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: patient recorded as having no known allergies to drugs attending: chief complaint: anorexia, nausea/vomiting major surgical or invasive procedure: -r inguinal lymph node biopsy () exploratory lap/open ccy/liver biopsy/pancreatic biopsyx/peri-portal lymph node biopsy () exploratory-lap/washout/gj tube () history of present illness: 76ym diagnosed with a pancreatic head mass s/p stenting presents with 3 weeks of nausea, vomiting and anorexia. pt states that he has not been able to take anything by mouth for the past three weeks due to decreased appetite and more recently, nausea and vomiting. he reports a 50lb weight loss in the last 3 months. he also c/o vague diffuse bandlike abdominal pain. otherwise, no fevers, normal bowel movements. he presents for further evaluation of his pancreatic head mass and rehydration. past medical history: htn itp multiple orthopedic procedures pancreatic head mass s/p stenting x 2 social history: live with wife, retired engineer, 7 children, 13 grand children, hx of smoking, no etoh, no drugs, independent on all adl, iadls except financing (wife does that). family history: not contributory physical exam: gen elderly nad heent eomi, perrl, oropharynx without erythema/exudate neck supple cv rrr resp cta bilaterally abd soft ntnd ext bilateral groin with palpable lymph nodes, no le edema neuro aao x 4 pertinent results: sinus rhythm consider left atrial abnormality left axis deviation t wave changes are nonspecific since previous tracing of , no significant change read by: , a. intervals axes rate pr qrs qt/qtc p qrs t 61 178 104 -51 42 ct abd w&w/o c 11:40 am ct abd w&w/o c; ct pelvis w/contrast reason: please evaluate lympadenopathy field of view: 42 contrast: optiray medical condition: 75 year old man with panc head mass, lympadenopathy reason for this examination: please evaluate lympadenopathy contraindications for iv contrast: none. indication: 75-year-old male with pancreatic head mass and lymphadenopathy. evaluate lymphadenopathy. comparison: ct abdomen and pelvis. technique: mdct acquired axial images of the abdomen and pelvis were performed without iv contrast. multiphasic scans were then obtained of the abdomen and pelvis. ct abdomen without and with iv contrast: bibasilar dependent atelectasis. no pleural effusions. no focal liver lesions identified. pneumobilia is again seen and stable. hyperemic gallbladder wall with small amount of surrounding low-attenuation density likely representing fluid is also unchanged. a stent is seen extending from the distal common bile duct into the duodenum. the head, body, tail of the pancreas are unremarkable. spleen is within normal size limits and contains multiple punctate low-attenuation lesions too small to characterize. the right kidney contains multiple low attenuation lesions too small to characterize. the previously seen hypovascular left kidney lesion is decreased in size likely secondary to interval core biopsy. as previously described there is extensive lymphadenopathy seen surrounding the pancreatic head and extending retroperitoneal in the periaortic region extending to the bifurcation of the iliacs. a representative node is seen on series 4, image 48. it is left periaortic, measures 21 mm and is unchanged compared to previously measuring 20 mm. no free air or free fluid. multiple scattered, nonpathologically enlarged mesenteric nodes. small bowel and large bowel are unremarkable. ct pelvis with iv contrast: the urinary bladder, rectum are unremarkable. there are multiple pathologically enlarged nodes bilaterally within the inguinal region. a representative node seen on series 4, image 76 measures 17 mm and node is located lateral to the left external iliac artery. large prostate again noted, unchanged with periureteric edema/filling defect on the right upon insertion into the right hemitrigone. as mentioned previously these raise possibility of a possible bladder base lesion and recommend correlation with cystoscopy. unchanged bilateral fat containing inguinal hernias and extensive iliac nodal lymphadenopathy unchanged. bone windows: no suspicious lytic or sclerotic bony lesions. impression: 1. extensive lymphadenopathy unchanged compared to prior study from three weeks ago. findings consistent with systemic process such as lymphoma. less likely to represent diffuse metastatic disease. percutaneous biopsy can easily be achieved in various locations including retroperitoneum and external iliac chain specifically within the left external iliac region as marked on scan and indicated above. 2. left renal lesion significantly decreased in size, likely secondary to prior biopsy. lymphoma still a strong consideration within differential. 3. multiple low attenuation lesions within right kidney, too small to characterize. 3. right bladder base lesion. as previously described recommend cystoscopy for further evaluation. 4. multiple unchanged splenic lesions too small to characterize. 