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: simvastatin / tricor attending: chief complaint: admission for scheduled allogeneic sct for mds major surgical or invasive procedure: right internal jugular vein tunneled triple-lumen catheter placement by ir left internal jugular temporary triple-lumen catheter placement by ir history of present illness: mr. is a 47-year-old gentleman with history of myelodysplasia with refractory anemia and excess blasts (raeb) who presents for admission for a scheduled allogeneic stem cell transplant. he has been doing well. no current complaints. of note he has a skin graft in the leg after that is somewhat discolored so he was seen by dermatology, who biopsed the lesion. the biopsy showed some evidence of a recent ecchymosis but no evidence of active infection (special stains for microorganisms were negative) and felt that the patient could go forward with transplant at this point. he also had a recent eye stye which was treated by i and d then a 40 day course of tobradex. ros per hpi fevers, sweats, chills, recent infection, sore throat, chest pain, shortness of breath, cough, abdominal pain, nausea, vomiting, or diarrhea. past medical history: mds with refractory anemia hypercholesterolemia history of staph infection in leg wound pilonidal cyst s/p drainage polyps etoh abuse surgery right arm after tree climbing accident as a child oncologic history: is a 47 year old man with transfusion dependent mds (raeb-2) who was diagnosed in 2/. he has received no chemotherapy but has required red cell and platelet support. mr. had a repeat marrow on , that showed approximately 15% blasts, but still consistent with an mds. as this was thought to be some progression towards leukemia in the interim before transplant it was decided to give him a cycle of dacogen. he started dacogen on . social history: he has been married for 15 years. he is a self-employed carpenter who is currently on a leave. he has a 27-year-old daughter who is healthy. he has been a pack per day smoker for 32 years, he quit drinking alcohol in with one relapse in after being told that he needed a stem cell transplant. h/o dui x 2. family history: his father has cancer. his mother is alive and well. he has a full sister who is healthy and a half brother who is also healthy. maternal grandfather died from cancers. maternal grandmother died from a heart condition. his paternal grandmother died from bone cancer in her 70s. physical exam: admission physical exam: vs t: 97.7 bp:102/68 p:55 rr:16 pox: 100% ra gen: aaox3, nad heent: perrl, 5mm lesion on left eye, non-erythematous, eomi, mmm, no thrush, no op erythema or lesions neck: supple, no lad, no jvd cvs: rrr, no m/r/g lungs: reg resp rate, breathing unlabored, lungs clear to auscultation bilaterally, no w/r/r abd: soft, nt, nd, nabs ext: 2+ pulses, no c/c/e, 2cm skin graft present on right leg, discolored skin surrounding graft, no erythema skin: no rashes, lesion on left leg, healing wound above right ankle neuro: cn 2-12 intact, no focal deficits, strength 5/5 in ue and le bilat. discharge physical exam: vs: t98.2, bp 98/60, hr 70, rr 16, 100% ra gen: aaox3, nad heent: perrl, left eye lesion resolved, conjunctiva injected, eomi, mmm, no thrush, no op erythema or lesions neck: supple, no lad, no jvd cvs: rrr, no m/r/g lungs: reg resp rate, breathing unlabored, lungs clear to auscultation bilaterally, no w/r/r abd: soft, nt, nd, nabs ext: 2+ pulses, no c/c/e skin: no rashes, 2cm skin graft present on right leg, hyperpigmented skin surrounding graft, no erythema neuro: cn 2-12 intact, no focal deficits, strength 5/5 in ue and le bilat. pins and needles sensation over right forearm, no extension distal to wrist, reproducible with ulnar nerve palpation pertinent results: admission labs: 09:40pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-40 bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 09:40pm urine color-yellow appear-clear sp -1.018 09:45am urea n-14 creat-0.8 sodium-142 potassium-5.0 chloride-108 total co2-31 anion gap-8 09:45am alt(sgpt)-35 ast(sgot)-41* ld(ldh)-364* alk phos-73 tot bili-1.0 dir bili-0.2 indir bil-0.8 09:45am albumin-4.7 calcium-9.2 phosphate-4.2 magnesium-2.2 uric acid-5.3 09:45am wbc-1.9* rbc-2.70* hgb-8.9* hct-26.5* mcv-98 mch-32.8* mchc-33.6 rdw-21.7* 09:45am neuts-52 bands-0 