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: shortness of breath major surgical or invasive procedure: none history of present illness: 67 yo m c h/o stage iiib igg kappa multiple myeloma d+24 auto sct who was discharged and presented to clinic with increasing dypnea and productive cough since discharge from bmt service 1 week ago. he was recently admitted with fever, felt pneumonia on ct chest, described as patchy b/l infiltrates. he was treated with vanc/cefepime, and d/c'd to completed a 14-d course of levaquin, set to finish . he states his cough has actually improved since d/c, but his dypnea, especially on exertion, seems worse. he denies fever, chills, chest pain, abdominal pain, dysuria, or trauma. pa/l cxr today revealed improvement in his infiltrates. he has a h/o pituitary adenoma s/p resection and adrenal insufficiency. initial vitals in clinic were t 97.4, bp 138/80, hr 94, rr 20, and 94% on room air. he was noted to be wheezing on exam, and desatted to 89% with ambulation. while in clinic, he received 100mg iv solumedrol, 1 albuterol inhaler, 1l ns, and 2l o2 by nasal cannula, with some improvement in his dyspnea. past medical history: past onc hx: - dx with iiia multiple myeloma after presenting with hypercalcemia and hematuria. upep w/ monoclonal protein - ct abd with lytic lumbar and sacral lesions - bmbx with 30-50% plasma cells, elevate igg kappa- 6781 - treated with thalidomide and dexamethasone with response in - s/p high dose cytoxan - s/p auto sct (received melphalan), c/b neutropenic fever without clear source, briefly on tpn mucositis . pmh: - multiple myeloma as above - pituitary adenoma in , s/p transsphenoidal resection/adrenal insufficiency - intrasellar meningioma s/p resection on - melanoma in situ - hypotestosterone - hypothyroidism secondary to pituitary ablation - history of adult-onset diabetes (initially controlled with oral agents and diet but subsequently requiring insulin while on steroids) per patient has had normal glucose recently and has not needed insulin social history: patient is a retired engineer. married, lives with wife in , . has one son who lives in , has close relationship with son. and his wife are avid organic gardners. no tobacco, etoh, illicits, ivda. family history: maternal uncle with unknown type of cancer (patient thinks that it was myeloma) physical exam: pe: t 97.5 bp 135/79 hr 81 rr 24 98% 2l ht 68" gen - thin but comfortable, speaking in full sentences skin- hematoma over l lateral thigh, no rashes or petechiae noted heent - sclerae anicteric, mmm, op clear, neck supple, no lad cv - rrr, +s1/s2, no m/r/g lungs - bronchial bs throughout with scattered wheeze and crackle abd - soft, nt, nd, normoactive bs, no organomegaly ext - no edema neuro - aao x 3 pertinent results: 12:40pm wbc-4.4 lymph-8* abs lymph-352 cd3-68 abs cd3-240* cd4-31 abs cd4-110* cd8-39 abs cd8-136* cd4/cd8-0.8* 12:40pm gran ct-3423 12:40pm plt smr-normal plt count-185 12:40pm hypochrom-normal anisocyt-normal poikilocy-1+ macrocyt-normal microcyt-normal acanthocy-1+ 12:40pm neuts-69.7 bands-8.1* lymphs-1.0* monos-20.2* eos-0 basos-1.0 12:40pm wbc-4.4 rbc-4.38* hgb-13.9* hct-39.4* mcv-90 mch-31.7 mchc-35.3* rdw-16.0* 12:40pm albumin-3.9 phosphate-1.4* magnesium-2.0 12:40pm probnp-188 12:40pm alt(sgpt)-18 ast(sgot)-27 ld(ldh)-364* alk phos-60 tot bili-0.5 dir bili-0.1 indir bil-0.4 12:40pm estgfr-using this 12:40pm glucose-156* urea n-10 creat-0.7 sodium-134 potassium-3.3 chloride-96 total co2-27 anion gap-14 . cxr pa/l: improvement in the patchy densities seen in both lung bases, particularly on the left side. minimal residual patchy density persists . cta chest: impression: 1. slightly limited examination due to large amount of motion artifact, however no evidence of aortic dissection or pulmonary embolism to the subsegmental level. 2. interval worsening of rml abutting fissure opacity may represent worsening consolidation or atelectasis. no significant interval change to other patchy peripheral opacities and peribronchial wall thickening. differential remains infectious including viral etiologies or atypical bacterial pneumonias. . echo : the left atrium is normal in size. