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: amoxicillin / percocet attending: chief complaint: respiratory distress major surgical or invasive procedure: central line placement, arterial line placement history of present illness: 80yo f with h/o chronic lung disease from h/o lymphoma and xrt to the chest area in , in remission since , rll pneumonia in and recurrent pseudomonas and mrsa pnas presented to with respiratory distress now transferred to micu here for further workup. she was recently admitted to on for hypotension and hypoxia, found to have pulmonary edema vs. pneumonia and dehydration. she was started on azithromycin and cefepime on . cta of the chest ruled out a pe but did show a possible narrowing of the previously stented left main bronchus concerning for endobronchial mass, lad, or esophageal mass impinging on the airways. she was evaluated by speech and swallow who recommended thin liquids and soft solids and suggested gi workup of esophageal dysfunction which was deferred to o/p workup. she was taken off cfp after three days because she was stable and finished a 5 day course of azithromycin prior to being discharged to home on . her son emailed her pcp and reported that since leaving the hospital she had had poor po intake, coughing non-stop, and poor uop. the pcp faxed her prescription for guaifensin with codeine which she had been on before and recommended earlier followup. she then vomited yesterday and was weak. her son brought her to . she was initially admitted to the floor even though her lactate was 5 and 86% on 2l nc with bandemia on her differential. they thought possibly aspiration pna. was doing ok til this am when they tried to get her up to commode where she had pre-syncope but when took sounded like vaso-vagal syncope. started on ivf but because extremely crackly throughout did cxr and was not fluid overloaded. she was transferred to icu was placed on nrb and was given lasix and moved to micu. at first tried to take her off nrb but was low 90s/high 80s on 6l. abg: 7.2/72/66. so started bipap. tachycardic in 110s, temp 100.1. bp 100/80. mentating ok but abg abnormalities persisted so intubated. peri-intubation was hypotensive and receiving 3rd liter ns now. creatinine is only 1, calcium corrected is 12 with known history of lymphoma. has also a port from chemotherapy as well as subclavian placed at . had abdominal pain prior to intubation and with lactate elevation they wanted to do abd ct but did not get to it. in addition they wanted a chest ct to eval for pe and re-eval the esophagus and lad seen previously but did not get to that either. they did place an ngt at with lots of resistence and unclear if in right place per the attending at the osh. cxr read there pending. . en route received fentanyl bolus. also put out about 60ml urine on the way over. on the floor, patient was initially 100% on 350x16 60% and 5 of peep. bp was 108/80 on 7mcg/min levophed. she was not completely sedated and with palpation of the abdomen had grimacing but did not answer questions or follow commands. . review of systems: unable given intubated but per son no diarrhea, fevers, abdominal pain. positive for and profound weakness (able to walk with walker normally and yesterday could not at all). past medical history: large b-cell lymphoma in with significant lymphadenopathy causing compression to the left main bronchus s/p stent in the left bronchus, and chemotherapy and xrt to the chest area. the lymphoma has been in remission since mid and endobronchial stent was removed in . pseudomonas pna in c diff colitis diastolic chf hypothyroidism htn rheumatic heart disease as a child hyperlipidemia social history: prior to recent hospitalizations lived with son and daughter. retired teacher from . moved to us in . no recent travel. no tobacco, etoh or drugs family history: n/c physical exam: : bp: 114/53 p:97 r:16 o2:98% on 350x16 50% and 5 peep general: intubated sedated awake but not following commands heent: sclera anicteric, drymm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: rhochorous bs bilaterally. no wheezing. cv: irregularly irregular. sm rusb abdomen: soft, ttp diffusely (grimaces on palpation), bowel sounds present, gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis 2+ edema on right 1+ edema on left pertinent results: admission labs: 07:00pm blood wbc-11.1*# rbc-3.35* hgb-9.7* hct-33.0* mcv-98# mch-28.8 mchc-29.3* rdw-17.8* plt ct-111* 07:00pm blood neuts-87.0* lymphs-9.9* monos-2.6 eos-0 baso-0.5 07:00pm blood pt-14.0* ptt-28.7 inr(pt)-1.2* 07:00pm blood glucose-99 urean-25* creat-0.8 na-137 k-4.2 cl-99 hco3-23 angap-19 07:00pm blood alt-56* ast-118* ld(ldh)-953* ck(cpk)-50 alkphos-189* totbili-1.0 07:00pm blood calcium-9.2 phos-3.3 mg-1.6 . lactate trend: 07:52pm blood lactate-8.4* 12:36am blood lactate-5.8* 11:47am blood lactate-6.3* 09:20pm blood lactate-3.6* 02:50pm blood lactate-3.4* 12:11pm blood lactate-6.4* 09:32pm blood lactate-7.6* 10:43am blood lactate-12.6* 08:46pm blood lactate-19.1* 10:15pm blood lactate-20.2* 12:03am blood lactate-12.9* . 10:55am blood igg-1661* iga-574* igm-201 10:21am blood cortsol-42.0* 11:45am blood pth-11* 03:43pm blood triglyc-173* 07:00pm blood alt-56* ast-118* ld(ldh)-953* ck(cpk)-50 alkphos-189* totbili-1.0 02:52am blood alt-63* ast-147* ld(ldh)-976* ck(cpk)-37 alkphos-149* totbili-0.8 04:44am blood alt-101* ast-234* ld(ldh)-1608* alkphos-152* totbili-1.5 03:02am blood alt-108* ast-246* ld(ldh)-2047* ck(cpk)-67 alkphos-135* totbili-1.9* 03:02am blood alt-108* ast-246* ld(ldh)-2047* ck(cpk)-67 alkphos-135* totbili-1.9* 08:39pm blood alt-1741* ast-* ld(ldh)-* ck(cpk)-688* alkphos-869* totbili-3.3* 11:09pm blood alt-1644* ast-* ld(ldh)-* alkphos-852* totbili-2.7* . cta torso: impression: 1. no evidence of pe. 2. consolidation in the basilar segments of both lower lobes, consistent with pneumonia or aspiration. 3. ascites and generalized mural thickening of the small and large bowel, most prominent in the ileocecal region. this is most likely due to third spacing of extracellular fluid. 4. the celiac artery and superior mesenteric artery are patent, with known obstructive calcified plaque at the origin of the celiac artery. 5. mediastinal and retroperitoneal lymphadenopathy as seen on ct , which is probably related to known history of lymphoma. lymphadenopathy in the upper abdomen has increased in comparison to ct . . echocardiogram: , portable tte (complete) done at 10:56:57 am final referring physician information , , critical care & , e/ks-b23 , status: inpatient dob: age (years): 80 f hgt (in): 64 bp (mm hg): 106/62 wgt (lb): 131 hr (bpm): 118 bsa (m2): 1.64 m2 indication: pericardial effusion. hypotension icd-9 codes: 423.9, 424.1, 424.0, 424.2 test information date/time: at 10:56 interpret md: , md test type: portable tte (complete) son: bzymek, rdcs doppler: full doppler and color doppler test location: west micu contrast: none tech quality: adequate tape #: 2010w000-0:00 machine: vivid i-3 echocardiographic measurements results measurements normal range left atrium - long axis dimension: 3.0 cm <= 4.0 cm left atrium - four chamber length: 4.7 cm <= 5.2 cm left atrium - peak pulm vein s: 0.7 m/s left atrium - peak pulm vein d: 0.4 m/s right atrium - four chamber length: 4.3 cm <= 5.0 cm left ventricle - septal wall thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 4.4 cm <= 5.6 cm left ventricle - systolic dimension: 3.1 cm left ventricle - fractional shortening: 0.30 >= 0.29 left ventricle - ejection fraction: >= 60% >= 55% aorta - sinus level: 2.8 cm <= 3.6 cm aorta - ascending: 3.4 cm <= 3.4 cm aortic valve - peak velocity: 1.4 m/sec <= 2.0 m/sec mitral valve - e wave: 0.5 m/sec mitral valve - a wave: 0.7 m/sec mitral valve - e/a ratio: 0.71 mitral valve - e wave deceleration time: 160 ms 140-250 ms tr gradient (+ ra = pasp): *30 mm hg <= 25 mm hg findings this study was compared to the prior study of . left atrium: normal la and ra cavity sizes. left ventricle: normal lv wall thickness, cavity size and regional/global systolic function (lvef >55%). no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. mildly dilated ascending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. trace ar. mitral valve: normal mitral valve leaflets. no mvp. mild thickening of mitral valve chordae. mild (1+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. mild tr. mild pa systolic hypertension. pulmonic valve/pulmonary artery: pulmonic valve not visualized. no ps. physiologic pr. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor subcostal views. resting tachycardia (hr>100bpm). conclusions the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , regional left ventricular systolic function is now normal and the severity of aortic regurgitation is reduced ?impact of lower systolic blood pressure). brief hospital course: 80yo f with h/o nhl s/p xrt to lung with left main bronchus narrowing s/o stent and recent admission for pna treated with azithro now re-admitted in respiratory failure. . # hypoxic respiratory failure: unclear etiology of this as patient's cxr did not initially overloaded or with any focal infiltrate, she was intubated at for hypercarbic respiratory failure. with her history of pseudomonal pneumonias and recent hospital admissions was broadly covered for hcap. she also underwent leni's and a cta torso that were both negative for thrombus. during her stay she underwent a bronchoscopy for further evaluation of her airways and samples for culture. her respiratory status stabilized, however given her multiple other comorbidities she was unable to be weaned from the ventilator. . # hypotension: initially thought to be likely secondary to sepsis, given the elevated lactate and abdominal pain there was concern for bowel ischemia or infection. ct scans were negative for ischemia and she was treatedly broadly with vancomycin and cefepime. despite the initial improvement in her lactate, it again began to rise and was not responsive to fluids, concerning for a type 2 lactic acidosis that was not reversible, which given her rising ldh was likely related to an underlying malignancy especially given her lymphadenopathy seen on ct and h/o diffuse large b cell lymphoma. over her hospital course at first she was able to be weaned down from her initial pressor requirement, then the day it was decided that her care was not to be escalated her hypotension worsened and she needed to be increased to three pressors. simultaneously her ldh climbed to over 40,000 and her lactate rose to over 20. this decline was presumed to be due to an aggressive malignancy, however given her poor clinical status and uncertain diagnosis the only treatment offered was high dose steroids, which did help her overall clinical picture. the evening of after discussion with the family it was decided to make her dnr and not to escalate her care further, later that evening she passed away with her family at the bedside. medications on admission: medications (on d/c ): aspirin 325 mg by mouth daily calcium carbonate 500 mg by mouth twice a day. cholecalciferol 400 unit by mouth daily dextromethorphan hbr 5 ml by mouth every 6 hours prn diltiazem er120 mg by mouth once a day. docusate sodium 100 mg by mouth twice a day prn ipratropium bromide 0.02 % 1inh every 6 hours prn levothyroxine 137 mcg by mouth daily (daily). mirtazapine 7.5 mg by mouth hs (at bedtime). . medications on transfer: vanc zosyn levophed midaz fentanyl xopenex levoxyl discharge medications: none, patient expired discharge disposition: expired discharge diagnosis: patient expired discharge condition: patient expired discharge instructions: patient expired followup instructions: patient expired procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more biopsy of bone marrow arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: acidosis thrombocytopenia, unspecified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism other and unspecified hyperlipidemia other malignant lymphomas, unspecified site, extranodal and solid organ sites acute respiratory failure septic shock chronic diastolic heart failure 

Answer: The patient is high likely exposed to