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: presenting for elective surgery major surgical or invasive procedure: total abdominal hysterectomy and bilateral salpingo-oopherectomy endotracheal intubation central venous catheter placement arterial line placement history of present illness: the patient is a 60 year old female, with no significant past medical history, recently referred to gynecology-oncology for a diagnosis of ovarian cancer. she initially presented to hospital with a complaint of progressive shortness of breath. she also reported a 20-30 pound weight loss, gradual abdominal distention and bilateral lower extremity swelling. she was found to have a large right pleural effusion and underwent a 2.5 l thoracentesis, with negative cytology. the patient also had a paracentesis with negative cytology at the osh. ct torso on showed bilateral pulmonary opacities, diffuse lymphadenopathy, ascities, and ovarian masses. ultrasound on showed bilateral pelvic soft tissue masses with ascites and normal uterus. ca-125 was elevated at greater than 2500. she was then transferred to the gyn-onc service for further management. . patient underwent tah/bso, and ascites drainage. right pelvic lymph node was sent for frozen section which was found to be consistent with lymphoma. the right ovarian mass was found to be benign. multiple enlarged lymph noes were found, the largest was over 5 cm. intraoperatively, she received 1 l ivf and was bolused subsequently for low uop and for post-operative hypotension. patient was transferred to the for ongoing treatment. . upon arrival to the , patient was intubated and mildly sedated, vs: bp 84/52 map 65 hr 88 o2 sat 95% on ac. central line was placed under ultrasound guidance in the right ij. while in the icu, she was put on up to 3 pressors for her hypotension. she went into acute renal failure (thought to be from hypotension-related atn with a possible component of tumor lysis syndrome from steroid-induced lysis) requiring cvvh and rasburicase. she was successfully taken off cvvh and extubated. she was diuresed aggressively for a 20l net positive fluid status since her icu admission. her abdominal wound was draining up to 1l/day. also while in the icu, she was noted to have an ef of 20%,; it is unclear if this is from an mi in the setting of hypotension or if it is just "shocked" myocardium. . after her acute issues stabilized, the patient was transferred to 7 for further management. past medical history: none social history: the patient smoked one pack per day for 30 years, but currently does not smoke. she drinks occasionally. she is married and has two daughters and one son from a previous marraige. family history: colon cancer physical exam: upon arrival in : gen: sedated, intubated. not responsive to voice or noxious stimuli heent: perrl cv: distant heart sounds, nl s1, s2, no m/r/g pulm: cta anteriorly abd: midline abdominal dressing clean and intact. obese, nontender, hypoactive bowel sounds. ext: warm, trace edema, no cyanosis. pedal pulses present neuro: not responsive to voice or noxious stimuli sedation. pertinent results: 09:05am pt-11.4 ptt-23.1 inr(pt)-1.0 09:05am wbc-6.5 rbc-4.24 hgb-11.3* hct-34.3* mcv-81* mch-26.7* mchc-33.0 rdw-14.7 09:05am plt count-453* 09:05am tot prot-5.9* albumin-3.9 globulin-2.0 calcium-9.3 magnesium-2.3 09:05am alt(sgpt)-6 ast(sgot)-14 alk phos-84 amylase-87 tot bili-0.5 09:05am glucose-78 urea n-22* creat-0.7 sodium-139 potassium-4.1 chloride-96 total co2-27 anion gap-20 03:52pm pt-12.0 ptt-23.7 inr(pt)-1.0 03:52pm plt count-390 03:52pm wbc-10.9# rbc-3.56* hgb-9.7* hct-28.4* mcv-80* mch-27.2 mchc-34.0 rdw-14.9 . ct scan for lymphoma staging: there is mildly heterogeneous and enlarged thyroid gland with a small 1-cm hypodense nodule within the right lobe. there are multiple nodes present within the mediastinum, the largest of which is seen within the paraesophageal space measuring 16 mm in diameter. there are bilateral enlarged hilar lymph nodes which cannot be definitely measured given lack of iv contrast. there is marked axillary lymphadenopathy with a representative node on the right measuring 20 x 18 mm and is seen on series 2, image 6. a representative node within the left axilla is seen on series 2, image 8, measuring 16 x 12 mm. there are multiple tiny nodules seen within the breasts bilaterally, the largest on the left hand side measuring 12 x 15 mm, seen on series 2, image 16. there are bilateral large pleural effusions. the lungs are otherwise clear. along the right thorax just below the scapula, there is a moderate amount of air within the subcutaneous and intramuscular space, probably sequelae from prior thoracentesis. the heart and great vessels are unremarkable. there is a 27 x 15 mm node along the right pericardium measuring 15 x 27 mm, seen on series 2, image 36. the patient is intubated and has a nasogastric tube extending with tip in the post-pyloric region. ct abdomen without iv contrast: there is a moderate amount of ascites. the liver is unremarkable. the gallbladder wall is thickened likely secondary to third spacing. the pancreas is not clearly defined but appears grossly unremarkable. the spleen is prominent, slightly displacing the stomach medially 12 x 7 cm. the adrenal glands are not well visualized secondary to an extensive amount of retroperitoneal lymphadenopathy extending from the level of the sma inferiorly and encasing the aorta and ivc. a representative size of this conglomeration is seen on series 2, image 74 measuring 86 x 52 mm. there is extensive lymphadenopathy within the mesentery with a conglomerate of nodes measuring 57 x 40 mm, seen on series 2, image 85. there is a moderate amount of ascites. the small and large bowel are unremarkable and opacified with oral contrast extending