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the left ventricular inflow pattern suggests impaired relaxation. there is no pericardial effusion. impression: preserved biventricular systolic function with impaired left ventricular relaxation. no structural valvular disease or pericardial effusion. . ecg: sinus rhythm. right bundle-branch block. rightward axis. compared to the previous tracing of no definite change brief hospital course: 67 yo m c stage iiib igg kappa multiple myeloma d+27 of auto sct presents with worsened sob. . # hypoxia/sob: initial w/u negative for worsening pna (no fever, cxr and ct showed improved appearance of prior infiltrates, and cough was improved since last admission). he completed his final 2 days of levofloxacin for his prior pna. cardiac cause was investigated with bnp, echo and cxr, and there was no evidence of heart failure (patient did not improve with iv lasix). his hypoxia worsened significantly over the first 24 hours of hospitalization, and he eventually required non-rebreather with 100% o2 and icu admission. cta was negative for pe. he was emperically treated with stress dose steroids. since he had received melphalan induction during stem cell transplant, toxicity was suspected. treatment for melphalan toxicity is high dose steroids, and the patient improved dramatically with this. he was continued on hydrocort 100 q8 when called out of the icu, which was changed to 40mg po bid. he was continued on albuterol and atrovent nebs while hospitalized. plan is for outpatient steroid taper by dr. . . # multiple myeloma: s/p auto sct, when he received melphalan. pt was not neutropenic. he will continue on prophylaxis for pcp with bactrim while on increased dose steroids. . # h/o pituitary adenoma s/p resection/adrenal insufficiency. he was continued on his outpatient dose of testosterone patch and synthroid. steroids were increased as above, and pt to be d/c'd on prednisone 40 , which will be tapered as outpatient. . # meningioma: s/p excision and xrt. is being followed by dr. as outpt. no further w/u needed while inpt. . # dm ii - not on oral regimen or insulin at home, but placed on insulin ss while on steroids. pt has regular insulin at home and knows how to follow a sliding scale, which he will use upon discharge. . # fen: regular diet # ppx: sc heparin while in icu, then ambulatory, po diet, bowel regimen # code: full medications on admission: levofloxacin 500mg po daily levothyroxine 137 mcg daily testosterone 2.5 mg/24 hr patch q24 hydrocortisone 25mg qam hydrocortisone 12.5 mg qafternoon acyclovir 400 mg q8h (stopped ) fluconazole 200 mg daily (stopped ) bactrim ppx (stopped discharge medications: 1. levothyroxine 137 mcg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. testosterone 2.5 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal q24h (every 24 hours). 4. prednisone 20 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 5. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po qmowefr (monday -wednesday-friday). disp:*15 tablet(s)* refills:*2* 6. insulin regular human 300 unit/3 ml insulin pen sig: as directed units subcutaneous three times a day: please use regular insulin for blood glucose >150, as directed by sliding scale at home. 7. acyclovir 200 mg capsule sig: two (2) capsule po three times a day. disp:*180 capsule(s)* refills:*2* discharge disposition: home discharge diagnosis: 1. dyspnea secondary to melphalan pulmonary toxicity 2. multiple myeloma discharge condition: breathing and saturating comfortably on room air. discharge instructions: you were admitted with shortness of breath felt due to toxicity from your chemotherapy, melphalan. you are being treated with steroids (currently prednisone 40mg twice a day), which will be tapered by your outpatient oncologist, dr. . . call you doctor or return to the hospital if you have worsened shortness of breath, fever, chills, or any other symptom that concerns you. followup instructions: please call dr. office for an appointmet in 1 week. procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified peripheral stem cells replaced by transplant antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use multiple myeloma, without mention of having achieved remission hypoxemia other postablative hypothyroidism 

Answer: The patient is high likely exposed to