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: sulfa (sulfonamides) attending: chief complaint: neutropenic fever, atrial fibrillation major surgical or invasive procedure: none history of present illness: the patient is a 33 year old female with a recently diagnosed thymoma. she is s/p her first round of chemotherapy with cyclophosphamide, doxorubicin and cisplatin which she underwent . now, she has been referred to the ed by her oncologist, dr. , for her febrile neutropenia. at home her temperature was 101.9. of note, she was also recently admitted from for afib with rvr. at that time she was complaining of chest pain at the biopsy site. she was found to be in atrial flutter on f/up ekg and ruled out for mi. n echo during that admission revealed an effusion but was negative for tamponade. she was rate controlled with metoprolol and a digoxin load. a cta showed large mediastinal mass and cardiothoracic surgery did not feel there was any need for intervention as it was not felt to be hematoma. a repeat echo during admission showed decrease in size of her pericardial effusion. during her admission she had episodes of hypoxia requiring supplemental o2 which was felt to be due to combination of afib and pulmonary edema and atelectasis. she had a port placed during the admission for chemotherapy. following her discharge, she returned to the ed on for low bps found by vna services. she was rehydrated with ivfs and her hypotension soon resolved. . on the current admission, she presented to ed w/fevers to 101.9 f. she was tachycardic with hr up into the 200s. she had blood cultures drawn and received vancomycin and cefepime, as well as ibuprofen 600mg x 1. she received 3l ivf. labs were significant for anemia, neutropenia, thrombocytopenia, and a transaminitis, which has been stable and extensively worked up on a prior admission but exact etiology still unknown. brief oncology history : ms. presented with afib in that began during a leep procedure for hgsil. she presented again with afib/rvr in to hospital. at that time cxr showed a large anterior mediastinal mass. she was referred to dr. at and underwent biopsy on with pathology showing a lymphocyte thymoma. flow cytometry showed a non-specific t cell dominant lymphoid profile with diagnostic immunophenotypic features of involvement by a b cell non-hodgkin lymphoma seen in specimen. she was initially evaluated at oncology on and recommendations were made for neoadjuvant chemoradiation prior to surgical resection. as per hpi above she is s/p her 1st course of chemo on including cyclophosphomide, doxurubicin, cisplatin. the plan for her is chemo-radiation and then surgical intervention. b1 thymoma has a good prognosis and rx is curative. past medical history: # thymoma () and status post chemotherapy (cyclophosphamide, doxorubicin and cisplatin regimen) #afib/flutter, diagnosed # h/o transaminitis/lft elevations - liver bx from in nonspecific minimal lobular and portal mononuclear cell inflammation w/ rare hepatocyte necrosis. - negative for hep a, b, and c # anemia, etiology # h/o high grade cervical sil social history: previously worked as a case manager for a home care company, out of work since recent diagnosis of thymoma. lives with her mother in . history of social alcohol use, none current. no tobacco or illicits. unmarried but has boyfriend currently. family history: sister has atrial fibrillation and elevated liver enzymes, unknown cause. father with dm-2, htn, hypercholesterolemia. mother-gerd. other cancers per patient. physical exam: on admission/ transfer to the icu the patient's physical exam was as follows: physical exam: t: 98.8 bp: 104/54 hr: 104 rr: 16 o2 100% ra gen: ill appearing, pale, anxious affect heent: + conjunctival pallor. no icterus. mm dry. op clear, no thrush. neck: supple, no lad, no jvd. no thyromegaly. cv: irregularly irregular. nl s1, s2. no murmurs, rubs or lungs: ctab, good bs bl, no w/r/c abd: nabs. soft, nt, nd. no hsm ext: wwp, no cce. 2+ dp pulses bl skin: no rashes/lesions, ecchymoses. neuro: sleepy, but arousable and appropriate. cn 2-12 grossly intact. preserved sensation throughout. 