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 / sulfur / demerol / amphotericin b / allopurinol / vicodin / percocet attending: chief complaint: scheduled admission for chemotherapy major surgical or invasive procedure: s/p antegrade nephrostogram s/p picc line placement history of present illness: ms. is a 50 year old woman with history of aml, allogenic transplant in , and recent admissions for right-sided hydronephrosis (), donor lymphocyte infusion in (discharged ), and left-sided hydronephrosis (discharged ). she has been admitted for chemotherapy in preparation for donor lymphocyte infusion vs. second bone marrow transplant. . she reports feeling "lousy" for the past several weeks, with feelings of fatigue and lack of stamina. she has had increased bruising. her steroids were increased last friday to 40mg daily from 30mg daily. she reports a headache and fever to 100.5 last night which came down with tylenol. past medical history: oncology hx: - acute myelogenous leukemia s/p allo transplant - : 5 of 6 matched family member allogenic bmt for aml. father was her donor. she has remained in complete remission; no gvhd. her performance status was 100%. - mid- found to have peripheral blasts and host cells in marrow, suggestive of relapsed aml, planning for dli . pmh: 1. aml- as above 2. allergic rhinitis 3. depression social history: married, lives with her husband and three children ages 13, 8, 6. works as a controller. no tobacco or etoh. family history: both parents living. mother with htn, mi, sle; father with htn. father (donor) recently had mi. siblings with hypertension. physical exam: vitals: t 98.6 bp 107/67 p 98 rr 18 o2sat 98% gen: well-appearing, no acute distress heent: perrl, eomi, op clear, mmm neck: no lad card: rrr, normal s1/s2, no m/r/g pulm: cta bilaterally back: no cvat, mild tenderness around percutaneous nephrostomy insertion site, ecchymoses abd: soft, non-distended, ruq and epigastric tenderness ext: no clubbing or cyanosis, 1+ non-pitting edema bilaterally, 2+ pulses bilaterally skin: some ecchymoses, no rashes neuro: a&ox3, responds appropriately pertinent results: urine cytology : negative for malignant cells. . ruq u/s : mildly distended gallbladder. mildly distended common bile duct. negative sign. hida can be performed for further evaluation if clinically warranted. . ct abd/pelvis : 1. ascites and edema of the small and large bowel. the appearances may be consistent with enteritis or a graft versus host disease. 2. no evidence of perforation. 3. left nephrostomy tube. 4. moderate dilation of right kidney. 5. unchanged appearance of low attenuation lesions in pancreas and liver. . abd x-ray : findings: left nephrostomy tube is present. no dilated bowel loops are identified. stool and air is present in the colon. the osseous structures are unremarkable. impression: no obstruction. . bone marrow core biopsy: diagnosis: markedly hypocellular bone marrow with extensive fibrosis and focal increased blasts, see note. note: the aspirate material is aspicular. the core biopsy shows extensive areas of grade 3 reticulin fibrosis. an immunohistochemical stain for cd34 highlights a focal area with increased interstitial blasts within the extensively fibrotic background, which likely represents minimal residual disease. this was reviewed in consultation with dr. who concurs. compared to the previous biopsy, the current biopsy shows a marked reduction in cellularity. microscopic description. peripheral blood smears: red blood cells show hypochromasia and anisopoikilocytosis with rare microcytes, red cell fragments and dacrocytes. the white blood cell count appears markedly decreased. platelet count appears markedly decreased. large/giant forms are not seen. a limited 25 cell differential shows 100% lymphocytes. aspirate smears: the aspirate material is inadequate for evaluation due to a lack of spicules, hemodilution, and clotted sample. clot section and biopsy slides: the biopsy material is fragmented, but adequate for evaluation. one bony piece is hypocellular with new bone formation and likely represents previous biopsy site. a second bony core fragment contains diffuse background fibrosis occupying more than half the length of this piece. in the remaining half, the cellularity is variable (overall 10%) and is comprised predominantly of plasma cells, lymphocytes, and hemosiderin-laden macrophages. a small lymphoid aggregate is seen. maturing myeloid and erythroid precursors are extremely scant. a cd34 immunohistochemical stain is performed to better assess presence of blasts, given the architectural distortion by background fibrosis. the cd34 stain highlights scattered interstitial mononuclear cells within the fibrotic areas overall comprising ~10% of marrow cellularity (the remaining being lymphocytes and plasma cells). special stains: iron stain is inadequate for evaluation due to lack of spicules. reticulin stain shows extensive grade 3 reticulin fibrosis. trichrome stain does not show any collagen fibrosis. addendum: additional immunohistochemical studies with antibodies against favor viii-related antigen highlights endothelial cells. definite staining amongst blasts is not seen, however, scant tissue remains on deeper sections used for immunohistochemical staining. . renal u/s: impression: no definite evidence of hydronephrosis. left-sided nephrostomy tube is seen in place. likely right-sided ureteral jet. no left ureteral jet identified. . antegrade nephrostogram:impression: persistent narrowing of the distal left ureter, probably from the extrinsic compression, unchanged from the study from one month ago brief hospital course: #) aml. she was admitted for scheduled mec with initial plans for either second dli vs. second bmt. she tolerated mec, but her course was complicated by severe mucositis. pain was controlled with fentanyl pca. she also developed diarrhea (c. diff and other stool cultures negative and symptomatically treated with immodium). day 14 marrow revealed markedly hypocellular bone marrow with extensive fibrosis and focal increased blasts. on discharge, she is to follow-up with her outpatient oncologist for a repeat bone marrow bx and further discussion of additional chemotherapy/mini transplant. . #) abdominal pain: patient was admitted with complaints of mild abdominal discomfort. then, on am of , developed worsening abdominal pain, diffuse, worse in