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: autologous bmt major surgical or invasive procedure: continuous renal replacement therapy hemodialysis intubation and mechanical ventilation tracheostomy paracentesis history of present illness: mr. is a 56-year-old male who was diagnosed with follicular lymphoma transitioning to a marginal zone lymphoma in 01/. he had a long preceding history of night sweats and dry cough, followed by the development of right leg swelling and a right inguinal mass. in he developed swelling in his right lower extremity and a mass in his inguinal area. ct scan of his abdomen and pelvis on revealed generalized lymphadenopathy beginning at the crural lymph nodes and extending inferiorly into the periaortic, mesenteric, celiac, pararenal, common iliac, and external iliac chains. in the right groin, there was a large lymph node mass approximately 6 x 5 x 6.6 cm. there was also a rounded low-density area just medial to the femoral artery which was felt to represent thrombosed femoral and external iliac veins. overall, the findings were concerning for lymphoma. he was referred for a ct of his chest on which showed prominent adenopathy, principally in the left supraclavicular and left axillary regions, with the largest mass measuring 2.6 cm in his left axilla. based on that, he was referred for excisional biopsy of the right inguinal adenopathy on which revealed follicular lymphoma with partial marginal zone differentiation, grade i-ii by large cell quantitation. these cells were cd19 and cd20 positive and also co-expressed cd5 and cd10. they were also kappa light chain restricted. there was no expression of cd-23 or cyclin d1. ki67 was 20-30%. his lymphoma was felt to represent a transitional state between follicular lymphoma and marginal zone b-cell lymphoma. he was then started on r-cvp. he tolerated therapy fairly well, but suffered from fatigue, hyperglycemia, flushing, and hypertension. his prednisone dose during treatment was eventually lowered from 200 mg daily to 100 mg daily. he received 2 days of neupogen after each cycle of chemotherapy. after three cycles of r-cvp, the vincristine was discontinued due to neuropathy. he underwent a pet scan on after the third cycle and this continued to show extensive fdg avid disease. however, his night sweats and leg swelling had improved. he continued on r-cvp for two additional cycles, but after the fifth cycle, he noticed the recurrence of right inguinal lymphadenopathy. he had also developed recurrent night sweats and cough. the lymphadenopathy grew quite quickly and became the size of a quarter over the span of 24 hours. he underwent a second pet scan on which showed little significant change, with hyperactive adenopathy at the left axilla and extensively below the diaphragm in the mesentery, para-aortic and pelvic regions. he underwent a second excisional biopsy on which again showed follicular lymphoma, grade i-ii. the decision was made to hold on further r-cvp as his lymphoma was no longer responding to the current therapy. cytogenetics cd19 and cd20 positive, also co-expressed cd5 and cd10, and kappa light chain restricted; no expression of cd-23 or cyclin d1; ki67 was 20-30%. chemotherapy history : he received cyclophosphamide, vincristine, prednisolone plus rituximab (r-cvp) x 3 cycles; the vincristine was discontinued due to neuropathy. night sweats and leg swelling improved. : pet scan showing extensive fdg avid disease : continued on r-cvp for two additional cycles, but after the fifth cycle, he noticed the recurrence of right inguinal lymphadenopathy. he had also developed recurrent night sweats and cough. : repeat pet - little interval change : repeat lesion biopsy - similar findings : transferred care to , presented with bilateral inguinal lymphadenopathy; received 4 cyclyes r-bendamustine by local oncologist at time of transfer; planned for two more cycles of r-bendamustine : mobilization hidac, final cumulative cd-34 yield of 5.19 x 10e cd-34 cells/kg over three days, discharged on cipro, neupogen and compazine. wbc at discharge 20.9. two weeks later wbc 0.7 and one week later 0.5 w/anc 0, asymptomatic. started on moxifloxacin and neupogen. stem cell harvesting . : w1 rituxan/zevalin: wbc 7.3, hct 34.9, plt 244. : w1 rituxan/zevalin: wbc 5.4, anc 4560, hct 32.5, plt 292. today he presents for admission for his beam autologous bmt. no current complaints. denies headache, nausea, vomiting, diarrhea, abdominal pain, weakness, fevers, chills, recent night sweats, blurry vision, shortness of breath. reports only mild ongoing cough significantly improved from prior and occasional fatigue when his counts get low. past medical history: diagnosed with follicular lymphoma transitioning to a marginal zone lymphoma in (these cells were cd19 and cd20 positive and also co-expressed cd5 and cd10. they were also kappa light chain