to the rectum. there is no evidence of obstruction. ct pelvis with iv contrast: the urinary bladder is catheterized. the rectum is unremarkable. the uterus is not well visualized. there are no adnexal masses with the exception of extensive lymphadenopathy that extends into the deep pelvis bilaterally inferiorly from the above-mentioned retroperitoneal lymphadenopathy along the iliac nodal chains. the largest bulk of this lymphadenopathy measures 94 x 47 mm along the left iliac nodal chain seen on series 2, image 105. there is extensive inguinal lymphadenopathy, the largest nodal conglomerate seen on the left measuring 49 x 62 mm. also noted within the subcutaneous tissue in the midline of the abdomen are a few pockets of air seen along a linear soft tissue defect likely secondary to prior surgical intervention. bone windows: no suspicious lytic or sclerotic bony lesions. . echo (): the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is severe regional left ventricular systolic dysfunction with near akinesis of the distal 2/3rds of the ventricle. basal segments contract well. the apex is milldy aneurysmal and akinetic, but no masses or thrombi are seen in the left ventricle, though the apex is trabeculated. right ventricular chamber size is normal. there is focal akinesis of the apical half of the rv free wall. the aortic valve leaflets appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. repeat echo prior to r-chop (): the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. there is severe regional left ventricular systolic dysfunction with near akinesis of the distal 2/3rds of the ventricle. basal segments contract well. the apex is milldy aneurysmal and akinetic, but no masses or thrombi are seen in the left ventricle, though the apex is trabeculated. right ventricular chamber size is normal. there is focal akinesis of the apical half of the rv free wall. the aortic valve leaflets appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. abdominal ultrasound (): there are again identified bilateral pleural effusions, partially imaged. there is a moderate-to-large amount of ascites present in all four quadrants, best appreciated in the left lower quadrant. in the left lobe of the liver there are two uniformly hyperechoic lesions, the largest of which measures 2.0 x 1.6 x 1.7 cm with appearance consistent with hemangiomas. no other focal abnormalities are demonstrated within the liver. the gallbladder is collapsed with likely wall thickening again, which could be secondary to third spacing of fluid. a shadowing gallstone is demonstrated within the gallbladder lumen. the spleen is stable in size measuring 11 cm in its longest length. a small roughly 1 cm anechoic lesion, without blood flow is demonstrated within the spleen, not fully characterized on this study, though possibly a cyst. the previously described extensive mesenteric or retroperitoneal adenopathy is not well assessed on this study. color flow and doppler evaluation of the hepatic vasculature was performed given history of ascites. the hepatic veins, hepatic arteries main portal vein and its branches are patent with appropriate direction of flow and normal waveforms. the inferior vena cava is generally narrowed without intraluminal filling defects. this appearance could be secondary to fluid status or secondary to ascites. . cta (): 1. there is a large right pleural effusion with complete passive collapse of the right lung. there is a small left pleural effusion. 2. again seen is mediastinal and pericardial lymphadenopathy, which is not significantly changed in comparison to the prior study. 3. a large amount of ascites. 4. three hypodensities are seen within the visualized portion of the liver which are not completely characterized. . . cytology: pleural fluid: by immunohistochemical stains, the lymphocytes are a mixture of cd20 positive b-cells along with cd3 positive (b greater than t). although definite co-expression of cd5 amongst b-cells could not be discerned, a subset of weak cd5 expressing cells is seen amongst the brighter cd5 positive t-cells. scattered cd10 positive lymphocytes are seen. bcl-1/cyclin d1 is expressed in a minor subset. overall, the findings indicate involvement by the patient's known mantle cell lymphoma. peritoneal fluid: three color gating is performed (light scatter vs. cd45) to optimize lymphocyte yield. abnormal/lymphoma cells comprise 5% of lymphoid gated events. b cells demonstrate a monoclonal lambda light chain restricted population. they co-express pan-b cell markers cd19 along with cd5 and fmc-7. they do not express any other characteristic antigens including cd10, cd23. a subset express cd20. t cells express mature lineage antigens. interpretation findings are of involvement by a lambda restricted, cd5-positive b cell lymphoproliferative disorder, immunophenotypically consistent with patient's known mantle cell lymphoma. given the small percentage of involved b-cells, peripheral blood contamination cannot be ruled out. brief hospital course: 1. see hpi for micu course . 2. mantle cell lymphoma: received 300mg/m2 of cytoxan twice a day for six doses, with high-dose decadron. the decadron was discontinued after the patient developed psychotic paranoia. she developed tumor lysis syndrome with elevated uric acid, and initially requiring cvvh. her counts dropped in response to chemotherapy and she was neutropenic for several days. the patient was treated with neupogen until her counts normalized, and she remained afebrile. her effusions (below) continued to re-accumulate after taps, and ultimately the decision was made to treat the patient with the first round of r-chop. she tolerated the regimen very well, and had no issues completing the prednisone portion of the therapy. the patient was transfused to keep her hematocrit above 25 and platelets above 10. . 