4+/5 strength throughout, but nonfocal. + reflexes, equal bl. gait assessment deferred . pertinent results: pertinent past studies: echo : left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. the mitral valve leaflets are structurally normal. there is a small to moderate sized pericardial effusion subtending primarily the posterior and lateral walls of the left ventricle. there are no echocardiographic signs of tamponade. no right atrial or right ventricular diastolic collapse is seen. compared with the findings of the prior study (images reviewed) of , the pericardial effusion is smaller. . cta chest : impression: 1. no pe but limited study due to large anterior mediastinal mass. 2. rounded hyperdense swirling density arising from site of prior biopsy, extending through the right anterior chest wall into the subpectoral soft tissues, most c/w hematoma; however, concerning for possible superinfection vs residual air related to bx. also possible contiguous tumor extension and invasion through the chest wall, though unlikely 3. no significant interval change in appearance of biopsy-proven thymoma 4. increased small to moderate pericardial effusion, and small bilateral pleural effusions. : liver bx from in showed nonspecific minimal lobular and portal mononuclear cell inflammation w/ rare hepatocyte necrosis. current admission : ekg : aflutter 2:1 block @ 125, right bundle pattern in v1-v2 and iii. normal axis. good r wave progression. . cxr : wide mediastinum with known anterior mediastinal mass. no other focal infiltrates or edema noted. 10:35pm digoxin-0.4* 11:26pm lactate-2.0 11:02pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 11:02pm urine rbc-0 wbc-0-2 bacteria-few yeast-none epi-0-2 10:35pm glucose-111* urea n-5* creat-0.5 sodium-139 potassium-4.2 chloride-101 total co2-28 anion gap-14 10:35pm alt(sgpt)-62* ast(sgot)-60* alk phos-451* tot bili-0.7 10:35pm calcium-9.5 phosphate-2.5* magnesium-2.0 10:35pm pt-15.8* ptt-43.8* inr(pt)-1.4* 03:00pm urea n-9 creat-0.6 03:00pm digoxin-0.5* 03:00pm wbc-0.6* rbc-2.71* hgb-8.7* hct-25.1* mcv-93 mch-32.0 mchc-34.6 rdw-11.9 03:00pm gran ct-40* 02:34pm albumin-3.8 calcium-9.7 phosphate-2.4* magnesium-2.0 02:34pm wbc-0.7*# rbc-2.96* hgb-9.5* hct-27.6* mcv-93 mch-32.0 mchc-34.4 rdw-12.1 - throat culture pending - final blood and urine cx pending from and , negative to date as of . brief hospital course: # sirs : on admission, the patient met sirs criteria of fever, leukopenia, and tachycardia plus suspected infection on initial presentation. blood, urine and throat cultures were negative and cxr remained without evidence of infiltrates. the patient has a left sided subclavicular placed port which appeared clean and without bleeding, discharge on daily exams so it is an unlikely infection source. uas and cultures do not reveal any uti sources to date nor are there any clinical symptoms to suspect gi source (no diarrhea, abdominal pains, occasional nausea likely chemo related). she completed a course of iv vancomycin and cefepime, and remained afebrile for the remainder of her admission. . # fevers: persistent fevers alongside neutropenia s/p recent chemotherapy ()prior to admission. as of , the patient is no longer neutropenic. she remained afebrile for the duration of her admission. . # afib: with rvr in ed on . etiology of a-fib thought to be due to tumor burden irritation on pericardium, pulmonary vessels. ddx also includes fevers, tamponade, hypovolemia, sepsis. currently her plan for ablation at hospital is on hold until patient stabilizes. anemia may be contributing to afib/tachycardia also, thus was transfused 2 u prbcs on - volume replete with ns ivfs - monitored uop, keeping >35cc/hr - rate control attained through beta blocker, increased dose during icu stay and continued home level digoxin. no evidence of tamponade on exam currently. - chads score of 0 so icu team felt there was no need for systemic anticoagulation. #anxiety - patient had crying and appeared extremely anxious during her stay so a psychiatric consult obtained and per recs she began remeron as it was felt this would not only help her anxiety and mood but boost her poor appetite too. she was also given prn ativan as dosing of remeron will take several weeks for full effects/benefits. #chest pain: patient c/o intermittent chest pain throughout her icu stay. it was felt this pain was due to mediastinal mass or recent biopsy or combination of both. there is possible contribution of pericardial inflammation from mass. unlikely ischemic in nature given pattern and presentation. pain was control with oxycontin and oxycodone prn and later morphine prn given as her