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 / aztreonam attending: chief complaint: hemoptysis major surgical or invasive procedure: intubation bronchoscopy extubation on history of present illness: 65m h/o multiple myeloma, amyloid, s/p autologous stem cell transplant , on hd for renal failure with hemoptysis x 1 day x 3 episodes. patient came into from for an appointment with dr. , and was found to be coughing blood, with hypoxia, and chest pain. per the wife, the was in his normal state of health until yesterday; he had come up on thursday to visit with dr. on tuesday. he was out chopping ice yesterday, and noted that this am when lifting his grandson he felt slightly sob. additionally, in the very early morning of , he noted at 4 am he was sob, and the wife could hear him wheezing and gurgling (a prior time this had happened the wife said it resolved with dialysis). afterwards, the hsuband showed his wife three bloody coughs he had produced into the toilet. he had also had a cough back in , whcih was trated wtih antibiotics. he has never been sob int he past, and does not have any heart problems, or any obvious problems with bleeding. he does not take any blood thinneres. there are some family members who have been congested. he had a colonscopy recently which showed some polyps, but no obvious source of bleeding. patient has also recently started taking another medication for his rls, although the wife is not certain what this medication is. . in the ed, initial vs were: 96.8 90 188/98 18 97%. patient was started on a heparin gtt, and intubated due to hypoxia and to get a cta. ekg with rate 130 with new lbbb, new st elevation in v2-v3. 10-15 min after, ekg returned to baseline. cta showed pulm hemorrhage and no pe and ? aspiration. patient was reversed with protamin. patient was given furosemide 40mg iv, midazolam 2mg/2ml, fentanyl citrate 100mcg/2ml, acetylcysteine 20% 30ml vial, and a heparin gtt (subsequently dc'ed and reversed) . vitals on transfer -> 97, 63. 152/65, 100% on vent. access: 2 piv cmv, fio2 100%, vt 500, rr 22, peep 15 abg: 7.33/49/61/27 . on the floor, the patient is intubated, but does not appear in any acute distress. . review of systems: unable to obtain secondary to intubation past medical history: oncology history: - multiple myeloma, s/p autologous stem cell transplant in - amyloidosis other medical history: - esrd amyloidosis - hyperlipidemia - restless leg syndrome - h/o genital herpes - depression - anxiety - s/p lens implantation (left) for cataracts - s/p discectomy - history of shoulder injury social history: - he works as a sales executive for luggage store, has been married for about 40 years. he has two children aged 39 and 37, one of whom lives in . - drinks occasionally. - ex-smoker, quit in . family history: he has a significant family history notable for one brother with cll and two first cousins with aml. his son had a recent pe. father died at age 89 of prostate cancer and mother of pe and an mi. physical exam: vitals: t 98.5 bp 160/92 p 82 rr 18 sat 93% on ra general: middle-aged male sitting in bed in nad. heent: perrl, sclera anicteric, eomi, op clear neck: no lad, supple, jvp of heart: rrr, 4/6 systolic murmur heard best at the lusb lungs: patient is breathing comfortably. crackles present bilaterally at the bases. abd: +bs, soft ntnd ext: no edema, lue fistula present neuro: alert and appropriate. 5/5 strength in his upper and lower extremities bilaterally, sensation intact to light touch throughout physical exam on discharge: vitals: t96.8, bp 140/80, hr 78, rr 18, o2sat 92% ra, i/o 460/brp x2 general: middle-aged male sitting in bed in nad. heent: perrl, sclera anicteric, eomi, op clear, bilateral ear canals with evidence of cerum, right tm with good light reflection, but left tm not visible as it is impacted with cerum neck: no lad, supple heart: rrr, holosystolic and diastolic murmur lungs: patient is breathing comfortably. crackles present bilaterally at the bases. abd: +bs, soft ntnd ext: no edema, lue fistula present with presence of strong thrill, left superior knee with presence of mild effusion, left knee not warmer or red, but has point tenderess, rom intact but limited by pain neuro: alert and appropriate. 