llq. kub negative for free air and obstruction. she was given lorazepam 1g iv for anxiety and sent for ct abd/pelvis without contrast. after returning from ct, bp was found to be 70/40 with continued progression of her pain. she also had some associated nausea. she was mentating normally throughout. she was given a 1l ns bolus with transient improvement of her blood pressure to 95/50s. she was also given aztreonam 2g iv, vancomycin 1g iv, and metronidazole 500mg iv. she also received morphine 1mg iv for pain with little relief. surgery was consulted and she was transferred to the icu. abd ct revealed ascites and edema of the small and large bowel. the appearances may be consistent with enteritis or a graft versus host disease with no evidence of perforation. ultimately, this was felt not to be an acute surgical abdomen. once her blood pressure stabilized and she was aggressively diuresed. following diuresis, her abdominal pain also subsided. by the time of discharge, she was feeling well without abdominal discomfort. . #) hypotension: in the setting of severe abdominal pain, she was found to have sbp in 80's, which responded well to fluid boluses. initially, there was concern for sepsis, and she was started on stress dose steroids, which were ultimately tapered down. afterwards, her bp remained stable. she was discharged on a tapered down dose of 5 mg prednisone qd. . #) fevers: beginning on , she developed fevers to 101. she was empirically covered with aztreonam, vancomycin and caspofungin. there was concern for a line infection from her left ij, which waspulled. the tip was sent for culture, but no organisms grew. blood cx subsequently grew out lactobacillus x3. id was consulted and suggested starting meropenam. given she has a hx of hives to penicillins, she was premedicated and tolerated the meropenam without incident. she was discharged to complete a total of 14 day course of meropenam. ertapenam as qd antibiotic was discussed, but as there was no literature to support its efficacy against lactobacillus, she was discharged with vna services to help administer her iv meropenam. by dicharge, she had been afebrile for greater than 72 hours. . #) hydronephrosis: patient has a history of obstruction of her ureters. the etiology remains unclear as the ureters behave as if there is external compression, but there are no compressing masses seen on any imaging. she was s/p urgent placement of l nephrostomy tube, and had been responding well. on , she developed r flank pain (very mild and intermittent) as well as decreased urine output. there was concern for right ureteral obstruction as well, but abd u/s revealed normal flow through r ureter. urology was consulted regarding taking out her left nephrostomy tube prior to discharge. she had a antegrade nephrostogram, which revealed essentially unchanged partial obstruction of left ureter with only minimal and slow flow. the decision was made for her to follow-up with her urologist, dr. , as an outpatient to further assess in 2 weeks. . #) f/e/n: ivf, bolus as needed, replete electrolytes as needed. she was started on tpn for nutrition given her abdominal pain and was gradually weaned off. by discharge, she was tolerating po's. medications on admission: ciprofloxacin 250mg ritalin 20mg qd citalopram 20mg qd loratadine 20mg qd beclonase fluconazole 200mg qd acyclovir 400mg protonix 40mg sudafed 30 mg qd potassium 20meq powder fluconazole qd prednisone 40mg (increased on friday) discharge medications: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. loratadine 10 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 3. pseudoephedrine hcl 30 mg tablet sig: one (1) tablet po daily (daily). 4. methylphenidate 10 mg tablet sig: one (1) tablet po once a day. 5. beclomethasone diprop monohyd 42 mcg (0.042 %) aerosol, spray sig: one (1) nasal (2 times a day). disp:*qs qs* refills:*2* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 7. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. loperamide 2 mg capsule sig: one (1) capsule po q4h (every 4 hours) as needed for diarrhea. disp:*30 capsule(s)* refills:*1* 9. acyclovir 400 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 10. meropenem 500 mg recon soln sig: one (1) recon soln intravenous q8h (every 8 hours) for 7 days: please premedicate with tylenol. disp:*21 recon soln(s)* refills:*0* 11. potassium chloride 20 meq packet sig: one (1) po once a day. disp:*30 packets* refills:*2* 12. fluconazole 200 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 13. line care please flush and care for line as per iv network protocol discharge disposition: home with service facility: vns of and county discharge diagnosis: primary: aml lactobacillus bacteremia ureteral stricture discharge condition: good discharge instructions: you have aml and received induction chemotherapy during this admission. during this hospital course, you have some narrowing of your left ureter requiring the nephrostomy tube to be in place. you will need to address this issue with your urologist, dr. . also, you have a bacteria called lactobacillus growing in your blood. to treat this bacteria, you will need to take an antibiotic called meropenam iv every 8hours for one week. please attend all follow-up appointments and take all medications as prescribed. followup instructions: please follow-up with dr. at at 12:30. . also, please follow-up with your urologist, dr. to discuss when you can have your nephrostomy tube removed. your appointment with him is on 2:50pm in building , . procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances biopsy of bone marrow transfusion of packed cells injection or infusion of cancer chemotherapeutic substance transfusion of platelets percutaneous pyelogram diagnoses: bone marrow replaced by transplant hypotension, unspecified bacteremia rash and other nonspecific skin eruption peritoneal effusion (chronic) stricture or kinking of ureter neutropenia, unspecified anemia in neoplastic disease other specified bacterial infections in conditions classified elsewhere and of unspecified site, other anaerobes acute myeloid leukemia, without mention of having achieved remission unspecified drug or medicinal substance causing adverse effects in therapeutic use ulcer of anus and rectum encounter for antineoplastic chemotherapy stomatitis and mucositis, unspecified 

Answer: The patient is high likely exposed to