nausea seemed to increase with oxycontin dosing. . # anemia: current hct consistent with prior values during recent admission. tsh, b12, folate nl. retic was 1.8% in setting of anemia suggesting poor erythropoiesis. currently no suggestion of hemolysis with low normal k, tbili of 0.7. ddx includes myelosuppression s/p chemo, thymoma/mds(pure red cell aplasia). gi source less likely. her hematocrit was trended without further need for transfusion. # thrombocytopenia: trended upward throughout icu stay. suspect this change was due to myelosuppression from chemotherapy. she was given transfusions plts for plts<10. she had no evidence of bleeding during stay and by hd#4, on her plts had come back up to 170s range. they remained stable and no further transfusions were needed. . # transaminitis: lfts c/w recent values. per liver c/s, ddx includes congetive, autoimmune, drug induced. hepatitis serologies were negative. hemochromatosis ruled out by fe/tibc < 45. tsh normal. ggt significantly elevated suggesting possible biliary process. ruq u/s showed only cholelithiasis. anti-smooth muscle negative. igg normal. mitochondrial m2 igg normal. ceruloplasmin normal. ttg-iga was normal. had liver bx at osh which was unrevealing. liver had also recommended checking lkm-1, , ama abs to r/o autoimmune hepatitis but cannot find record of those in system. lfts were trended during her admission and remained stable. tylenol and other hepatotoxic agents were avoided during admission. . # b1 thymoma: s/p her 1st course of chemo on including cyclophosphomide, doxurubicin, cisplatin. the overall plan for her is chemo-radiation and then surgical intervention. b1 thymoma has a good prognosis and rx is curative. she has a follow-up appointment with dr. in clinic the week after her discharge to continue with chemotherapy. medications on admission: medications on admission: cyclophosphomide doxurubicin cisplatin oxycodone sr 20 mg q12h docusate sodium 100 mg prn senna 8.6 mg prn oxycodone 10 mg q4h prn metoprolol tartrate 50 mg digoxin 125 mcg daily prochlorperazine 10 mg q6h prn ondansetron 4 mg q8h prn lactulose 30 ml po q6h prn discharge medications: 1. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. oxycodone 20 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 4. oxycodone 5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 5. ondansetron 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed. 6. metoprolol tartrate 25 mg tablet sig: two (2) tablet po tid (3 times a day). 7. lorazepam 0.5 mg tablet sig: one-half tablet po q4h (every 4 hours) as needed for anxiety. 8. acyclovir 400 mg tablet sig: one (1) tablet po five times a day for 8 days: take 1 tablet five times per day for eight days. then take 1 tablet three times per day. disp:*100 tablet(s)* refills:*0* 9. mirtazapine 15 mg tablet sig: two (2) tablet po hs (at bedtime). disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: thymoma atrial fibrillation anxiety depression discharge condition: stable, afebrile discharge instructions: you were admitted with neutropenia, fever and atrial fibrillation (an irregular heart beat). you were treated with antibiotics, iv fluids and rate control medication for your heart rate (metoprolol, digoxin). please continue to take your heart rate medications as ordered. you were also started on medications for your depression and anxiety (lorazepam and remeron). please make sure to follow up with your outpatient psychiatrist to continue these mediations. if you experience any dizziness, racing heart beat and/or shortness of breath, chest pains or any other concerning symptoms please contact your doctor or return to the hospital. followup instructions: provider: , md phone: date/time: 11:00 provider: , md phone: date/time: 11:00 provider: , rn phone: date/time: 12:00 md procedure: injection or infusion of cancer chemotherapeutic substance diagnoses: atrial fibrillation atrial flutter constipation, unspecified major depressive affective disorder, single episode, unspecified antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use other chest pain hypovolemia systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction herpes simplex without mention of complication neutropenia, unspecified nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] malignant neoplasm of thymus other specified aplastic anemias 

Answer: The patient is high likely exposed to