5/5 strength in his upper and lower extremities bilaterally, sensation intact to light touch throughout pertinent results: admission labs: 10:10am wbc-7.2 rbc-3.75* hgb-11.7* hct-35.5* mcv-95 mch-31.3 mchc-33.0 rdw-17.4* 10:10am neuts-70.6* lymphs-17.2* monos-6.3 eos-4.8* basos-1.0 10:10am plt count-169 10:10am pt-14.0* ptt-26.6 inr(pt)-1.2* 10:10am glucose-123* urea n-70* creat-8.6* sodium-139 potassium-5.4* chloride-95* total co2-28 anion gap-21* 10:10am ck(cpk)-115 10:10am ck-mb-4 ctropnt-0.08* 01:33pm lactate-1.6 01:33pm type-art tidal vol-500 o2-100 po2-61* pco2-49* ph-7.33* total co2-27 base xs-0 aado2-607 req o2-99 intubated-intubated 03:02pm urine color-yellow appear-clear sp -1.017 03:02pm urine blood-tr nitrite-neg protein-500 glucose-250 ketone-tr bilirubin-neg urobilngn-neg ph-8.0 leuk-neg 03:02pm urine rbc-0-2 wbc-0-2 bacteria-rare yeast-none epi-0-2 03:35pm ck(cpk)-47 03:35pm ctropnt-0.04* 05:30pm fibrinoge-457* 05:30pm alt(sgpt)-10 ast(sgot)-15 ld(ldh)-205 ck(cpk)-66 alk phos-72 tot bili-0.4 pertinent labs: 02:34am blood anca-negative b 02:34am blood -negative 05:30pm blood pep-trace abno igg-871 iga-108 igm-60 03:06am blood free kappa and lambda, with k/l ratio: free kappa, serum 88.0 h 3.3-19.4 mg/l free lambda, serum 165.6 h 5.7-26.3 mg/l free kappa/lambda ratio 0.53 0.26-1.65 02:34am blood anti-gbm- <1.0 ref: <1.0 ai 06:16pm bal: polys-71* lymphs-10* monos-13* eos-6* discharge labs: 05:35am blood wbc-5.3 rbc-3.09* hgb-9.3* hct-29.1* mcv-94 mch-30.2 mchc-32.0 rdw-16.6* plt ct-120* 05:35am blood pt-14.9* ptt-27.9 inr(pt)-1.3* 05:35am blood fibrino-462* 05:35am blood glucose-98 urean-51* creat-7.9*# na-140 k-4.0 cl-98 hco3-29 angap-17 05:35am blood totbili-0.4 05:35am blood calcium-8.7 phos-4.1 mg-2.0 05:35am blood hapto-159 micro: blood culture blood culture, routine-pending inpatient urine urine culture- no growth blood culture blood culture, routine-pending inpatient rapid respiratory viral screen & culture respiratory viral culture- negative; respiratory viral antigen screen- negative influenza a/b by dfa not processed inpatient blood culture blood culture, routine-pending inpatient urine legionella urinary antigen - negative blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient rapid respiratory viral screen & culture respiratory viral culture-final; respiratory viral antigen screen-final inpatient bronchoalveolar lavage gram stain- 1+ pmn, no microorganisms seen; respiratory culture- no growth; legionella culture- not isolated; potassium hydroxide preparation- cancelled; fungal culture- not isolated mrsa screen mrsa screen- negative urine urine culture- no growth studies: ekg: baseline artifact. sinus rhythm. q waves in leads v1-v2 with small r waves in lead v3. st segment elevation in leads v1-v3. consider anteroseptal myocardial infarction, age undetermined. low limb lead voltage. since the previous tracing of the precordial lead voltage has increased. the early precordial q waves with st segment elevation are new. consider anteroseptal myocardial infarction, possibly acute. cxr: pa and lateral views of the chest were obtained. there is perihilar ground-glass opacity which is concerning for central pulmonary vascular congestion though given history of hemoptysis, could reflect alveolar hemorrhage. there are small bilateral pleural effusions. cardiomediastinal silhouette appears grossly within normal limits. no pneumothorax is present. bony structures are intact. cta chest: 1. diffuse pulmonary alveolar ground-glass opacities with minimal septal thickening at the apices and peripheral sparing is most consistent with diffuse pulmonary alveolar hemorrhage. 2. dense posterior consolidations in the lower lungs are most compatible with aspirated blood. 3. small bilateral pleural effusions. 4. ng tube terminates in the mid stomach. ett tip 7 cm above carina. 5. poor enhancement of the kidneys is consistent with patient's known chronic renal disease. tte: the left atrium is mildly dilated. 