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: latex attending: chief complaint: acute lymphoblastic leukemia major surgical or invasive procedure: central line placement history of present illness: 72-year-old woman with history of breast cancer who presents with a new diagnosis of acute lymphoblastic leukemia. patient reports mild fatigue for the past several weeks. for the past week or so she has also experienced left upper quadrant abdominal pain that is constant. there is no fever, chills, nausea, vomiting, bleeding. she had her routine 5-year checkup for her breast cancer on when she was found to have thrombocytopenia. (her platelet count was 58 on and 40 on .) she received platelet transfusion and underwent a bone marrow biopsy that reported showed acute lymphoblastic leukemia. she was then referred to . of note, patient was treated for a urinary tract infection on with tmp-smx ds for two and a half days. she currently has no urinary symptom. in the ed, her initial vitals were t 97, bp 148/73, hr 79, o2 sat 96% on ra. exam revealed luq tenderness. she was admitted to bmt for further management of her acute leukemia. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations. denies cough, shortness of breath, or wheezes. denies nausea, vomiting, diarrhea, constipation. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. denies rashes or skin breakdown. no numbness/tingling in extremities. all other review of systems negative. past medical history: oncologic history: # acute lymphoblastic leukemia: see hpi # breast cancer: right outer quadrant stage iia t1n1 hormone-receptor-positive, her2-negative mixed ductal and lobular carcinoma, currently on anastrozole - : biopsy revealed er-positive, pr-positive, her2-negative invasive carcinoma - : lumpectomy and lymph node dissection - : re-excision - : cytophosphamide, doxorubicin, docetaxel along with adjuvant xrt complete - : started on anastrozole - : mammogram negative other medical history: knee arthritis diet-controlled hypercholesterolemia labile hypertension migraines pneumonia in benign polyp in morbid obesity s/p cataract surgery diverticulosis seen on colonoscopy social history: retired. used to work as a toxicologist for the mass department of public health. no smoking. no drinking or illicit drug use. family history: father had cancer. mother had pancreatic cancer. one brother had a skin cancer. another brother died of head and neck cancer. physical exam: vitals: t 99.8, bp 153/96, hr 104, rr 24, 94%ra gen: very pleasant, morbidly obese elderly woman in no acute distress, awake, alert, with two sons at bedside : extraocular movements intact, conjunctivae clear, sclerae anicteric, oropharynx moist and without lesion neck: supple cv: no jugular venous distention, normal rate, regular rhythm, normal s1/s2, no murmur lungs: clear to ascultation bilaterally, no crackles or wheezes abd: obese, soft, minimally tender at luq, nondistended, bowel sounds present, unable to palpable liver or spleen tips ext: warm, well-perfused, no cyanosis or edema neuro: oriented x 3, answering all questions appropriately, cranial nerves ii-xii intact, 5/5 strength bilaterally throughout, intact sensation to light touch throughout skin: no rash, no ecchymosis or petechiae pertinent results: admission labs: 07:10pm blood wbc-3.6* rbc-3.20* hgb-10.6* hct-28.6* mcv-89 mch-33.2* mchc-37.2* rdw-14.9 plt ct-21* 07:10pm blood neuts-8* bands-1 lymphs-56* monos-1* eos-0 baso-0 atyps-2* metas-0 myelos-0 blasts-32* nrbc-1* other-0 07:10pm blood pt-12.6 ptt-24.0 inr(pt)-1.1 07:10pm blood plt smr-very low plt ct-21* 07:10pm blood glucose-117* urean-24* creat-0.9 na-139 k-4.6 cl-102 hco3-26 angap-16 07:10pm blood alt-33 ast-50* ld(ldh)-805* alkphos-45 totbili-0.5 07:10pm blood totprot-6.2* albumin-4.1 globuln-2.1 calcium-8.9 phos-3.7 mg-2.1 uricacd-5.1 hematology 12:00am blood wbc-1.2*# rbc-2.69* hgb-8.8* hct-24.6* mcv-91 mch-32.7* mchc-35.7* rdw-14.3 plt ct-17* 12:00am blood wbc-0.9* rbc-2.89* hgb-9.3* hct-25.0* mcv-87 mch-32.1* mchc-37.1* rdw-14.8 plt ct-16* 12:00am blood wbc-0.3* rbc-2.77* hgb-8.7* hct-24.6* mcv-89 mch-31.6 mchc-35.6* rdw-14.5 