3. malignant effusion: the patient originally presented with shortness of breath from a right pleural effusion and ascites. her ascites fluid was drained in the operating room, and not sent for studies. her right pleural effusion was tapped twice, both large volume. cytology was positive for lymphoma. the patient had reaccumulation of both fluid collections, which were unintervenable while she was neutropenic. once her counts recovered, the patient underwent therapeutic paracentesis of 3 liters, which demonstrated malignant cells. the patient remained short of breath after this procedure and underwent a 1.6 liter thoracentesis by interventional pulmonary. she tolerated the procedure well with immediate symptomatic improvement. on a post-procedure x-ray, however, her right lung remained -out. she underwent cta which demostrated a very large right pleural effusion with right lung collapse. the patient, however, had an improvement in her symptoms and decrease in her oxygen requirement. she underwent r-chop in an effort to treat the underlying cause of her effusions. she was discharged on 40 po lasix to take daily, to which she responded well in the hospital. . 4. s/p tah-bso: the patient was originally thought to have ovarian cancer, and she underwent tah-bso on . the diagnosis of lymphoma was made on an intraoperative lymph node biopsy. her ovarian pathology was cystadenofibroma. . 5. cardiomyopathy: in the icu, her ejection fraction was found to be 20%, which is likely ischemic in origin from "shocked" myocardium. repeat tte, when her critical illness resolved revealed an ejection fraction of 55%, but persistent right sided failure. prior to beginning treatment with r-chop, the patient again had an echocardiogram which demonstrated resolution of the right heart failure and 2+ mr. . 6. id: the patient had asymptomatic pyruia on , and was treated for 7 days with zosyn for a citrobacter uti. repeat urine culture was negative. she remained afebrile while neutropenic. . 7. chronic back pain: mri demonstrated no spinal or vertebral involvement of her lymphoma. she was maintained on narcotics for pain control. as her ascites reaccumulated, her pain medication requirement increased. she was discharged on 10 mg oxycontin and 5 mg oxycodone q4 prn. mri revealed no spinal involvement of her lymphoma . 8. disposition: the patient will go to rehabilitation to assist her after her prolonged hospitalization and very low functional status at this point. patient had a port placed by surgery on , which was functional through the hospitalization. she was full code. medications on admission: hnone discharge medications: 1. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 2. artificial tear with lanolin 0.1-0.1 % ointment sig: one (1) appl ophthalmic qid (4 times a day) as needed. 3. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day). 4. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 5. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day) as needed for sob, wheeze. 6. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for bloating. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 10. olanzapine 2.5 mg tablet sig: one (1) tablet po hs (at bedtime). 11. acyclovir 200 mg capsule sig: two (2) capsule po q8h (every 8 hours). 12. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed. 13. oxycodone 10 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po twice a day. 14. oxycodone 5 mg tablet sig: one (1) tablet po every four (4) hours as needed. 15. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 17. prednisone 10 mg tablet sig: one (1) tablet po once a day. 18. heparin lock flush (porcine) 10 unit/ml solution sig: ten (10) ml intravenous daily (daily) as needed. 19. lasix 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* discharge disposition: extended care facility: medical center - discharge diagnosis: mantle cell lymphoma malignant pleural effusion malignant ascites s/p tah/bso tumor lysis syndrome cardiogenic shock chronic low back pain discharge condition: afebrile, hemodynamically stable. on 2l nc discharge instructions: please return to the ed with chest pain, shortness of breath, fevers, chills, or vomiting. . please keep all follow up appointments and take all medications as prescribed. followup instructions: provider: , md phone: date/time: 10:30 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube hemodialysis thoracentesis percutaneous abdominal drainage arterial catheterization other removal of both ovaries and tubes at same operative episode insertion of totally implantable vascular access device [vad] injection or infusion of cancer chemotherapeutic substance biopsy of peritoneum simple excision of other lymphatic structure infusion of vasopressor agent biopsy of pituitary gland, transfrontal approach other local excision or destruction of vulva and perineum other and unspecified total abdominal hysterectomy diagnoses: acidosis mitral valve disorders acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified adrenal cortical steroids causing adverse effects in therapeutic use acute myocardial infarction of other anterior wall, initial episode of care cardiac complications, not elsewhere classified lipoma of other specified sites acute respiratory failure cardiogenic shock antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use reticulosarcoma, unspecified site, extranodal and solid organ sites drug induced neutropenia drug-induced psychotic disorder with delusions benign neoplasm of ovary acute kidney failure with other specified pathological lesion in kidney mucositis (ulcerative) due to antineoplastic therapy torsion of ovary, ovarian pedicle, or fallopian tube 

Answer: The patient is high likely exposed to