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 aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a very small pericardial effusion. impression: very small pericardial effusion. normal global and regional biventricular systolic function. mild pulmonary hypertension. brief hospital course: 65m h/o multiple myeloma, amyloid, s/p autologous stem cell transplant , on hd for renal failure with hemoptysis admitted on and discharged on . # diffuse pulmonary hemorrhage: patient has dah as seen on both ct as well as on bronchoscopy with non-clearing vials even after wash. differential included cytotoxic and non cytotoxic drugs, infection, or connective tissue disorder. rheumatologic labs were sent (anca, anti-gbm, ) which returned negative. echocardiogram was performed which showed only a mild pericardial effusion, not likely asssociated with connective tissue etiologies. bal was not impressive for infection and patient w/o history or clinical signs of infection. he was continued on continuous mandatory ventilation and was weaned off as his oxygenation improved (extubated on ). per his primary oncologist, patient was started on oseltamivir and levofloxacin for empiric coverage of infectious etiologies. he was ruled out for flu and oseltamivir was d/c-ed. ultimately etiology of dah was unclear but was attributed to receiving heparin in the setting of strain. steroids were not started in this patient as his clinical course improved without intervention. he was discharged with levofloxacin to last him for a total 7-day course until his follow up appointment with his primary oncologist. # esrd: patient has known esrd secondary to myeloma requiring dialysis. was seen by renal and continued on dialysis. during initial session experienced some ectopy with ventricular bigeminy, aflutter, and afib intermittently during dialysis. vss otherwise stable and enzymes rechecked and stable. lytes were checked and wnl. he was started on metoprolol for control of this rhythm, but this was ultimately d/c-ed when he returned to sinus rhythm after completion of his dialysis session. he had no further issue with his dialysis. his last dialysis was performed on the day of discharge . # hld/?cad: patient has somewhat elevated tropinins (0.04-0.08), and per ed report was noted to have some chest pain. ekg has showed variable changes in the precordial leads. patient is not a good candidate for heparin gtt secondary to known dah. enzyme leak was attributed to renal insufficiency and enzymes were trended and remained flat. continued home simvastatin. # myeloma: spep and upep as well as kappa and lambda light chains were sent which showed increased activity of his myeloma. he was discharged with instruction to follow up with his primary oncologist to further discuss the findings. # restless leg syndrome: patient was recently started on a pramipexole. this was uptitrated from his home dose of 0.125 to 0.25 with improved effect. # depression: continued citalopram and home temazepam as needed for insomnia. # htn: initially held antihypertensives given dah, but as patient stabilized, restarted home valsartan 160 mg , nifedepine xl 60 mg , doxazosin 2 mg. his nifedepine was uptitrated to 90 mg , and he was informed of the change and advised to have his blood pressure monitored closely on this new dose. # genital herpes: continued home acyclovir 400 mg daily. # left knee pain, likely prepatellar bursitis. patient was advised to follow up with his physician should the pain not improve with conservative management. # left ear pain, cerumen impaction. he was advised to use over the counter medicine to soften his cerumen and to have his primary care physician to assist with cerumen removal. medications on admission: home medications: acyclovir 400 mg daily citalopram 10 mg daily simvastatin 20 mg daily ranitidine 150 mg daily diovan 160 mg nifedical xl 60 mg doxazosin 2 mg daily ropinirole 2 mg daily temazepam 30 mg qhs renegel 800 mg tid with emals calcium acetate 667 mg 1-2 tabs with meals multivitamin men's 50 1 tab daily epogen 21,000 prn hg - iron 8.8 mg prn zemplar vitamin d 4 mg prn medication on transfer from icu to floor pramipexole *nf* 0.25 mg oral qhs temazepam 30 mg po