plt ct-40* 12:00am blood wbc-0.1* rbc-2.79* hgb-8.7* hct-24.1* mcv-87 mch-31.3 mchc-36.2* rdw-15.0 plt ct-17* 04:31pm blood wbc-0.9* rbc-2.85* hgb-8.6* hct-24.9* mcv-87 mch-30.1 mchc-34.5 rdw-16.1* plt ct-20* 07:10pm blood neuts-8* bands-1 lymphs-56* monos-1* eos-0 baso-0 atyps-2* metas-0 myelos-0 blasts-32* nrbc-1* other-0 12:00am blood neuts-14* bands-0 lymphs-67* monos-0 eos-0 baso-0 atyps-0 metas-0 myelos-0 blasts-19* nrbc-1* 12:16am blood neuts-7* bands-0 lymphs-87* monos-1* eos-1 baso-0 atyps-2* metas-0 myelos-1* blasts-1* 12:00am blood neuts-38.4* lymphs-54.1* monos-2.8 eos-1.9 baso-2.7* 12:14am blood neuts-0 bands-0 lymphs-100* monos-0 eos-0 baso-0 atyps-0 metas-0 myelos-0 12:00am blood neuts-28* bands-6* lymphs-62* monos-2 eos-0 baso-0 atyps-2* metas-0 myelos-0 04:31pm blood neuts-82* bands-1 lymphs-14* monos-2 eos-0 baso-0 atyps-0 metas-1* myelos-0 nrbc-1* chemistry 12:00am blood glucose-143* urean-25* creat-0.6 na-143 k-3.5 cl-103 hco3-30 angap-14 12:16am blood glucose-113* urean-20 creat-0.5 na-137 k-3.5 cl-101 hco3-30 angap-10 12:33pm blood urean-9 creat-0.5 na-136 k-3.5 cl-98 12:00am blood glucose-94 urean-20 creat-0.7 na-133 k-4.2 cl-102 hco3-26 angap-9 12:01am blood glucose-102* urean-31* creat-1.1 na-133 k-4.0 cl-103 hco3-23 angap-11 12:09am blood glucose-91 urean-41* creat-1.9* na-130* k-4.0 cl-101 hco3-22 angap-11 04:31pm blood glucose-82 urean-46* creat-2.3* na-132* k-3.8 cl-104 hco3-20* angap-12 12:00am blood calcium-8.4 phos-3.0 mg-2.1 uricacd-1.5* 04:31pm blood calcium-7.3* phos-2.2* mg-2.1 cardiac: 10:03am blood ck-mb-4 ctropnt-0.01 probnp-* imaging: ct abdomen w/contrast study date of 11:53 am impression: 1. no evidence for pulmonary embolus or acute aortic syndrome. there is dependent and lingular atelectasis, without focal consolidation suspicious for pneumonia. 2. coronary calcification. 3. splenomegaly, without evidence for splenic infarct or perisplenic hematoma. ct chest w/o contrast study date of 8:37 pm impression: as compared to the previous examination of , small areas of atelectasis in the lung bases have partially resolved. no newly appeared parenchymal opacities, notably no evidence of pneumonia or other infection. unchanged small hiatal hernia. no pleural effusions, no pericardial effusions. ct chest w/contrast study date of 12:49 pm impression: 1. no evidence of infectious process or lymphadenopathy in the chest, abdomen or pelvis. 2. less than 2mm right lower lobe pulmonary nodule, attention on follow up examinations. tte (complete) done at 2:44:28 pm conclusions the left atrium is moderately dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the ascending aorta is moderately dilated. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function. no valvular pathology or pathologic flow identified. biatrial enlargement. dilated ascending aorta. compared with the prior study (images reviewed) of , the overall findings are similar. portable tte (complete) done at 12:59:15 pm the left atrium is moderately dilated. the right atrium is markedly dilated. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall function is probably low normal but difficult to assess. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis or regurgitation. the mitral valve leaflets are structurally normal. physiologic mitral regurgitation is seen (within normal limits). there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. right ventricular function cannot be assessed due to limited image quality. left ventricular function difficult to assess due to poor images and rapid heart rate, but is probably low-normal to normal. brief hospital course: 72-year-old woman with history of breast cancer who presents with a new diagnosis of acute lymphoblastic leukemia. patient was subsequently started on ivf, bowel regimen, allopurinol, and pain management. icu course: patient was transferred to icu for hypoxia, hypotension, and oliguria on . initially received 1l fluid bolus for hypotension and oliguria. at time of arrival, she also has af with . her symptoms were multifactorial with likely underlying infection in the setting of neutropenia, pulmonary edema in the