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: adhesive tape / ativan attending: chief complaint: weakness, diplopia, sob and swallow difficulties. major surgical or invasive procedure: none history of present illness: is a 56 year-old right handed woman with significant hx of musk ab positive mg here with progressive weakness, respiratory trouble as well as swallow difficulties concerning for mg exacerbation. patient has been in the prednisone wean process for the past few month in order to prepare for her planned surgery to correct the cystocele and plastic correction of the scars in the neck. she reported that 2 weeks ago her chronic prednisone regimen was adjust from 12.5mg to 10mg daily. since then she developed progressive weakness, mostly in the proximal upper extremities. difficulties on breathing with heaviness sensation on her chest. the shortness of the breath were noticed with minimun effort. in addition she also has experienced swallow difficulties for the past 3 days. she called dr office on and and the dose was increased slowly up to 20mg daily, from the 10mg dose. she continue to have the symptoms and they seemed to progress. today patient also reported diplopia with lateral gaze to the right side. of note, last ivig treatment was in /, and according to the patien, it hasn't helped in controlling her disease. ros: the pt reported a right sided hemicrania headache this morning which has resolved with analgesics. patient denied loss of vision, blurred vision, lightheadedness, vertigo, tinnitus or hearing difficulty. denied difficulties producing or comprehending speech. no bowel or bladder incontinence or retention. the pt denied recent fever or chills. denied chest pain or palpitations. denied nausea, vomiting, constipation or abdominal pain. she tends to have loose stools. no recent change in bowel or bladder habits. no dysuria. past medical history: 1. myasthenia - musk ab+, initial symptoms (dyspnea, diplopia, neck weakness) in . transferred to icu in in myasthenic crisis. underwent ivig (at prior to transfer) then plasmapheresis at that time, also started on prednisone and cellcept. due to difficulty to wean, she also underwent tracheostomy and placement of a peg tube at that time. 2. tracheobronchomalacia status post tracheal stent in - since replaced then removed. 3. gerd and hiatal hernia. 4. history of nephrolithiasis. 5. anxiety. 6. status post partial hysterectomy. 7. status post bladder suspension at age 29. 8. cystocele. 9. dm - prednisone induced, treating with insulin. social history: lives with son with whom she has had problems- does not work but was a former case manager. no tobacco, etoh or illicit drug use. family history: no fh of mg - multiple members with dm. physical exam: vitals: t: 97f p: 95 r: 16 bp: 115/77mmhg sao2: 98% vc 600 nif -32. deep breath following by counting, she reached 21. general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. attentive. language is fluent with intact repetition and comprehension. normal prosody. there were no paraphasic errors. pt. was able to name both high and low frequency objects. able to read without difficulty. speech was not dysarthric. able to follow both midline and appendicular commands. there was no evidence of apraxia or neglect. cn i: not tested ii,iii: vff to confrontation, pupils 4mm->2mm bilaterally, fundi normal iii,iv,vi: eomi, fatigue ptosis l>r. no nystagmus v: sensation intact v1-v3 to lt vii: facial strength decreased/symmetrically, viii: hears finger rub bilaterally ix,x: palate elevates symmetrically, uvula midline : scm/trapezeii bilaterally xii: tongue protrudes midline, no dysarthria motor: normal bulk and tone; no asterixis or myoclonus. no pronator drift. dreased strength in neck extension and preserved in neck flexion delt tri we fe grip io c5 c6 c7 c6 c7 c8/t1 t1 l 4- 5 5 5 5 5 5 r 4- 5 5 5 5 5 5 ip quad hamst df pf l2 l3 l4-s1 l4 l5 s1/s2 l 5 5 5 5 5 5 r 5 5 5 5 5 5 reflex: no clonus tri bra pat an plantar c5 c7 c6 l4 s1 cst l 3 3 3 4 4 flexor r 3 3 3 4 4 flexor -sensory: no deficits to light touch, pinprick, cold sensation, vibratory sense, proprioception throughout. no extinction to dss. -coordination: no intention tremor, dysdiadochokinesia noted. no dysmetria on fnf or hks bilaterally. -gait: not tested. pertinent results: 12:02am blood wbc-3.9*# rbc-3.88* hgb-11.7* hct-37.1 mcv-96 mch-30.2 mchc-31.6 rdw-18.8* plt ct-273 01:47am blood wbc-8.7 rbc-3.91* hgb-11.8* hct-37.5 mcv-96 mch-30.2 mchc-31.4 rdw-18.8* plt ct-307 02:30pm blood wbc-5.8 rbc-4.13* hgb-12.4 hct-39.0 mcv-94 mch-29.9 mchc-31.7 rdw-18.5* plt ct-356 02:30pm blood neuts-83.2* lymphs-13.2* monos-2.8 eos-0.7 baso-0.1 01:47am blood glucose-181* urean-15 creat-0.6 na-137 k-3.4 cl-95* hco3-37* angap-8 01:47am blood alt-49* ast-52* alkphos-76 totbili-1.3 02:30pm blood alt-48* ast-57* ld(ldh)-261* alkphos-78 totbili-0.9 01:47am blood ggt-30 02:30pm blood lipase-43 ggt-30 12:02am blood calcium-8.9 phos-3.9 mg-2.0 01:47am blood albumin-4.0 calcium-9.1 phos-4.5 mg-1.7 02:30pm blood albumin-4.4 02:24pm blood type-art temp-36.4 po2-130* pco2-67* ph-7.37 caltco2-40* base xs-10 intubat-not intuba 06:16am blood type-art po2-82* pco2-69* ph-7.36 caltco2-41* base xs-9 intubat-not intuba 10:16pm blood type-art temp-36.7 po2-86 pco2-65* ph-7.34* caltco2-37* base xs-6 intubat-not intuba 04:23pm blood type-art po2-69* pco2-62* ph-7.37 caltco2-37* base xs-7 intubat-not intuba comment-nasal 02:33pm blood type-art po2-110* pco2-81* ph-7.32* caltco2-44* base xs-11 intubat-not intuba 01:55am blood type-art po2-79* pco2-68* ph-7.35 caltco2-39* base xs-8 06:16am blood o2 sat-95 10:16pm blood o2 sat-96 02:30pm urine color-amber appear-clear sp -1.024 02:30pm urine blood-sm nitrite-neg protein-25 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-5.0 leuks-tr cxr impression: 1. minimal increase in the right lung base opacity which most likely represents atelectasis; however, infectious process such as pneumonia cannot be completely excluded in the correct clinical setting. 