hs:prn insomnia multivitamins 1 tab po/ng daily ranitidine 150 mg po/ng daily nifedipine cr 90 mg po bid levofloxacin 250 mg po/ng daily duration: 3 doses day 1 = ; last dose on doxazosin 2 mg po/ng hs albuterol 0.083% neb soln 1 neb ih q6h:prn sob/wheezing trazodone 50 mg po/ng hs:prn insomnia lorazepam 1 mg po/ng hs:prn anxiety/insomnia acetaminophen 325-650 mg po/ng q6h:prn pain,fever valsartan 160 mg po/ng docusate sodium (liquid) 100 mg po/ng bisacodyl 10 mg po/pr daily:prn constipation senna 1 tab po/ng :prn constipation nephrocaps 1 cap po daily citalopram 10 mg po/ng daily sevelamer carbonate 800 mg po tid w/meals calcium gluconate iv sliding scale acyclovir 400 mg po q24h simvastatin 20 mg po/ng daily discharge medications: 1. acyclovir 400 mg tablet sig: one (1) tablet po once a day. 2. citalopram 10 mg tablet sig: one (1) tablet po once a day. 3. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 5. valsartan 160 mg tablet sig: one (1) tablet po bid (2 times a day). 6. nifedipine 90 mg tablet extended release sig: one (1) tablet extended release po bid (2 times a day). disp:*60 tablet extended release(s)* refills:*0* 7. doxazosin 1 mg tablet sig: two (2) tablet po hs (at bedtime). 8. pramipexole 0.25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 9. temazepam 15 mg capsule sig: two (2) capsule po hs (at bedtime) as needed for insomnia. 10. sevelamer carbonate 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 11. calcium acetate 667 mg tablet sig: 1-2 tablets po with meals. 12. multivitamin tablet sig: one (1) tablet po daily (daily). 13. epogen 21,000 units as needed per your kidney doctor 14. zemplar 4 mg, as needed per your kidney doctor 15. levofloxacin 500 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 1 doses: take this dose on to complete a total of 7 day course. . disp:*1 tablet(s)* refills:*0* 16. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 capsule* refills:*2* 17. hg-iron 8.8 mg as needed per your kidney doctor discharge disposition: home discharge diagnosis: primary diagnosis: - diffuse pulmonary hemorrhage secondary diagnoses: - end stage renal disease - hypertension - history of multiple myeloma - restless leg syndrome - left ear cerum impaction - left knee prepatellar bursitis 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 to take care of you at the . you were admitted to the hospital because of coughing blood. because your oxygen level was compromised, you were in the intensive care unit. you were intubated on the ventilator, and multiple studies were done including a bronchoscopy (a camera going down to your breathing pipes to look at your airways). it was thought that the bleeding in your lung was due to a lung infection. you were given antibiotics. your symptoms improved and you were extubated from the ventilator. while in the hospital, you also received your dialysis. you have a left knee pain which is thought to be from bursitis. however, you should let your doctor know at follow-up appointment if you continue to have pain in the area. please note the following changes in your medications: - please start levofloxacin 500 mg, 1 tab, by mouth, once every other day to complete the 7-day course on . you have 1 tablet due on . this is dosed for your kidney function. - please increase nifedipine cr to 90 mg, 1 tab, by mouth, twice a day. this was increased because your blood pressure has been high. you can talk to your kidney doctor the dose if necessary. - please start nephrocap, 1 tab, by mouth, once a day. followup instructions: you should call your oncologist, dr. , at on monday to set up a follow-up appointment on tuesday, . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis closed [endoscopic] biopsy of bronchus diagnoses: end stage renal disease renal dialysis status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia peripheral stem cells replaced by transplant acute respiratory failure multiple myeloma, without mention of having achieved remission restless legs syndrome (rls) amyloidosis, unspecified impacted cerumen hemoptysis, unspecified prepatellar bursitis 

Answer: The patient is high likely exposed to