restricted. there was no expression of cd-23 or cyclin d1. ki67 was 20-30%.) right thigh lymphedema (significantly improved, per patient) rle dvt from compression (was on coumadin until ) mild diverticulitis s/p vasectomy, tonsillectomy social history: works in a management position at a metal fabrication plant overseeing production and quality control. he is married and has four children, ages . he and his family live in hooksett, . he denies any current tobacco use. he previously smoked but quit 15 years ago after a 20-pack-year history. he generally drinks several martinis a day but has decreased his drinking while on treatment. family history: father - died at 80, lung cancer, charcot--tooth disease, pulmonary embolism mother - alive at 80, diabetes and asthma three brothers - all in good health no family history of leukemia or lymphoma has 2 children from previous marriage and 2 children from his current marriage physical exam: on admission: vs: 96.6 132/96 109 18 98/ra 195lbs 71" general: nad heent: sclerae are anicteric. perrla. eomi. o/p clear. neck: supple. lymph: no cervical, supraclavicular, or axillary lymphadenopathy; some left supraclavicular fullness; possible right inguinal lymphadenopathy although possibly just scar tissue from biopsy cardiac: rrr normal s1/s2 no r/g/m lungs: ctab abdomen: soft, nontender, nondistended, normoactive bowel sounds; no hsm extremities: no edema . on discharge: tmax: 36.5 ??????c (97.7 ??????f) tcurrent: 36.3 ??????c (97.3 ??????f) hr: 117 (109 - 117) bpm bp: 79/57(62) {64/40(48) - 93/59(68)} mmhg rr: 30 (21 - 30) insp/min spo2: 95% heart rhythm: st (sinus tachycardia) wgt (current): 80.3 kg (admission): 98.2 kg height: 72 inch 24 hr: smn: total in: 1,807 ml 722 ml po: tf: 1,017 ml 602 ml ivf: blood products: total out: 0 ml 0 ml urine: 0 ml 0 ml ng: stool: drains: balance: 1,807 ml 722 ml respiratory support: o2 delivery device: trach mask 50% spo2: 95% physical examination: general appearance: well nourished, no acute distress, thin, eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic, tracheostomy in place, ng tube in place lymphatic: no cervical or supraclavicular adenopathy cardiovascular: pmi normal, s1: normal, s2: normal, no murmurs, rubs, gallops. chest: expansion: symmetric excursion, no dullness, ctab. abdominal: soft, non-tender, bowel sounds present, distended, + fluid wave. non-tender. extremities: no edema, cyanosis, clubbing, 2+ peripheral pulses. musculoskeletal: muscle wasting, unable to stand, skin: warm, no rash, no jaundice neurologic: attentive, follows commands, responds to verbal stimuli, oriented x3, moving all extremeties equally, strength in ue & le bilat, dizzy if not in supine position, moving all extremeties equally, sensation intact. pertinent results: labs on admission: 10:15am blood wbc-3.9* rbc-4.62 hgb-13.8* hct-41.5# mcv-90 mch-29.9 mchc-33.3 rdw-15.7* plt ct-144*# 10:15am blood neuts-88.5* lymphs-4.0* monos-6.4 eos-0.7 baso-0.3 10:15am blood pt-11.2 ptt-21.2* inr(pt)-0.9 12:00am blood gran ct-4380 10:15am blood urean-14 creat-0.8 na-141 k-4.6 cl-102 hco3-32 angap-12 10:15am blood alt-35 ast-33 ld(ldh)-157 alkphos-102 totbili-0.3 dirbili-0.1 indbili-0.2 10:15am blood totprot-7.0 albumin-4.5 globuln-2.5 calcium-10.0 phos-3.8 mg-2.0 uricacd-8.3* lab trends during admission: wbc: max 47.8 on --> 35.3 on --> 25.9 on -->18.9 on --> 15.5 on hct: stable at 28-33 for past 2 weeks plt: stable at 40-70 for past 2 weeks. coags: have been within normal limits. chem7: patient on hd tues, thurs, sat lfts: ast: 1341 & alt: 2472* max on trended down to ast: 59* alt: 40 by and ast & alt have been normal since . ldh: 1466 max on trended down to normal by alk phos: 170 on trended up to max on 248 on and then down to 172 on . tbili: 10.0 max on trended down to 2.9 on lipid/cholesterol cholest triglyc hdl chol/hd ldlcalc 08:46am 173 196* 11 15.7 123 cortisol stimulation test: 03:30pm 29.4*1 02:37pm 17.91 hepatitis hbsag hbsab hbcab hav ab igm hav 03:46am negative positive negative positive negative heparin dependent antibodies: negative 12:00pm aspergillus antigen: 0.1 <0.5 considered to be negative b-glucan: 65 pg/ml negative less than 60 pg/ml indeterminate 60 - 79 pg/ml positive greater than or equal to 80 pg/ml labs on discharge: 04:21am blood wbc-15.5* rbc-2.61* hgb-10.0* hct-31.1* mcv-119* mch-38.1* mchc-32.0 rdw-19.6* plt ct-40* 04:21am blood pt-12.8 ptt-25.9 inr(pt)-1.1 04:21am blood plt ct-40* 04:21am blood glucose-140* urean-54* creat-5.0* na-139 k-5.5* cl-103 hco3-23 angap-19 ****prior to hd today***** 04:21am blood alt-27 ast-34 alkphos-172* totbili-2.9* imaging: ruq ultrasound . impression: 1. apparent reversed flow in the main portal vein with normal flow direction in the left and right portal veins. these findings are discrepant and do not appear to be artifactual in nature. given that the etiology of these findings is unclear, whether there is true portal vein reversal or possibly more proximal thrombus, we would recommend focused mri of the abdomen including 2d time-of-flight sequences (with saturation bands to determine directionality of flow) through the portal vein to clarify this issue. 