lymphs-46* monos-0 eos-2 basos-0 atyps-0 metas-0 myelos-0 nuc rbcs-3* 09:45am pt-11.8 ptt-34.2 inr(pt)-1.1 10:12am alt(sgpt)-36 ast(sgot)-35 ld(ldh)-323* alk phos-72 tot bili-1.1 relevent labs: 09:22am blood tacrofk-5.3 08:53am blood tacrofk-6.7 09:35am blood tacrofk-6.9 discharge labs: 12:00am blood wbc-7.5 rbc-3.83* hgb-11.5* hct-34.5* mcv-90 mch-30.0 mchc-33.4 rdw-18.7* plt ct-147* 12:00am blood neuts-66 bands-3 lymphs-11* monos-8 eos-4 baso-0 atyps-0 metas-5* myelos-2* promyel-1* 12:00am blood pt-12.0 ptt-27.8 inr(pt)-1.1 12:00am blood glucose-106* urean-11 creat-0.6 na-134 k-4.3 cl-98 hco3-28 angap-12 12:00am blood alt-26 ast-18 ld(ldh)-285* alkphos-76 totbili-0.6 12:00am blood albumin-3.7 calcium-8.4 phos-3.9 mg-1.6 pertinent micro: : hhv6 pcr, cmv vl negative : ebv h : ebv pcr undetectable pertinent imaging: head ct for headache & thrombocytopenia impression: small fluid within the sphenoid sinus. no acute intracranial hemorrhage. tte the left atrium is mildly dilated. 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. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (coanda effect). the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: normal regional and global biventricular systolic function. mild mitral regurgitation directed anteriorly. compared with the prior study (images reviewed) of , the degree of mitral regurgitation has increased. the other findings are similar. liver ultrasound for elevated lfts impression: 1. coarsened echotexture of the liver and spleen along with borderline splenomegaly. these findings are non-specific. no ascites. 2. 6 mm angiomyolipoma in the left kidney. ct abd for elevated lfts & neutropenic fever impression: 1. no ct explanation for patient's symptoms. 2. borderline splenomegaly is nonspecific. 3. liver cysts as seen on ultrasound. ct chest for hypotension & neutropenic fever findings: the thyroid gland is homogeneous. the lungs are clear. there is no consolidation, effusion or pneumothorax. the airways are patent to the subsegmental level. heart size is normal. a left-sided central catheter terminates in low svc. a right-sided central catheter terminates at the cavoatrial junction. there is no supraclavicular, mediastinal, hilar or axillary adenopathy. limited views of the upper abdomen redemonstrate two cysts in the right lobe of the liver. other visualized intra-abdominal structures are unremarkable. there are no concerning lytic or sclerotic bone lesions. skin biopsy the changes are not well developed. the keratinocyte apoptosis may be the result of recent cytotoxic therapy. possible diagnostic considerations include early evolving drug eruption, viral exanthem, and graft versus host disease. if the eruption progresses, rebiopsy of a more developed lesion may be further revealing. brief hospital course: 47 yo m with history of myelodysplasia with refractory anemia and excess blasts admitted for allogeneic stem cell transplant. course was complicated by neutropenic fever, atrial fibrillation with rapid ventricular response, drug rash, and blepharitis. # myelodysplastic syndrome: 47m with transfusion dependent mds (raeb-2) diagnosed in . he had previously received no chemotherapy but required red cell and platelet support. patient had a repeat marrow on , that showed approximately 15% blasts, but still consistent with an mds. as this was thought to be some progression towards leukemia in the interim before transplant it was decided to give him a cycle of dacogen which was started on . transplant was delayed for question of right shin skin graft infection (evaluated by dermatology) and left eye stye. patient underwent ablative flu/bu/atg, followed by allogenic mud sct, with cmv negative recipient, cmv positive donor. day 0 was . overnight following transfusion of graft, patient became febrile and developed atrial fibrillation with rvr as discussed below, as well as on a second occasion (d+12) just prior to engraftment. tacrolimus levels were monitored closely, patient received prophylaxis with acyclovir and micafungin, and neupogen was stopped upon engraftment. dexamethosone was given in a three-day pulse for suspected engraftment syndrome. antibiotics for neutropenic fever were stopped following engraftment as discussed below. - continue acyclovir and antifungal prophylaxis - continue 2mg tacrolimus, goal level - follow