contrast which showed "surrounding edema which is slightly increased since the previous study. however, previously seen diffuse increased signal in the occipital lobes bilaterally and in the posterior temporal lobes have resolved confirming the findings to be secondary to posterior reversible encephalopathy. in the area of hemorrhage in the right occipital region, subtle enhancement is identified following the administration of gadolinium. subtle leptomeningeal enhancement is also seen in this region. " she will be discharged on a decadron taper. she will follow up in brain clinic where decision will be made whether to pursue biopsy. a repeat mri will be done in weeks to assess for underlying mass. she will continue keppra for seizure prevention. onc: oncology (dr. followed her throughout her admission. she started her 2nd steroid pulse for multiple myeloma and completed 4 days of high dose decadron (10mg q 6h). because it is not common for myeloma to cause parenchymal cns disease, there was concern that her hemorrhage could be due to a second primary tumor with metastasis. her last ct scans showed small thyroid nodules and lung nodules as well as multiple renal cysts. she had a thyroid and renal us to further evaluate. thyroid us showed evidence of multinodular goiter and renal us showed multiple simple cysts and one complex cyst. a renal mri was done to further characterize the complex cyst and showed: "cyst within the upper pole of the left kidney demonstrates a 5 mm enhancing nodule in its anteromedial aspect, which is concerning for an intracystic neoplasm". a mammogram was also ordered and the patient will be getting it as an outpatient. ca 27.29 level was sent and is pending. urine cytology was sent and is pending at the time of discharge. csf cytology was negative. renal: arf secondary to cast nephropathy due to light chain production. creatinine is slowly trending down. at this time is 4.0 bun is in the lower 60's. renal recommended starting bicitra for metabolic acidosis. continue low k diet, renal dose medications. cv: troponin leak present on admission was felt to be due to renal failure. repeated troponin trended down. there were no acute ischemic ekg changes. her hypertension was initially well controlled on metoprolol, but her bps slowly began to increase. metoprolol increased to 100mg po bid and amlodipine 10mg po qd added to control hypertension. will continue to monitor bp with goal sbp<140 and increase meds as needed to maintain this pressure. heme: -she received 2 units of prbcs on for hct 25. also rec'd procrit 40 on . -mild coagulopathy: likely poor po and early vitamin k deficiency. repleated with subcutaneous vitamin k. inr now 1,2. dispo: patient is going to be discharged to rehab. medications on admission: 1. triamcinolone 0.025 % cream (2 times a day) prn for breast rash. 2. oxycodone hcl 5-10 mg po q4-6h prn 3. pantoprazole 40 mg po q24h 4. metoprolol tartrate 25 mg po bid 5. docusate sodium 100 mg po bid 6. bisacodyl 10 mg po daily as needed. 7. allopurinol 100 mg po every other day 8. trimethoprim-sulfamethoxazole 160-800 mg tablet po qmowefr 9. isoniazid 300 mg po daily 10. pyridoxine hcl 50 mg po daily 11. decadron 4 mg po once a day for 10 doses. discharge medications: 1. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po qmowefr (monday -wednesday-friday). disp:*24 tablet(s)* refills:*0* 2. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*1* 3. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*180 tablet(s)* refills:*1* 4. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*1* 5. amlodipine besylate 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*1* 6. sodium citrate-citric acid 500-334 mg/5 ml solution sig: ten (10) ml po twice a day. disp:*900 ml(s)* refills:*2* 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 9. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 10. decadron 0.5 mg tablet sig: eight (8) tablet po every eight (8) hours: taper dose as follows: 8 tablets q8h for 2 days, then re-start decadron pulse (see rx). restart 4mg q 8hours on (after decadron pulse). disp:*200 tablet(s)* refills:*2* 11. oxycodone hcl 5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. disp:*90 tablet(s)* refills:*0* 12. decadron 4 mg tablet sig: 2.5 tablets po every six (6) hours for 16 doses: please begin on thursday, . disp:*40 tablet(s)* refills:*0* 13. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: extended care facility: - discharge diagnosis: 1. intracranial hemorraghe. 2. seizures. 3. multiple myeloma igd 4. acute renal failure discharge condition: stable. discharge instructions: please continue to take your medications as directed. your dose of decadron will slowly be tapered. you should continue to take keppra to prevent seizures. if you feel more lethargic, have new weakness, numbness, change in vision, chest pain, shortness of breath, or fever please call dr. or return to the emergency room. followup instructions: 1. oncology provider: . where: bldg. floor #9, at noon. 2. brain clinic provider: , md where: neurology phone: date/time: 11:30 3. primary care: dr. provider: , m.d. where: phone: date/time: 11:50 procedure: spinal tap incision of lung transfusion of packed cells diagnoses: anemia, unspecified unspecified essential hypertension acute kidney failure, unspecified gout, unspecified other convulsions intracerebral hemorrhage personal history of malignant neoplasm of large intestine multiple myeloma, without mention of having achieved remission other thalassemia nontoxic multinodular goiter 

Answer: The patient is high likely exposed to