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: no known allergies / adverse drug reactions attending: chief complaint: neutropenic fever, diffuse large b-cell lymphoma. major surgical or invasive procedure: none history of present illness: mr. is a 59 year-old man with a history of diffuse large b-cell lymphoma s/p ivac d11 who presents with fever, nausea and vomiting of 1 day duration. he was feeling overall well until this morning when he developed a fever of 102. he vomited twice (bilious, non-bloody). denies abdominal pain or diarrhea. denies cough, sore throat, rhinorrhea or headache. denies sick contacts though was concerned his milk was old. denies shortness of breath or chest pain. denies rashes. does report increased urinary frequency but no dysuria. yesterday he went to his outpatient oncology appointment, received 1 unit platelets with no complications and felt well enough to walk home. . in the ed, initial vitals were t 100.3, bp 112/89, hr 94, rr 18, 100% nrb. during ed course tmax 102.7. he was noted to be in afib at a rate of 135-160 which improved without intervention. o2 sat 98-100% 2l. bp dropped to 76 and he was given 5l ns and started on levophed. he received vancomycin and cefepime before being transferred to the icu. on arrival to the icu patient was actively rigoring. . patient recently admitted and treated with ivac chemotherapy x 5 days which was complicated by neutropenia, thrombocytopenia, dizziness and diarrhea. hospital stay was also complicated by atrial fibrillation treated with metoprolol and digoxin. patient also has history of pulmonary embolism ( admission) felt to be secondary to right atrial catheter-associated thrombus complicated by likely tia/amaurosis fugax. patient was treated with fondaparinux but this was then stopped last admission due to thrombocytopenia. . ros: the patient denies melena, hematochezia, chest pain, shortness of breath, orthopnea, pnd, lower extremity edema, cough, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash or skin changes. past medical history: oncologic history: mr. initially presented in early with fever, weight loss, and muscle and joint aches. he was diagnosed with pmr and started on prednisone with improvement in his symptoms. during the preceding six months, he reported a history of the generalized body pain as well as fatigue, weakness, and poor appetite. he also reported periodic fevers, drenching night sweats, and a 25-pound weight loss also over the same six months. marked improvement of both his musculoskeletal and constitutional symptoms after prednisone treatment. he then presented to the emergency room on with palpitations and dizziness and was found to be in atrial fibrillation. he has had a history of paf in the past. he was febrile to 101.6 with a heart rate of 126. ct scan of the chest, abdomen, and pelvis on showed multiple low-attenuation lesions within the liver, spleen, and kidneys with characteristics felt atypical for lymphoma. a follow-up mri of the abdomen showed hypovascular masses in both kidneys and spleen of various sizes consistent with lymphoma. mr. then underwent bone marrow aspirate and biopsy on , which showed extensive necrosis with focal involvement by a high-grade b-cell lymphoma, diffuse large b-cell type. fish translocation was notable for c-myc and bcl-2 indicating a "double hit" lymphoma characterized by a burkitt's-like lymphoma. . mr. has overall tolerated his chemotherapy relatively well. he has continued on his fondaparinux daily when on , he noted sudden onset sudden of a dark cover in the lower half of the visual field in his right eye, which lasted minutes, then self-resolved. he presented to the emergency room for evaluation. tee revealed thrombus at the tip of his right atrial catheter, with no pfo. ophthalmology work up was negative and the episode was attributed to tia with recommendation to continue fondaparinux. he was discharged on with no further episodes. . treatment history: 1. initiated treatment with chemotherapy on with two doses of rituxan on and . follow up ct imaging on showed stable lymphomatous lesions in the kidney, spleen, and abdominal nodes. 2. rituxan 500 mg given on with a fever that evening and admission for neutropenia. during admission, noted for atrial fibrillation with rvr and was started on digoxin at 0.125 mg daily along with metoprolol 200 mg daily. 3. readmitted on for his second cycle of chemotherapy, which was delayed for two days due to hypotension and cough. a ct of the chest showed bilateral lower lobe opacities, right greater than left, concerning for infection and he was treated with a course of levaquin. 4. on , received rituxan at 375 mg/m2. 