up in hematology/oncology clinic # neutropenic fever: no source identified on ct of chest () or ct abdomen/pelvis (). antibiotic course was as follows :cefepime8/3-8/11, meropenem , aztreo , flagyl , vancomycin . antibiotics were stopped following engraftment and patient was stable and afebrile thereafter. all blood and urine cultures were negative. # afib with rvr: transfusion reaction vs. infection vs. volume depletion vs. nicotine bolus. on the night following graft infusion patient was tachycardic and febrile to 103f, with pressures 80s/50s, responsive to fluids. several hours later, and ekg for persistent tachycardia showed afib with rvr. patient was noted to have nicotine patch was was noted to be in place on arm, with likely increased absorption during fevers, which would predispose to this rhythm. rate control was not achieved following iv metoprolol and iv diltiazem. he was transferred to the icu for further management, including pressors briefly and diltiazem drip. he was transferred back to bmt service on po metoprolol in normal sinus rhythm. one one other occasion patient had similar episode (day +12) requiring another brief stay of similar course in the icu. at time of discharge patient was in normal sinus rhythm, stable on po metoprolol. - discharged on 25mg po metoprolol tartrate q8h - will follow up as outpatient with cardiology clinic #rash: likely drug rash vs. associated with high fevers. erythematous blanchable rash on abdomen and back, petechial rash over anterior thighs. resolved following discontinuation of cefepime, worsened with meropenem, improved on aztreonam and following resolution of fevers. developed a second rash following engraftment with transient papules over thorax on mid axillary line bilaterally. dermatology was consulted, took biopsy out of concern for possible skin graft-versus host disease. biopsy showed early changes with keratinocyte apoptosis (possible result of recent chemotherapy), possible evolving drug eruption, viral exanthem, and graft versus host disease. - if the eruption progresses, rebiopsy of a more developed lesion may be further revealing - will need suture removal # blepharitis: likely due to recent immune reconstitution, possible reaction to normal flora, vs conjunctival gvhd. edematous upper eyelids likely causing conjunctival irritation. patient was evaluated by ophthalmology. - erythromycin ointment, fluorometholone drops for one week following discharge - artificial tears for symptom relief has changes in vision chronic issues: # skin graft right shin: concern for infection on admission. lesion was evaluated by dermatology and biopsied. cultures were negative and pathology showed scar tissue with red cell extravasation and abundant hemosiderin deposits, no signs of infection to delay transplant. lesion was noted to darken during nadir, lightened following engraftment. #hypercholesterolemia: fish oil was held during this admission for risk of myelosuppression. #left eye chalazion: small hyperpigmented lesion was noted on left eye lower lid. patient has remote history of full course of antibiotics for this stye. it was monitored on physical exam daily throughout his hospitalization. ophthalmology was consulted when patient complained of increased tenderness around the area during neutropenic nadir, and had five day course of erythromycin ointment. transitional issues: - will need suture removal on from left chest skin biopsy - tacrolimus dose 2mg po q12h - target tacrolimus dose 5-10 - patient will be followed closely by outpatient hematology/oncology - continuation of metoprolol to be determined by outpatient cardiologist - will need to start bactrim for pcp prophylaxis on +30 - positive ebv titer from medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr. 1. lovaza *nf* (omega-3 acid ethyl esters) 2 g oral 2. nepafenac *nf* 0.1 % ou daily:prn inflammation 3. lorazepam 1 mg po undefined anxiety 4. tobramycin-dexamethasone ophth oint 1 appl left eye qid discharge medications: 1. lorazepam 1 mg po bid:prn anxiety rx *lorazepam 1 mg 1 tablet by mouth twice a day disp #*60 tablet refills:*0 2. acyclovir 400 mg po q8h rx *acyclovir 400 mg 1 tablet(s) by mouth every eight (8) hours disp #*90 tablet refills:*2 3. ursodiol 300 mg po bid rx *ursodiol 300 mg 1 capsule(s) by mouth twice a day disp #*60 capsule