setting of af with and poor forward flow, and from decreased renal perfusion (pre-renal based on urine studies/lytes and negative renal us). pe was part of the differential diagnosis for her symptoms, but no cta was done give . lenis negative. echo could not r/o rv strain. her hr improved with initiation of amiodarone and esmolol gtt, and her sbp improved with better hr control. her probnp was found to be elevated and exam showed peripheral edema, suggesting chf exacerbation in the setting of recent af with , she was given lasix 10 mg and 40 mg while in the icu. while in the icu, she also had voriconazole switched back to micafungin given transaminitis possibly drug toxicity and metronidazole was discontinued metallic taste in the mouth. she was on braod spectrum antibiotics for underlying infectious etiology given her neutropenic fever. crt remained elevated while in the icu but uop remained > 20 cc/hr on average. with improved symptoms with the above mentioned management, patient was transferred back to the floor. #all: on arrival, the patient had a cxr that showed no intrathroacic pathology, a splenic ultrasound that showed a mildly enlarged spleen with no intrasplenic abnormalities, an echo that showed an ef of 55%; the patient subsequently udnerwent a procedure for central line placement. she was started on the protocol for chemotherapy. patient received a modified dose of daunorubicin as she had previously received anthracyclines for treatment of her breast cancer. she received day 1 daunorubicin and vincristine, and day 8 vincristine. following this administration, she c/o numbness and tingling in her fingertips. thus, day 15 and 22 vincristine were held. she was scheduled for day 15 intrathecal methotrexate; however, this was also delayed as 2 attemps at flouro-guided lp were unsuccessful. . # febrile neutropenia: patient was placed on iv vanco and cefepime. she continued to have fevers, so she was placed on iv micafungin. she remained afebrile for a week, and then began spiking to 101. ct scan of the chest showed a new lung nodule. micafungin was thus switched to voriconazole for better coverage of aspergillus. she also had been started on neupogen when she began respiking fevers, so it was initially discontinued. subsequent days () she continued to , a weight appropriate dose of neupogen was started. her antibiotic coverage was broadened to include vancomycin, cefepime, voriconazole, bactrim ppx, and on , levofloxacin and metronidazole were added. . # hypotension: on she was hypotensive in the morning and was found to have blood pressures in the 90's systolic. she had been saturating at ~93% on ra during hospitalization. she was given a unit of blood and pressures responded to the 100s-110s. she was again hypotensive the following morning, and was given a fluid bolus, and she had pressures that were erratic in the 130s and 100s. on the morning of the 27th she was hypotensive to the high 80's and low 90's. she had developed a new oxygen requirement and worsening renal failure, so a cta was not able to be completed. she was transferred to the micu for further management. . # hypoxia: she developed a new oxygen requirement on going from 93% on room air to 91% on 5 liters. coupled with her hypotension and tachycardia, there was concern for sepsis vs. mi vs. pe. she was unable to get a chest cta because of worsening creatinine to 1.9. she was transferred to the unit for further management, and an echo showed massive dilation of the right atrium, in an otherwise difficult to asses echo. she was diuresed some in the unit, but uop was low because of atn. she continued to require oxygen at 3-5l via nc. her bnp was checked and it was >10k suggesting new heart failure. . # tachycardia: on the night of she became tachycardic to 110-130, irregular, and was found to be in a-fib, which was a new diagnosis for her. she was initially was treated with a fluid bolus of a liter for dehydration and hypotension. there was concern for pe vs. sepsis vs. heart failure. the cta could not be done at that time as above. she responded initially to fluid, but then continued to be hypotensive with