5. follow up pet scan on showed no evidence for lymphoma but was notable for multiple peripheral base pulmonary opacities with rims of soft tissue density and relative central lucencies most of which were new. he underwent ct of the chest for further evaluation, which showed multiple filling defects within the segmental and subsegmental branches of the right lower lobe arteries compatible with pulmonary emboli. 6. admitted on for initiation of anticoagulation with fondaparinux and began third cycle of treatment with on (dose level 2) 7. received rituxan 375 mg/m2 on . 8. admitted on for fourth cycle of treatment with (dose level 3). 9. received rituxan 375 mg/m2 on . 10. admitted on for fifth cycle of treatment with (dose level 3 with adriamycin at dose level 2. received rituxan on . 11. admitted on for high-dose cyclophosphamide. 12. admitted on for ivac (originally admitted for high-dose mtx, but pet scan showed progressive disease). . other medical history: 1. diffuse large b-cell lymphoma, burkitt's like with c-myc and bcl-2 positivity s/p x 5 cycles and multiple rituxan infusions. he has had recurrent disease within 2 - 3 months of his last treatment. patient recently admitted for cns prophylaxis with high-dose mtx for his aggressive lymphoma. however, pet scan prior to admission was concerning for rapidly progressive disease and ct torso on admission agreed with these findings and his ldh continued to rise. he was therefore started on ivac chemotherapy x5 days and discharged on neupogen. 2. paf diagnosed in with now chronic atrial fibrillation in the past several months. he had no history of treatment with anti-arrhythmia or anticoagulation prior to his admission in , currently receiving treatment with metoprolol and digoxin. 3. pulmonary embolism, currently receiving treatment with fondaparinux. 4. polymyalgia rheumatica diagnosed in and managed by dr. , although further treatment on hold while getting treatment for lymphoma and unclear if his symptoms were related to lymphoma and not pmr. 5. remote history of syphilis, gonorrhea, and genital herpes in . 6. tonsillectomy and adenoidectomy in the . 7. myopia. 8. recent probable tia with from thrombus on right atrial catheter tip social history: mr. is married and lives in . he previously worked as a software engineer, but now works without pay from home contributing to open source software projects. he gas two adult children but has minimal contact with them. he is a nonsmoker, drinks alcohol on occasion, and denies any history of illicit drugs. family history: father had an mi in his 70s and his paternal grandfather had an mi in his 40s. his mother is status post aortic valve replacement. his younger brother had probable schizophrenia and died from suicide at age 18. there is no family history of cancer. physical exam: admission exam: vitals: t: 98.8 bp: 100/53 hr: 64 rr: 18 o2sat: 94% 2l gen: pale, thin, no acute distress. heent: eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, mmm, op clear, pale conjunctiva neck: no jvd, cor: irregular rate, no m/g/r, normal s1 s2, radial pulses +2 pulm: lungs ctab, no w/r/r abd: soft, nd, +bs, mild tenderness on llq and ruq but described as "tightness" and not overt abdominal pain, no hsm, no masses ext: no c/c/e, no palpable cords neuro: alert, oriented to person, place, and time. moves all 4 extremities. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. . discharge exam: gen: cachectic, nad cv: rrr, nl s1 and s2, no m/r/g chest: ctab abd: soft, ntnd, +bs pertinent results: admission labs: 12:20pm blood wbc-<0.1* rbc-3.32* hgb-10.0* hct-29.0* mcv-87 mch-30.2 mchc-34.5 rdw-14.8 plt ct-13*# 01:30pm blood wbc-0.1* rbc-3.17* hgb-9.5* hct-26.4* mcv-83 mch-29.8 mchc-35.8* rdw-14.9 plt ct-21* 12:20pm blood neuts-53 bands-0 lymphs-40 monos-0 eos-7* baso-0 atyps-0 metas-0 myelos-0 01:30pm blood neuts-0* bands-0 lymphs-100* monos-0 eos-0 baso-0 atyps-0 metas-0 myelos-0 01:30pm blood pt-14.5* ptt-29.5 inr(pt)-1.3* 01:30pm blood glucose-134* urean-19 creat-1.0 na-134 k-3.6 cl-104 hco3-20* angap-14 12:20pm blood albumin-4.2 calcium-8.9 12:20pm blood alt-15 ast-19 ld(ldh)-161 alkphos-94 totbili-0.5 01:30pm blood digoxin-0.7* 01:38pm blood lactate-1.9 . pertinent labs: , aspergillus galactommanan ag: negative , b-glucan: negative . discharge labs: 05:47am blood wbc-6.1 rbc-3.01* hgb-8.4* hct-25.9* mcv-86 mch-27.9 mchc-32.5 rdw-17.8* plt ct-201 05:47am blood neuts-61.1 lymphs-28.4 monos-9.4 eos-0.8 baso-0.2 05:47am blood pt-15.0* ptt-40.3* inr(pt)-1.3* 05:47am blood glucose-99 urean-21* creat-1.1 na-141 k-4.2 cl-107 hco3-27 angap-11 05:47am blood alt-55* ast-49* ld(ldh)-209 alkphos-81 totbili-0.2 05:47am blood albumin-3.3* calcium-8.6 phos-3.2 mg-2.0 ................................................................ microbiology: bal: no growth lung tissue: no bacterial, fungal, afb, or mycobacterial growth **all blood, urine, and stool cultures were negative** ................................................................ pathology: right 6th rib biopsy: unremarkable bone, cartilage and soft tissue . right lower lobe biopsy: acute and organizing pneumonia with abscess formation. no fungal organisms identified on gms and pas stains. . lymph node biopsy right, level 12: no carcinoma identified in three examined lymph nodes. ................................................................ imaging: cxr: as compared to the previous radiograph, there is a newly appeared right basal and perihilar opacity with subtle air bronchograms, in continuation with the inferior hilar structures. in the setting of neutropenia and fever, a newly appeared pneumonia must be suspected. . ct chest w/ con: 1. right lower lobe pneumonia. 2. small-to-moderate bilateral pleural effusions. 3. mesenteric edema and ascites may reflect third spacing. . cxr: ap chest compared to chest radiograph since , and a chest ct scan . sequence of radiographic findings to suggest pneumonia present on worsened in the right lower lobe on and then the patient subsequently developed pulmonary edema. since nearly all of these abnormalities have resolved. small bilateral pleural effusions remain. . ct chest/abd/pelvis w/ con: large area of consolidation within the right lower lobe now has a new area of cavitation. this could represent progression of known pneumonic consolidation or be representative of fungal disease. clinical correlation recommended. no lymphomatous involvement noted. . : cxr: moderate right pneumothorax has changed in distribution, with a change in posture from supine to erect, now visible in the upper hemithorax. two right pleural tubes are also in place. there is substantial atelectasis at the base of the postoperative right lung and perihilar consolidation which could be atelectasis. obviously follow up will be careful for possibility of postoperative pneumonia. left lung is clear. heart size is normal. a right subclavian infusion port ends in the right atrium. brief hospital course: 59m with burkitt's-like dlbcl s/p r-, high-dose cytoxan, and recent ivac for progressive disease, initially admitted to the icu for febrile neutropenia, found to have pneumonia. . # neutropenic fever: the patient presented on with neutropenic fever to 102 and nausea/vomiting. he became hypoxic requiring oxygen, and hypotensive requiring levophed, and was admitted to the . he had diarrhea, so the source was thought to be gi. he was empirically treated with vanc/cefepime/flagyl. urine and stool cultures (including multiple c.diff's), and urine legionella antigen were negative. cxr and ct showed rml/rll pneumonia (management of pneumonia is discussed below) and micafungin was added. he was eventually weaned off pressors and had improved oxygenation. the micafungin was d/c'd and he was transferred to the floor on . all blood cultures were negative. g-csf was continued post-chemo and his counts improved markedly, so it was stopped on . . # pneumonia: patient was found to have a rml/rll pneumonia on cxr, confirmed by ct chest. he was initially treated broadly with vanc/cefepime/flagyl/micafungin, which was later tapered to vanc/cefepime. he improved clinically, though continued to have intermittent low-grade fevers and productive cough. there was concern for aspiration so he underwent a video-assisted swallowing study which did not reveal any aspiration, though he was switched to thin liquids and soft solids with aspiration precautions. a repeat ct chest on showed new cavitary lesion within the pneumonia. pulmonary was consulted but felt that they would be unable to reach the area via bronchoscopy. antibiotics were switched to vanc/zosyn for better anaerobic coverage out of concern for aspiration pneumonia. at this point the patient was due for another round of chemotherapy, which could not be initiated in the setting of active pneumonia. therefore, ct surgery was consulted to evaluate for possible lobectomy. dr. took the patient to the operating room on where he underwent right thoracotomy and right lower lobectomy with buttressing of bronchial staple line with intercostal muscle, and bronchoscopy with bal. the patient remained in the icu pod 1, to monitor atrial fibrillation. he had afib with rvr pod 1, which stopped after metoprolol 7.5mg iv was given. the anterior chest tube was removed on , and he was transferred to the floor. the last chest tube was discontinued on . post-op course was complicated by a hydropneumothorax which required placement of a pigtail catheter on which was later removed. . # increased