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: penicillins / peanut / egg attending: chief complaint: seizure and hematemesis major surgical or invasive procedure: egd history of present illness: 47 l handed male with pmh sig for transverse myelitis dx undergoing tx with 6mo of steroids presents from osh with hematemesis, gastric ulcer with visible vessel s/p egd and cauterization here on . in , he started developing severe lower back pain with weakness in his legs and numbness in his hands. he had been diagnosed by his pcp as having back arthritis. he was progressively getting worse and one day he fell and could not stand up. his symptoms did not improve and he presented to on with worsened hand/le weakness 1/5 strength, hyperreflexia. full spine mri at revealed questionable mass and intramedullary t2 hyperintense from c2-l2 with cord expansion and patchy enhancement. further workup for malignancies included negative abd/chest ct and brain mri. csf analysis revealed wbc 8 , glucose 85, protein 38. , rf, hsv; mycoplasma pcr, vrdl pending; gram stain, cx showed ng. he was started on solu-medrol 1g iv daily x5d with considerable improvement of le strength. repeat mri showed diminished t2 hyperintesities. he was discharged to home on and arranged for solu-medrol taper. he was also started on balcofen for spasticity, and told to f/u as outpatient in clinic. shortly after d/c of steroids, symptoms relapsed. presented here with bacteremia, septic right knee and weakness. at that time pt was found to have a septic joint and gout which was treated appropriately with antibiotics and nsaids. he was later transfered to the neurology service for w/u of his weakness. an mri of the head was normal, but mris of the spine revealed edema and enhancement c3-c6 suggestive for lymphoma vs sarcoid vs myelitis. a chest ct revealed pulmonary nodules. a biopsy of the nodules were performed, which showed only lung parenchyma, however it is uncertain that the nodules were truly biopsied. an lp revealed increased protein, though tap was traumatic and many rbcs were present. csf viral studies-->+vzv, -ebv, and -hsv pcr. ace normal. he was started on a second course of high dose steroids 1gm soulmedrol x5days to be followed by a 6 month course of po steroids. pt was d/c'd home on with improving exam. pt had been doing well at home with pt/ot until , when pt's wife noticed pt undergo a possible seizure followed by coffee ground emesis. the pt's body stiffened. he then began having a rhythmic shaking of the lue for about 30 seconds. pt was then unresponsive for 5-10 minutes, after which he had coffee ground emesis. he was taken to osh, where an egd showed a gastric ulcer with a visible vessel and a hct was 26. pt was treated with h2 blocker and d/c'd home on . the following day, pt developed a second episode, which per the wife, was exactly like the first, and was followed by a large amount of hematemesis. pt taken to osh and then transferred to , where a hct on admission was 24.3. he was admitted to the micu for ugib. past medical history: htn gout hypercholesterolemia asthma c4-c6 spinal stenosis (recent dx) eczema social history: non-smoker former etoh user drinks per night no h/o ivdu married x 8yrs works as computer analyst family history: non-contributory no history of neurologic or ct disease physical exam: vitals: 97.3 110-138/70-90 hr68-90 rr16-18 o2 sat 95-100%. gen: sitting in chair, nad. heent: supple neck pulmonary: cta bilaterally cardiovascular: rrr, s1/s2 no murmur abd: +bs, soft nt/nd ext: no edema mental status: awake and alert, cooperative with exam, normal affect. oriented to person, place, and date. is attentive says backwards. able to relay coherent history. speech is fluent with normal comprehension and repetition; naming intact. registers , recalls . no evidence of apraxia or neglect. no right-left agnosia. cranial nerves: pupils equally round and reactive to light, 4 to 2mm bilaterally. visual fields are full to confrontation. extraocular movements intact bilaterally without nystagmus. ?subtle right lid ptosis. sensation intact v1-v3. no facial movements symmetric. hearing intact to finger rub bilaterally. palate elevation symmetrical shoulder shrug normal bilaterally. tongue midline without fasciculations, intact movements motor: normal bulk bilaterally. tone normal. tri wf we fe ff io apb ip h q df pf te tf r 4+ 5 5- 5 5 5 5 4 4 4 5- 5 5- 5 5- 5 l 5 5 5- 5 5 5 5 4 4 5- 5- 5 5- 5 5- 5 sensation: decreased vibration bilaterally. impaired jps in toes bilaterally. decreased sensation to pin r>l, patchy, no level. reflexes: b t br pa ach right 2 2 2 2 2 left 2 2 2 2 2 brisk throughout +crossed adductors toes were upgoing bilaterally coordination: intact fnf task gait: slow, narrow based, uses walker pertinent results: 11:05pm wbc-10.7 rbc-3.13* hgb-9.1* hct-26.7* mcv-85 mch-29.0 mchc-34.0 rdw-18.1* 11:05pm plt count-155 06:21pm wbc-9.0 rbc-2.91* hgb-8.4* hct-24.2* mcv-83 mch-28.8 mchc-34.6 rdw-18.4* 06:21pm neuts-88.7* lymphs-6.1* monos-4.8 eos-0.3 basos-0.2 06:21pm plt count-188 03:08pm glucose-145* urea n-28* creat-0.8 sodium-142 potassium-3.8 chloride-110* total co2-23 anion gap-13 10:48am blood wbc-10.3 rbc-3.96* hgb-11.6* hct-33.1* mcv-84 mch-29.3 mchc-35.0 rdw-16.8* plt ct-239 06:21pm blood neuts-88.7* lymphs-6.1* monos-4.8 eos-0.3 baso-0.2 10:48am blood plt ct-239 10:48am blood glucose-93 urean-18 creat-0.7 na-138 k-4.2 cl-102 hco3-27 angap-13 04:49am blood ck(cpk)-57 mri (brain) no abnormalities noted mri (c-spine) compared to the previous examination, there is decreased abnormal signal within the cervical cord, largely confined to the region of c3 and c4. there does not appear to be abnormal cord swelling at the present time. there is still some contrast enhancement but this also appears to be reduced compared to the previous examination. degenerative disease is again seen involving c3- c4, c4-c5, and c5-c6, and c6-c7 essentially unchanged compared to the previous examination. for details, see that report. eeg pending brief hospital course: 1. neuro- his last seizure was in . based on his history, probably had additional seizures before admission. here, he was started on trileptal and has remained seizure free. mri showed no evidence of intracranial pathology that may have led to his recent seizures. c-spine mri showed similar, though decreased region of enhancement in the cervical cord at c3/4. the etiology of his his cord pathology is not yet clear. was thought to be neurosarcoid due to presence of pulmonary nodules, but no clear evidence of granulomas or elevated ace was seen. repeat ct of his chest here was normal, with no lad and clear lungs. he has been on chronic steroids for several months though, so his initial findings may have cleared in this setting. in terms of malignancy, biopsy of the lung nodules was non diagnostic in the past and the csf cytology did not contain adequate cells to rule this out as a possible cause. infectious causes seem unlikley, but vzv was positive (pt never had clinic varicella). had a repeat lp here with essentially normal cell count, glucose, and very mildly elevated protein at 50. this was sent for tuberculosis-pcr and cytology. both pending at d/c. he has been on prednisone 60 mg for several months and apparently worsened when they tried to taper him off this medication. we decreased him to 40 mg here and he will f/u with neurology where they can continue to taper this as he tolerates. he had eeg here with no evidence of seizure activity, but his episodes do sound suspicious for seizure. given this, will continue his trileptal as an outpt. etiology of his neurological dysfunction still unclear, but ddx includes tuberculosis, lymphoma, neurosarcoid(less likely), ms. apparently had diffuse enhancement of spinal cord on past mri, which is not classic for any of the above. repeat scan here is much improved as above. will f/u on csf studies. 2. gi - ugib likely secondary to vessel in ulcer as seen on egd. received 2 units prbcs. this vessel was cauterized during this admission and his hct remained stable afterwards. his diet was slowly advanced and he was tolerating solids without issue by discharge. he did have 1 episode of heme positive stool while here, but would expect this given his recent bleed and fact that it was first bm since this. no drop in his hct with this. started on iron. also started on protonix 40 mg . will continue this as outpt and f/u with his pcp 10 days. 3. cv - he was ruled out for mi here. he did have tachycardia on telemetry with activity at times, but wasn't orthostatic. unclear etiology, but didn't suspect pe, dehydration, arrhythmia. encouraged po intake. held his ace-i for the majority of admission, but restarted when he was stable. bp was in 140s systolic without medication. 4.gout:continued his home allopurinol. no issues. told pt to avoid nsaids. 5.pulm:pt was continued on theophylline. could have been contributing to tachycardia, but has been on this for a long time, so decided to continue it. 6.id:continued bactrim for ppx as he is on high dose steroids. medications on admission: theophylline 200mg po bid beclovent 5qid prednisone 60mg po q24h allopurinol 300mg po qd zocor 40mg po qd enalapril 20mg po qd pepcid 20mg po bid bactrim 1tab po bid iron po supplement discharge medications: 1. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 2. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. theophylline 200 mg capsule, sust. release 12hr sig: one (1) capsule, sust. release 12hr po bid (2 times a day). disp:*60 capsule, sust. release 12hr(s)* refills:*2* 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. fluticasone propionate 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*1 mdi* refills:*2* 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 9. oxcarbazepine 300 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 10. prednisone 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: seizure myelitis upper gi bleed/duodenal ulcer discharge condition: improved-hct stable, no seizures, weakness at baseline discharge instructions: please continue to take your medications as directed. your dose of prednisone has been decreased to 40mg daily, you should continue on this dose until your follow up appointment with dr. . you have been started on a new medication called trileptal to prevent seizures, please continue to take this medication. if you have another seizure, or develop new or increasing weakness or numbness, please call dr. or dr. or come to the emergency room for evaluation. followup instructions: 1. neurology: provider: , where: cc clinical center neurology phone: date/time: 2:30 2. primary care: dr. 1:20pm procedure: spinal tap incision of lung endoscopic control of gastric or duodenal bleeding diagnoses: pure hypercholesterolemia unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) gout, unspecified other convulsions chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction 

Answer: The patient is high likely exposed to