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: past medical history: 1. multiple myeloma with xrt and decadron in the past, now on thalidomide. 2. status post laminectomy, l4-s1, and left epidural tumor removal in , complicated by three to four months of hospitalizations and various complications including mrsa debridement with flap closure, left parietal cva, atrial arrhythmias, and a bilateral v-y fasciocutaneous flap. 3. dvt in . 4. sick sinus syndrome/atrial fibrillation, currently followed by a cardiologist, dr. . 5. c. difficile colitis. medications (outpatient): 1. duragesic 100 tp q. 72 hours. 2. msir 15-30 q. four to six hours p.r.n. 3. ms contin 30 q. 12 hours. 4. neurontin 900 mg t.i.d. 5. coumadin 7 mg q.d. 6. dexamethasone 2 mg q. week. 7. thalidomide 200 q.d. 8. depakote 750 mg b.i.d. 9. vitamin d 400 units q.d. 10. tums three tablets q.d. 11. nystatin 15 milliliters swish and swallow q.d. social history: the patient currently lives with his fiance. he denied tobacco or alcohol use. physical examination on admission: vital signs: temperature 98.4, bp 81-95/47-69, heart rate 98-129 (irregular), respiratory rate 23, 100% on room air. general: the patient is not toxic appearing, in no acute distress with warm extremities. heent: the pupils were equal, round, and reactive to light. the extraocular movements were intact. no evidence of conjunctival pallor. neck: supple, full range of motion. no lymphadenopathy or jugular venous distention. pulmonary: clear to auscultation bilaterally. cardiovascular: tachy, irregularly/irregular without evidence of murmurs. abdomen: soft, nontender, nondistended, normoactive bowel sounds. extremities: no evidence of clubbing, cyanosis, or edema, mild pain with hip flexion. rectal: good tone, guaiac negative. neurologic: no evidence of saddle anesthesia. cranial nerves ii through xii were intact. no flaccid droop. there was 5/5 strength and sensation in all extremities. back: evidence of erythema of the patient's lower back with serous drainage from a 1 cm ulcer in the right lower back. no evidence of expressible pus. laboratory/radiologic data: white blood cell count 11.3, hematocrit 28.7, platelets 453,000. sodium 141, potassium 4.6, chloride 105, bicarbonate 33, bun 8, creatinine 0.6, glucose 80, lactate 1.4. inr 8.0 (at ). u/a negative. ekg revealed atrial fibrillation at 112 beats per minute, normal axis, poor r wave progression, no ischemic st-t wave changes. hospital course: 1. cardiovascular: on the night of admission, the patient was noted to be hypotensive and tachycardiac and was evaluated by the night float resident. the patient was eventually transferred to the micu with a concern for sepsis. the patient was briefly on neo-synephrine for blood pressure control but after one day was weaned off and was hemodynamically stable throughout the remainder of his hospital stay. the patient was evaluated with an echocardiogram on which was significant for an ejection fraction of 30-40%, decreased from a previous echocardiogram. the patient was continued on a beta blocker for rate control for the recommendation of the electrophysiology/cardiology service who followed the patient throughout this admission. given his history of atrial fibrillation, the patient was also maintained on coumadin with a heparin drip until his inr was therapeutic for 48 hours. the electrophysiology consult service recommended the patient having a repeat echocardiogram six weeks after discharge as well as possible cardioversion after one month of therapeutic anticoagulation. 2. infectious disease: the patient was admitted with serous drainage from his lower back with an extensive history of wound infections status post laminectomy and epidural tumor removal. given the patient's tachycardia and hypotension, there was a concern for sepsis. the patient was transferred to the micu, as described previously. the plastic surgery and neurosurgery teams were consulted and did not feel that surgical excision or intervention was warranted and recommended continuing antibiotics. the infectious disease consult service was contact and recommended vancomycin and meropenem for broad spectrum coverage. an mri performed was significant for increase in fluid collection posterior to the body of s2 with residual fluid pockets posterior to the previous operative site. the interventional radiation consult service was contact to aspirate this fluid collection and the patient was taken for a ct-guided aspiration on , the results of which are pending at the time of this dictation. the patient received a picc line and will receive iv antibiotics for at least four weeks given a concern for possible osteomyelitis. the patient was also noted to have loose stools and a c. difficile toxin came back negative and the patient was treated with flagyl. 3. oncology: the patient was admitted with a history of multiple myeloma on thalidomide and decadron. these medications were continued. an attempt was made to contact the patient's oncologist, dr. , who referred us to who has yet to see the patient at the time of this dictation. 4. heme: the patient also has a history of anemia with a stable hematocrit throughout this admission. the patient also has a history of a dvt and atrial fibrillation and was continued on heparin and coumadin as noted above until her inr is therapeutic for 48 hours. 5. fluids, electrolytes, and nutrition: the patient was placed on zinc and vitamin c for wound healing. his sodium was noted to increase throughout his stay in the micu and p.o. intake of free fluid was encouraged with a gradual resolution of his hypernatremia. 6. endocrine: given the patient's hypotension, there was a concern for adrenal insufficiency in this patient who has been on chronic steroids for his multiple myeloma. stim test was performed and the patient did not respond appropriately according to the sepsis protocol and was placed on three days of stress dose steroids for potential adrenal insufficiency. condition on discharge: good. discharge status: the patient is discharged to a rehabilitation facility. discharge diagnosis: 1. draining sinus tract. 2. clostridium difficile colitis. 3. multiple myeloma. 4. sick sinus syndrome. 5. anemia. 6. adrenal insufficiency. discharge medications: 1. gabapentin 900 mg p.o. t.i.d. 2. thalidomide 200 mg p.o. q.d. 3. divalproex sodium 250 mg p.o. t.i.d. 4. vitamin d3 400 units p.o. q.d. 5. calcium carbonate 500 mg p.o. q.i.d. 6. nystatin 5 milliliters p.o. q.i.d. 7. tylenol one to two tablets p.o. q. four to six hours p.r.n. 8. colace 100 mg p.o. b.i.d. p.r.n. 9. senna one tablet p.o. b.i.d. p.r.n. 10. bisacodyl 5 mg one to two tablets p.o. q.d. p.r.n. 11. pantoprazole 40 mg p.o. q.d. 12. dexamethasone 40 mg p.o. q. friday. 13. metoprolol 25 mg p.o. b.i.d. 14. coumadin 6 mg p.o. q.h.s. 15. ascorbic acid 500 mg p.o. b.i.d. 16. zinc sulfate 220 mg p.o. q.d. 17. vancomycin 1 gram iv q. 12 hours. 18. flagyl 500 mg p.o. t.i.d. 19. meropenem 1 gram iv q. eight hours. follow-up: the patient has a follow-up appointment with dr. on at 10:00 a.m. he also has a scheduled echocardiogram on at 2:00 p.m. and a follow-up appointment with cardiologist, dr. , on at 2:30 p.m. of note, the discharge medications and diagnoses are subject to change according to subsequent discharge addendums. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnostic ultrasound of heart catheter based invasive electrophysiologic testing excision or destruction of other lesion or tissue of heart, endovascular approach initial insertion of dual-chamber device initial insertion of transvenous leads [electrodes] into atrium and ventricle atrial cardioversion injection or infusion of immunoglobulin aspiration of other soft tissue diagnoses: other postoperative infection cellulitis and abscess of trunk unspecified septicemia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site intestinal infection due to clostridium difficile multiple myeloma, without mention of having achieved remission systemic inflammatory response syndrome, unspecified 

Answer: The patient is high likely exposed to