stool output: unclear etiology, but all of his stool studies negative, including numerous c. diff toxins. symptomatic control with imodium qid prn. the diarrhea eventually resolved. . # dlbcl: burkitt's-type lymphoma, previously on r-, high-dose cytoxan, and ivac with continued anemia and thrombocytopenia s/p chemo. he was transfused with goal plt>10, hct>24. he was continued on acyclovir and bactrim for viral and pcp . rituxan was given on , but complicated by a reaction of the way through the dose, and the dose was not restarted. he was given another dose of rituxan on . he is scheduled for a follow-up pet scan on . . # atrial fibrillation: his hr was poorly controlled despite uptitrating the digoxin and metoprolol. cardiology was consulted and a tee with cardioversion was performed on . digoxin was stopped. he was started on amiodarone 40mg tid for 1 week, then 400mg for 1 week, then 400mg daily. he was continued on anticoagulation with fondaparinux. his metroprolol succinate was decreased to 100 mg daily from 200 mg daily. he will follow-up with dr. from cardiology. medications on admission: 1. g-csf (neupogen) 300mcg sc daily 2. levofloxacin 500mg po daily 3. acyclovir 400mg po q8h 4. sulfamethoxazole-trimethoprim 800-160mg po mwf 5. digoxin 125mcg po daily 6. metoprolol succinate 100mg po hs 7. fondaparinux 7.5mg/0.6ml syringe sc daily, on hold since 8. oxycodone 5-10mg po q4h prn pain 9. calcium carbonate 200 mg (500 mg) po tid 10. cholecalciferol (vitamin d3) 400 unit po daily 11. famotidine 20mg po q12h 12. mvi one tablet po daily 13. ondansetron 4mg po tid prn discharge medications: 1. acyclovir 200 mg capsule sig: two (2) capsule po q8h (every 8 hours). 2. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po mwf (-wednesday-friday). 3. famotidine 20 mg tablet sig: one (1) tablet po once a day. 4. oxycodone 5 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. 5. multivitamin tablet sig: one (1) tablet po once a day. 6. amiodarone 200 mg tablet sig: two (2) tablet po see below: take 400 mg three times per day until , then two times per day until , then once per day after that. disp:*60 tablet(s)* refills:*2* 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 8. calcium 500 500 mg (1,250 mg) tablet sig: one (1) tablet po three times a day. 9. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po at bedtime. 10. guaifenesin-dm nr 10-100 mg/5 ml liquid sig: five (5) ml po twice a day as needed for cough for 5 days. disp:*1 bottle* refills:*0* 11. fondaparinux 7.5 mg/0.6 ml syringe sig: one (1) injection subcutaneous once a day. discharge disposition: home discharge diagnosis: primary diagnosis: - pneumonia - atrial fibrillation . secondary diagnosis: - diffuse large b-cell lymphoma 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 at the . you were initially admitted to the intensive care unit after becoming quite ill after your recent chemotherapy treatment. you were found to have a pneumonia which was treated with antibiotics and the surgeons then removed part of your infected right lung. we also converted your heart back to a normal rhythm and started medication for this. . the following changes were made to your medications: -stop digoxin. -decrease metoprolol succinate. -start amiodarone. . for your incisions: call dr. at if these become red, swollen, or drain. keep chest tube sites covered with gauze and bandages, changing daily, until healed. . you may shower but do not tub bath for 6 weeks. followup instructions: department: radiology - pet scan when: at 1:45 p.m. best parking: garage department: when: at 11:20 am with: , md building: campus: east best parking: garage . department: cardiac services when: wednesday at 2:00 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: insertion of intercostal catheter for drainage diagnostic ultrasound of heart atrial cardioversion closed [endoscopic] biopsy of bronchus injection or infusion of biological response modifier [brm] as an antineoplastic agent other lobectomy of lung diagnoses: polymyalgia rheumatica acute kidney failure, unspecified atrial fibrillation hemorrhage complicating a procedure pneumonitis due to inhalation of food or vomitus iatrogenic pneumothorax antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use abscess of lung other ascites awaiting organ transplant status removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation delirium due to conditions classified elsewhere other fluid overload pain in limb burkitt's tumor or lymphoma, unspecified site, extranodal and solid organ sites chronic pulmonary embolism other specified forms of effusion, except tuberculous gastrointestinal mucositis (ulcerative) 

Answer: The patient is high likely exposed to