refills:*2 4. multivitamins 1 tab po daily 5. gabapentin 300 mg po q8h rx *gabapentin 300 mg 1 capsule(s) by mouth every eight (8) hours disp #*90 capsule refills:*2 6. folic acid 1 mg po daily rx *folic acid 1 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*2 7. fluconazole 200 mg po q 12h rx *fluconazole 200 mg 1 tablet(s) by mouth every twelve (12) hours disp #*60 tablet refills:*2 8. docusate sodium 100 mg po bid:prn constipation rx *docusate sodium 100 mg 1 capsule(s) by mouth every twelve (12) hours disp #*30 capsule refills:*0 9. oxycodone (immediate release) 5-10 mg po q4h:prn pain rx *oxycodone 5 mg tablet(s) by mouth every four (4) hours disp #*60 tablet refills:*0 10. senna 1 tab po bid:prn constipation rx *sennosides 8.6 mg 1 tablet by mouth twice a day disp #*30 tablet refills:*0 11. tacrolimus 1 mg po q12h rx *tacrolimus 0.5 mg 2 capsule(s) by mouth every twelve (12) hours disp #*120 capsule refills:*2 12. ondansetron 8 mg po q8h:prn nausea rx *ondansetron hcl 8 mg 1 tablet(s) by mouth every eight (8) hours disp #*30 tablet refills:*2 13. metoprolol succinate xl 25 mg po daily rx *metoprolol succinate 25 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*2 14. fluorometholone 0.1% ophth susp. 1 drop both eyes tid duration: 1 weeks rx *fluorometholone 0.1 % 1 drop(s) in each eye three times a day disp #*1 bottle refills:*0 15. erythromycin 0.5% ophth oint 0.5 in both eyes duration: 1 weeks rx *erythromycin 5 mg/gram (0.5 %) 1 drop(s) in each eye twice a day disp #*1 bottle refills:*0 16. artificial tears preserv. free 1-2 drop both eyes prn dryness discharge disposition: home with service facility: home therapies discharge diagnosis: primary diagnosis: myelodysplastic syndrome secondary diagnosis: atrial fibrillation with rapid ventricular response discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking part in your care during your hospitalization at . you came to the hospital for stem cell transplant for your myelodysplastic syndrome. when your white blood cell counts were very low, you had fevers and were treated with antibiotics, though no infection was found. during those fevers you experienced a rapid irregular heart rhythm called atrial fibrillation which resolved after going to the intensive care unit for a medicine called diltiazem to slow your heart down. when your heart rate was normal and your cell counts had recovered we stopped the antibiotics. you were stable and able to be discharged soon after. it is very important that you follow up with the hematology/oncology clinic at the appointments listed, and with a new cardiologist as follow up for your atrial fibrillation. you will need your stitches from your skin biopsy removed on by one of your outpatient providers. followup instructions: please attend the following appointments which have been scheduled for you. department: hematology/oncology when: thursday at 8:30 am with: , rn building: sc clinical ctr campus: east best parking: garage department: bmt chairs & rooms when: thursday at 8:30 am department: bmt/oncology unit when: friday at 8:30 am building: fd building (/ complex) campus: east best parking: main garage department: cardiac services when: thursday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage md procedure: closed biopsy of skin and subcutaneous tissue injection or infusion of cancer chemotherapeutic substance allogeneic hematopoietic stem cell transpant without purging transplant from live non-related donor central venous catheter placement with guidance diagnoses: other iatrogenic hypotension pure hypercholesterolemia tobacco use disorder hyposmolality and/or hyponatremia cardiac complications, not elsewhere classified atrial fibrillation myelodysplastic syndrome, unspecified unspecified disorder of skin and subcutaneous tissue rash and other nonspecific skin eruption diarrhea headache systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction drug induced neutropenia other abnormal blood chemistry other fluid overload unspecified drug or medicinal substance causing adverse effects in therapeutic use fever presenting with conditions classified elsewhere blepharitis, unspecified other secondary thrombocytopenia mucositis (ulcerative) due to antineoplastic therapy other mononeuritis of upper limb chalazion 

Answer: The patient is high likely exposed to