2. cholelithiasis but no other evidence of acute cholecystitis. 3. small amount of ascites. mri abdomen. . impression: 1. reversal of flow within the main portal vein, both on breath-hold imaging and free breathing. 2. reversal of flow within the right anterior portal vein on breath-hold imaging. 3. suggestion of reversed flow within the right posterior portal vein during breath-hold, but antegrade flow during free breathing. this may reverse depending on phasicity of respiration. 4. directionality of flow within the left portal vein is not clearly demonstrated on this examination. 5. interval increase in ascites since yesterday's examination. 6. no evidence of focal hepatic lesion or hepatic or portal vein thrombus. 7. suggestion of siderosis within the spleen. possibility of iron deposition within the liver cannot be excluded without dual-echo gradient-echo images (omitted in this abbreviated examination due to patient intolerance of examination). 8. cholelithiasis. no biliary abnormalities noted. mr head w/o contrast study date of 12:31 pm impression: 1. hyperintense subarachnoid material, involving the sulci of both cerebral hemispheres, most likely representing subarachnoid hemorrhage, less likely proteinaceous material as seen in meningitis. oxygen therapy can also have this appearance. 2. no evidence of masses, mass effect or infarction. echo: at 3:47:46 pm conclusions: the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the prior study (images reviewed) of , the findings are similar. ct torso: 1:53 pm chest ct: bilateral small pleural effusions, on the left increased as compared to the prior study and the right slightly increased as compared to the prior study. linear atelectasis in the right lower lobe and left lower lobe accompanied by small patchy consolidations in the left lower lobe. this is new as compared to the previous study. small amount of pericardial effusion is noted (series 2, image 34). central line catheter is noted with its tip in the right atrium. tracheostomy. nasogastric tube with its tip in the stomach. abdominal ct: small-to-moderate amount of ascites is demonstrated. limited evaluation of the liver due to lack of i.v. contrast and artifacts. there is no evidence of intrahepatic or extrahepatic bile duct dilatation. the pancreas is within normal limits. gallbladder is nondistended. adrenals are unremarkable bilaterally. spleen is of normal size and attenuation on this non-contrast scan. visualized small bowel demonstrate diffuse mucosal thickening without evidence of dilatation. the findings may caused by ascites or gvhd. retroperitoneal and mesenteric lymphadenopathy, small but numerous, measuring up to 1 cm in mesentery and 1.4 cm in the retroperitoneum. pelvic ct: moderate amount of fluid is seen in the pelvis. urinary bladder is not distended. rectal tube is seen in the rectum. osseous structures: degenerative changes in the lumbar and sacral vertebra. impression: 1. bilateral small pleural effusions, slightly larger as compared to the prior study. 2. linear atelectasis in the right lower lobe and left lower lobe and left lower lobe patchy consolidation which is new as compared to the prior study. 3. moderate amount of ascites. 4. limited evaluation of the liver due to artifacts. cxr: findings: indwelling support and monitoring devices are similar in position, and cardiomediastinal contours are unchanged. there is a suggestion of increasing layering effusions on this semi-upright projection. persistent left retrocardiac opacity is probably due to atelectasis. patchy opacities in right mid and right lower lung could be due to either atelectasis or early sites of pneumonia, and followup radiographs may be helpful in this regard. brief hospital course: this is a 56 year old male with pmh of follicular lymphoma transitioning to a marginal zone lymphoma s/p r-cvp admitted for beam auto-sct (c1d1 () and as per bmt protocol, initiated carmustine day -7, followed by etoposide/cytarabine on days -6 to -3, then melphalan on day -2 (). he then underwent autologus stem cell transplant on . post-transplant course was complicated by mucositis, diarrhea, febrile neutropenia, and transient hyperuricemia that responded to 1 dose of allopurinol. on , the patient was transferred to the icu for respiratory distress, altered mental status, renal failure, and transaminitis secondary to -occlusive disease. 