2. unchanged bilateral trace pleural effusions. 3. stable appearance of right port-a-cath. video swallow eval impression: mild oropharyngeal dysphagia, without evidence for penetration or aspiration. tte the left atrium is normal in size. the right atrial pressure is indeterminate. left ventricular wall thicknesses and cavity size are normal. there is moderate to severe global left ventricular hypokinesis (lvef = 30 %). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. 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 abdomen/pelvis impression: 1. no evidence of retroperitoneal hematoma. 2. resolution of obstructing left distal ureteric stone since . 3. non-obstructing bilateral sub-2-mm renal calculi. ; hct 27.3, platelets 257 brief hospital course: ms. was admitted with shortness of breath, proximal muscle weakness, and dysphagia, thought to be consistent with myasthenia exacerbation, likely secondary to her recent wean of prednisone as an outpatient. due to concerns for respiratory status, she was admitted to the neurological icu for close observation. . neuro she underwent frequent neuro checks for keeping an eye on progression of symptoms of myasthenia. she did not have any cholinergic symptoms , thus excluding cholenergic crisis as possible cause. she was continued on outpatient doses of prednisone and azothioprine. she was started on ivig in dose of 2 gm/kg, divided over 4 days. she showed mild subjective as well as objective improvement in strength after initiation of ivig, but her respiratory status remained tenuous. after this, she completed a three day course of high-dose steroids (methylprednisolone 1000 mg daily) without significant change in examination. after this, her daily prednisone dose was increased to 60 mg and she underwent five courses of plasmapheresis. during this time she had a slow but steady improvement in her respiratory function and strength. her diplopia resolved, neck flexors and extensors as well as proximal muscles improved to 4+/5. her nif and vc improved significantly (-80 and 1.2 l at time of discharge). . resp she underwent initially q2h, monitering of mechanics including nif and vc. after staring ivig she steadily showed improvement from values as low as -30 /650 to -80 / 1.4 l. the apparently low values disproportionate to clinical status were though to be result of tracheomalacia. she underwent a line for checking abgs. she transiently required bipap during sleep due to tachypnea and rising pco2. she did not require intubation during the hospital course and had been doing well on room air at the time of discharge, and able to count to 40 in one breath. . cards she was constantly monitered on telemetry. she was noted to have atrial fibrilation during the hospital stay on night. this was preceded by placement of a central line which was thought to have possibly provoked the incident. she was evaluated by cardiology, was started on iv amiodarone and iv heparin was started. she converted back to sinus within 24 hrs. amiodarone was switched to po in dose of 400 mg and was advised to switch to 200 mg daiy after a period of 2 weeks. she underwent tte which showed ef of 30-35 percent. in view of dm, and chf, she was continued on heparin with goal ptt 50-70. she was started on coumadin once plasmapheresis was completed with goal inr . as she had been chemically cardioverted, anticoagulation for at least one month was recommended by cardiology. she was monitored on telemetry throughout the hospitalization and was in normal sinus rhythm from through time of discharge (). on inr was 1.3. patient will have outpatient follow up in clinic on . hematology the patient developed a slow drift in all cell lines (wbc, hematocrit, and platelets) during the hospital course. as her platelets dropped to a nadir of 130 while on heparin, hit antibody was checked and was negative. her hematocrit dropped to a nadir of 22.5 and the patient had multiple ecchymoses throughout her body. hemolysis labs were unremarkable and stool guaiacs were negative. ct abdomen and pelvis showed no evidence of retroperitoneal hematoma. it was thought the pancytopenia may have been a late result of her ivig infusions earlier in the hospital course. she received a total of 2 units prbcs due to presumed symptomatic anemia (lightheadedness on standing), and hematocrit remained stable after transfusion (27-30) at the time of discharge. . vascular the patient was found to have a left thigh ecchymosis on pm as well as bilateral foot edema, l>r. concern was highest for hematoma due to recent removal of left femoral central line the day prior, although dvt was also considered. a lle ultrasound is currently pending. the patient's hematocrit has been stable and is continuing to be