new oxygen requirement. her dilated right atrium on echo is a likely source of the a-fib. she was loaded with amiodarone drip and put on an esmolol drip to control her rate and rhythm. she was transitioned to po amio and metoprolol. her heart rate was moderately controlled on this regimen. . # transaminitis: she completed her course of aspariginase, and subsequently her lft's increased and were continuing to do so on transfer to the micu on . that morning, she was noted to have asterixis, but was oriented, though confused at times. her transaminitis was likely due to medications, however a ruq was ordered and showed no cholelithiasis, but fatty infiltrated liver, unable to exclude fibrotic disease. her lfts began to downtrend and her confusion resolved. she was lucid and oriented at her time of discharge. . # acute renal failure: her creatinine began to climb starting on and was 3.7 the last lab check. renal was consulted and the insult was consistent with atn. it was likely a combination of poor forward flow and medications that led to her renal failure. . # goals of care: beginning the evening of , and into , ms. expressed her wish to be comfort measure only. she no longer wished to undergo testing, and did not want to take medications any longer aside from pain control. we made available to her symptom control medications for nausea, pain, bowel regimen, and anxiety. we stopped lab draws and vital signs, and tried to the best of our abilities to transition her to hospice care at home. medications on admission: anastrozole 1 mg daily atenolol 25 mg daily discharge disposition: home with service facility: season hospice discharge diagnosis: primary diagnosis: all acute renal failure from atn pancytopenia discharge condition: mental status: clear and coherent. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: mrs. it was a pleasure taking part in your care. you were admitted to and found to have acute lymphoblastic leukemia (all). you were treated with chemotherapy, and your blood counts responded. however, you became sick possibly due to infection, and you also had increasing difficulty breathing, requiring oxygen. your kidneys began to have worsening function, and your heart was not pumping as well as it had in the past. we were treating you for the multiple medical problems that you developed; however, you decided to stop treatment and to be made comfortable. we worked to the best of our abilities to comply with this wish, and to help you transition home with symptom management. . while at home please take the following medications as they will help with your symptoms: please use oxygen, continuous flow 2-6l nasal cannula to help maintain your oxygen level please take morphine 5-10mg (liquid) by mouth every 2 hours as needed for pain control please take famotidine 20mg by mouth as needed for reflux symptoms please take reglan 10mg by mouth every 8 hours as needed for nausea please use lidocaine patches 12 hours on and 12 hours off for pain please take ativan 0.5mg every 8 hours as needed for anxiety please take docusate 100mg by mouth twice a day as needed for constipation please take senna 5ml by mouth twice a day as needed for constipation please take simethicone 40-80mg four times a day, as needed for gas followup instructions: please call your primary care provider , to schedule an appointment if you have any concerns procedure: spinal tap incision of lung injection or infusion of cancer chemotherapeutic substance central venous catheter placement with guidance diagnoses: other iatrogenic hypotension pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation personal history of malignant neoplasm of breast antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use morbid obesity other encephalopathy drug induced neutropenia migraine, unspecified, without mention of intractable migraine without mention of status migrainosus acute lymphoid leukemia, without mention of having achieved remission fever presenting with conditions classified elsewhere polyneuropathy due to other toxic agents other specified aplastic anemias 

Answer: The patient is high likely exposed to