1. respiratory distress - the patient was tachypneic to the 40s on admission to the icu and had an increasing oxygen requirement, thought to represent attempted compensation for metabolic acidosis and low lung volumes with atelectasis. the patient failed a trial of bipap and was intubated and placed on a/c mechanical ventilation. he had no evidence of pneumonia but was noted to be >7l fluid positive on admission, with increasing ascites secondary to his hepatic complications. serial cxrs over course of his icu stay demonstrated reduced lung volumes with small amounts of atelectasis but no new consolidation, effusion, or intravascular congestion. patient remained intubated in the for a) impaired mental status and b) restrictive physiology increased intra-abdominal pressure. the patient remained on the ventilator for approximately three weeks; his respiratory status remained relatively stable but his mental status precluded extubation. he did experience an episode of leukocytosis, detailed below, and was treated for a pseudomonas ventilator associated pneumonia with improvement in his leukocytosis. the patient eventually received a tracheostomy and was subsequently weaned down to trach collar, which coincided with an improvement in his mental status. 2. hypotension - the etiology was initially thought to be a combination of a) intravascular volume depletion decreased effective circulating volume and splanchnic vasodilation from liver failure, and b) sedation. sepsis thought to be a contributing factor as well, but he was maintained on broad-spectrum antimicrobial coverage, with no infectious source identified for the majority of his hospitalization. ct imaging was unremarkable for an infectious source. the patient was initiated on levophed and had a prolonged ongoing pressor requirement without an obvious cause for hypotension. although cortisol levels were normal, suggesting against adrenal insufficiency, the patient was trialed on a three day course of steroids, which temporarily improved his pressures and removed his pressor requirement. following the conclusion of the steroid trial, the patient again required vasopressor support to maintain his blood pressure. a cortisol stimulation test was performed to better assess for impaired adrenal response, did not reveal any significant abnormal findings. ultimately, vasopressin was started and levophed was weaned. after his cvvh was stopped, the patient had an episode of symptomatic hypotension, for which vasopressin was briefly restarted. for the rest of his icu course, the patient was maintained off of pressors and perfusion was monitored by assessing mental status. he was initiated on hd, and tolerated this well without ultrafiltration. his hypotension may be related to his liver disease in addition to severe deconditioning. he is persistently orthostatic which has somewhat improved with restarting midodrine. he mentates well with a blood pressure of 60s systolic. please continue to encourage thigh high compression stockings to increase peripheral resistance. please elevate head of bed as patient tolerates and continue passive motion in bed. autonomics was consulted prior to discharge and feels like hypotension is not likely related to dysautonomia given his hypotension even while supine. autonomics recommended continuation of midodrine and a trial of florinef to be started at rehabilitation. florinef will be started at low dose (0.1 mg daily) and can be uptitrated based on patient response to a maximum of 0.4 mg daily. it is felt that the hypotension is likely related to deconditioning and aggressive pt should be pursued. 3. leukocytosis - elevated wbc count beginning with persistent hypotension. filgrastim discontinued ; therefore, this could not account for the persistent leukocytosis. patient was at high risk for nosocomial infection (critically ill, ascites, multiple tubes/lines) with difficult-to-interpret fever curve on cvvh. he was empirically started on broad spectrum antibiotics with a mild improvement in his leukocytosis but with no obvious source on cultures. multiple paracenteses were negative for sbp. much later in the hospital course, a re-elevation in his white blood cell count corresponded with a new positive sputum culture for pseudomonas. the patient was treated with seven days of ceftazidime per infectious disease recommendations, after which his leukocytosis improved but still remained dramatically elevated. a large volume paracentesis was performed with fluid sent for cytology and flow cytometry, which was not revealing. ultimately, only his cvvh catheter tip grew out the same strain of pseudomonas on that was in his sputum on . it is felt that this was a colonizer only as surveillance blood cultures were negative. no other infectious sources were identified. his antibiotics were ultimately all discontinued and he did well. he should no longer be on precautions as he has no active infections. his leukocytosis continues to improve, but does remain elevated. a component of this elevation may be due to auto splenectomy that appears to have occurred during this hospitalization. 