monitored. . id the patient remained afebrile throughout her hospital course. at time of admission, routine infectious workup was negative. during the hospital course the patient was found to have a urinary tract infection, with urine cx growing klebsiella pneumonia. she completed a seven-day course of ciprofloxacin. on , she was found to have small sores in her mouth, similar to prior hsv infections. she was started on a 5-day course of acyclovir. . endocrine the patient was noted to have elevated fingersticks, ranging from low 100s to low 300s. this was thought to be secondary to her increased steroid doses. her lantus was gradually increased up to 35 units daily and regular insulin sliding scale was used for coverage during the day. medications on admission: 1. azathioprine 100mg 2. alendronate 70 mg po qsun (every sunday). 3. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal twice a day. 4. hyoscyamine sulfate 0.125 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual four times a day as needed for with mestinon. 5. pyridostigmine bromide 60 mg po q6h (every 6 hours). 6. ranitidine hcl 150 mg po hs (at bedtime). 7. paroxetine hcl 20 mg po hs (at bedtime). 8. prednisone currently 20 mg po daily 9. guaifenesin 600 mg tablet sustained release sig: two (2) tablet sustained release po bid (2 times a day) as needed for to manage secretions. 10. lasix 20 mg tablet sig: one (1) tablet po once a day. 11. potassium chloride 20 meq tab sust.rel. particle/crystal sig: one (1) tab sust.rel. particle/crystal po once a day. 12. insulin glargine 100 unit/ml solution sig: eighteen (18) units subcutaneous qam. 13. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous four times a day. discharge medications: 1. azathioprine 50 mg tablet sig: two (2) tablet po bid (2 times a day). 2. alendronate 70 mg tablet sig: one (1) tablet po qsun (every sunday). 3. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal (2 times a day). 4. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). 5. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 6. cholecalciferol (vitamin d3) 400 unit tablet sig: 2.5 tablets po qhs (once a day (at bedtime)). 7. hyoscyamine sulfate 0.125 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual q6h (every 6 hours). 8. pyridostigmine bromide 60 mg tablet sig: one (1) tablet po q6h (every 6 hours). 9. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 10. prednisone 20 mg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 12. ranitidine hcl 150 mg tablet sig: one (1) tablet po hs (at bedtime). 13. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. warfarin 5 mg tablet sig: one (1) tablet po once a day: please adjust as needed for goal inr . disp:*30 tablet(s)* refills:*2* 15. outpatient lab work please check inr two times weekly for goal inr . 16. insulin glargine 100 unit/ml cartridge sig: thirty five (35) units subcutaneous at bedtime. 17. insulin lispro 100 unit/ml cartridge sig: 2-10 units subcutaneous three times a day: sliding scale with meals as directed. discharge disposition: home with service discharge diagnosis: myasthenia atrial fibrillation urinary tract infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with shortness of breath and weakness, consistent with exacerbation of myasthenia . you underwent treatment with ivig, high-dose steroids, and plasmapheresis, with good clinical response. you were continued on your home dose of mestinon and azathioprine. your prednisone was increased to 60 mg daily and you should remain on this dose until you follow up with dr. in four weeks. you also developed atrial fibrillation and were treated with heparin and amiodarone for this. you will need to continue anticoagulation until you follow up with your cardiologist as an outpatient, and further management can be discussed at that time. you were also treated with acyclovir for lesions in your mouth and with an antibiotic for a urinary tract infection. also, your lantus dose was increased as your finger sticks have been running high. this is likely due to your higher dose of steroids. followup instructions: an appointment has been made for you with dr. on wednesday, at 2 pm. his office can be reached at ( with any questions or concerns. also, please continue coumadin as prescribed due to the irregular heart rhythm (atrial fibrillation) which you had during the hospitalization. an appointment has been scheduled for you with dr. on at 1:20 pm at , building, . you may discuss with him if you should continue on anticoagulation after this appointment. please follow up with your pcp, . within one week of discharge. her office can be reached at (. please have your inr checked at that time. provider: , md phone: date/time: 9:30 provider: scan phone: date/time: 8:15 provider: ,interpret w/lab no check-in intepretation billing date/time: 9:00 procedure: venous catheterization, not elsewhere classified therapeutic plasmapheresis diagnoses: esophageal reflux urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia atrial fibrillation diaphragmatic hernia without mention of obstruction or gangrene hemorrhage complicating a procedure anxiety state, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other diseases of trachea and bronchus herpetic gingivostomatitis cystocele, midline dysphagia, unspecified myasthenia gravis with (acute) exacerbation 

Answer: The patient is high likely exposed to