4. transaminitis/hepatic failure - right upper quadrant ultrasound and abdominal mri demonstrated reversal of flow through portal vein, suggestive of cirrhosis. on admission to the intensive care unit, he was noted to have new significant ascites. rising inr and worsening mental status were suggestive of progression to hepatic failure. liver biopsy confirmed a diagnosis of -occlusive disease. infectious workup of hepatitis was negative. per hepatology, patient would not be a candidate for liver transplant. the patient was then started on a defibrotide treatment protocol on with close monitoring of coags, plts, hct, fibrinogen due to concern of bleeding (goal inr < 1.5, plts > 30, hct > 30, fibrinogen > 150). lfts peaked with tbili 10, then trended down gradually. after 25 days of treatment for defibrotide, a head mri revealed a subarachnoid hemorrhage, which necessitated discontinuation of the treatment. the patient subsequently continued to show gradual, mild improvement in functional status, but continued to have large ascites on exam requiring periodic taps. currently he is requiring paracentesis every 10-14 days and his ascites should continue to be monitored and tapped prn. through his icu course, his lfts gradually improved; however, his bilirubin did remain elevated at 2.9 on discharge. he should have liver clinic follow-up with dr. within one month after discharge. 5. depression: the patient appears to be extremely frustrated and depressed about his current state. he was started on low dose amphetamine salts at 5mg to increase his energy and blood pressure. his cardiac status should be monitored closely as well as his mood on this new medication. it can also be titrated up slowly in an attempt to increase his energy. 6. thrombocytopenia: his platelets have fallen dramatically during his hospitalization. they have remained stable around 50. there was initial concern for hit, but antibody returned negative on . platelets should be transfused only if the patient is actively bleeding. caution should be used with blood thinners due to his low platelet level. 7. ileus - attributed to critical illness with ascites and opioid -based sedation. abdominal x-ray and ct scan were negative for obstruction. the patient was started on reglan and an aggressive bowel regimen. following withdrawal of sedation as patient's respiratory status improved, his ileus improved as well. lactulose was continued less frequently as prophylaxis against hepatic encephalopathy and was eventually discontinued. the reglan was stopped. he developed loose stools/ diarrhea that was treated as below. 8. diarrhea - patient has had continued loose stools ever since his ileus resolved. his stool frequency has improved after stopping lactulose but have continued to remain loose. c diff. toxin has been checked multiple times and has remained negative. it is likely that the diarrhea is related to tube feeds and banana flakes have been added recently with subsequent improvement in diarrhea. 9. altered mental status - attributed to hepatic encephalopathy in addition to sedating meds for treatment of his abdominal pain. standing lactulose was started for therapy of hepatic encephalopathy and was also given broad spectrum antibiotics for treatment of possible infections. patient had a protracted hospital course with minimal improvement in mental status but began to show dramatic improvement in mid , approximately one month after initiation of defibrotide. his mental status continued to improve throughout his icu course and he is now able to interact appropriately. his antibiotics and lactulose were ultimately discontinued. 10. renal failure - the patient was found to have new renal failure that began on . per renal, the etiology was most consistent with ischemic atn. his initial hypotensive insult was likely secondary to hepatorenal syndrome. the patient was started on cvvh on for worsening metabolic acidosis. he continued to be severely oliguric throughout his admission with no restoration in renal function. the patient's severe volume overload was corrected gradually via cvvh while he continued to have an ongoing pressor requirement. midodrine was started in an effort to improve the patient's blood pressures so that he could be transitioned to hd. he was eventually transitioned to hd without ultrafiltration, and has tolerated it well. 11. ekg changes: the patient had subtle st depressions at the beginning of in the setting of decreased mentation and hypotension. he was ruled out for an mi and these depressions have since resolved. it was likely related to demand in setting of hypotension. 12. neutropenic fevers - on admission, patient was kept on broad spectrum antibiotics for neutropenic fevers (vancomycin/cefepime/ganciclovir/micafungin). infectious disease was consulted. patient was culture negative and no source of infection was identified. antibiotics were stopped following recovery of his neutrophil counts. he was treated later in his hospital course for a pseudomonas pneumonia (see above). 13. hyperglycemia: patient with blood sugars persistently between 200-300. regular insulin was added to the tpn, and the patient was placed on a regular insulin ss. this may represent diabetes. he will need ongoing monitoring and upon discharge from rehabilitation center follow-up with his primary care provider. 14. follicular lymphoma: patient is status post beam auto sct on . patient engrafted. received iv solumedrol x1 for anti-inflammatory effect. received filgrastim until anc>1000 (discontinued ). he was continued on atovaquone prophylaxis for pcp but there was concern that it was not being absorbed as it appeared to be present in his diarrhea. he was given one dose of inhaled pentamidine on and will be continued on atovaquone. if his diarrhea continues to improve, he can remain on atovaquone and will likely not need another dose of inhaled pentamidine one month from . he also remains on acyclovir prophylaxis. 15. deep vein thombosis prophylaxis: patient not started on heparin due to low platelets. patient repeatedly offered pneumoboots, but usually declined to wear the pneumoboots. encourage aggressive physical therapy. medications on admission: multivitamin no other current medications discharge medications: 1. white petrolatum-mineral oil 42.5-56.8 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 2. midodrine 5 mg tablet sig: three (3) tablet po tid (3 times a day). 3. acyclovir 400 mg tablet sig: one (1) tablet po q24h (every 24 hours): give every day, on dialysis days give daily dose after dialysis. 4. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 5. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 6. ursodiol 300 mg capsule sig: one (1) capsule po qam (once a day (in the morning)). 7. ursodiol 300 mg capsule sig: two (2) capsule po qpm (once a day (in the evening)). 8. insulin regular human 100 unit/ml solution sig: per scale injection asdir (as directed). 9. atovaquone 750 mg/5 ml suspension sig: 1500 (1500) mg po daily (daily). 10. amphetamine-dextroamphetamine 5 mg tablet sig: one (1) tablet po bid (2 times a day). 11. fludrocortisone 0.1 mg tablet sig: one (1) tablet po daily (daily): uptitrate as tolerated. discharge disposition: extended care facility: - - discharge diagnosis: primary: - follicular lymphoma - renal failure, acute tubular necrosis, now requiring hemodialysis. - respiratory failure - hepatic failure secondary to venous occlusive disease - hypotension - multi-drug resistant pseudomonal pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. blood pressure: sbps 50-80s with good mentation. if concerned about blood pressure, monitor for change in mental status. patient tolerating very low blood pressures attributed to deconditioning. discharge instructions: you were admitted for bone marrow transplant. you had a prolonged hospital course that was complicated by liver failure, infection, persistent low blood pressure, kidney failure, and respiratory failure that ultimately required trach tube placement. your clinical status ultimately improved. you are now being discharged to a rehab facility for further care. you were started on many different medications during your hospital course. you should follow the medication list provided at the time of discharge. it was a pleasure taking part in your medical care. followup instructions: you will need to see the following providers within the timeframe below. we are working to schedule appointments for you, please call the following offices in days time to get the appointment information: provider: , md specialty: hematology/oncology telephone: ( timeframe: within 2-4 weeks provider: , md specialty: liver telephone: ( timeframe: within 2-4 weeks. you will need to see you primary care doctor within 2 weeks after discharge from the rehab facilty. md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube hemodialysis closed (percutaneous) [needle] biopsy of liver percutaneous abdominal drainage percutaneous abdominal drainage temporary tracheostomy injection or infusion of cancer chemotherapeutic substance autologous hematopoietic stem cell transplant without purging diagnoses: acidosis thrombocytopenia, unspecified acute kidney failure with lesion of tubular necrosis acute and subacute necrosis of liver depressive disorder, not elsewhere classified pulmonary collapse acute respiratory failure paralytic ileus other ascites diarrhea hepatic encephalopathy ventilator associated pneumonia pseudomonas infection in conditions classified elsewhere and of unspecified site orthostatic hypotension other stomatitis and mucositis (ulcerative) other specified disorders of circulatory system nodular lymphoma, lymph nodes of multiple sites other neutropenia 

Answer: The patient is high likely exposed to