5. liver lesions too small to characterize on prior study, not definitely seen on todays scan. specimen submitted: lymph node for immunophenotyping. procedure date tissue received report date diagnosed by dr. /kg previous biopsies: lymph nodes, left inguinal. kidney needle bx. flow cytometry report flow cytometry immunophenotyping the following tests (antibodies) were performed: kappa, lambda, and cd antigens 5, 19, and 45. results: due to paucicellular nature of the specimen, a limited panel is performed to determine b-cell clonality. b cells are scant but appear polyclonal and do not co-express cd5. interpretation non-specific lymphoid profile; no phenotypic evidence of lymphoma in specimen. correlation with clinical findings and morphology (see separate report) is recommended. flow cytometry immunophenotyping may not detect all lymphomas as due to topography, sampling or artifacts of sample preparation. note: this test was performed using analyte specific reagents (asrs). these asrs have not been cleared or approved by the us food and drug administration (fda). however, the fda has determined that such clearance or approval is not necessary . this test was developed and its performance characteristics determined by the flow cytometry laboratory at , which is licensed by clia to perform high complexity tests. this test was used for clinical purposes; it should not be regarded as for research. clinical: rule out lymphoma. gross: lymph node for immunophenotyping. cta head w&w/o c & recons; ct 100cc non ionic contrast reason: r/o stroke. pls perform this if head ct w/o contrast is nega contrast: optiray medical condition: 76 year old man with lymphoma workup in progress with acute changes in mental status; r/o stroke. pls perform this if head ct w/o contrast is negative. reason for this examination: r/o stroke. pls perform this if head ct w/o contrast is negative. contraindications for iv contrast: none. indication: rule out stroke. technique: cta of the head with and without contrast and reconstructions. comparisons: subsequent mri of showing normal diffusion. findings: no intracranial hemorrhage, mass effect, shift of normally midline structures or ct evidence of acute ischemia seen. there are hypodensities in the region of the left internal capsule and subcortical region of the left insular region consistent with old ischemic infarctions. there are mild periventricular hypodensities consistent with chronic small vessel angiopathy. vascular calcifications are seen within the intracranial portions of the internal carotid arteries and both vertebral arteries. there is opacification of several ethmoid air cells on the left. the reminder of the visualized portions of the paranasal sinuses and mastoid air cells are well pneumatized. the bony structures and surrounding soft tissue structures appear unremarkable. ct angiogram: no areas of hemodynamically significant stenosis are seen. there is no evidence of aneurysms or dissections. a fenestrated basilar artery is seen. impression: 1. no ct evidence of acute ischemia. old lacunar infarcts in left internal capsule and insular subcortical regions. 2. unremarkable ct angiogram without areas of stenosis, aneurysm or dissection. incidental note is made of a fenestrated basilar artery. object: r/o seizure in a patient with confusion. referring doctor: dr. dr. findings: abnormality #1: focal hz mixed delta and theta frequency slowing was seen involving left temporal region broadly. abnormality #2: bursts of generalized hz delta frequency slowing were seen throughout the recording. background: in the most awake-appearing portions of this tracing, a well-formed 11-11.5 hz alpha frequency background was seen with low voltage beta frequency activity superimposed. hyperventilation: was contraindicated. intermittent photic stimulation: could not be performed as the test was requested as a portable study. cardiac monitor: revealed a generally regular rhythm with average rate of 72 bpm. impression: this is an abnormal eeg due to the presence of focal slowing seen involving the left temporal region suggesting a subcortical abnormality in this area; neuroimaging is recommended. additionally, the presence of bursts of generalized slowing is suggestive of a mild encephalopathy of toxic, metabolic, or anoxic etiology. no evidence of ongoing seizures is seen. interpreted by: , b. mr head w & w/o contrast 4:22 pm mr head w & w/o contrast; mra brain w/o contrast reason: please assess for dwi lesion and cns malignancy w/ mri/mra w contrast: magnevist medical condition: 76 year old man with lymphoma & stroke reason for this examination: please assess for dwi lesion and cns malignancy w/ mri/mra w/ gadolinium clinical information: lymphoma and stroke. mri of the brain with gadolinium. there are scattered t2 high-signal intensity foci in the periventricular white matter and centrum semiovale consistent with microvascular angiopathy. there is some increased signal on the flair sequence in the region of the calcarine cortex on the left raising the question of a meningeal lesion. there is no evidence of abnormal diffusion in this area. the tensor images do not extend all the way to the vertex. there is a focal area of abnormal signal on the susceptibility sequence in the left subcortical parietal white matter without mass effect or abnormal surrounding signal consistent with a cavernoma but possibly reflecting hemorrhage from other source. there is no evidence of a focal extra-axial lesion or fluid collection. ventricles and sulci are mildly prominent consistent with mild brain atrophy. there is increased signal in the ethmoid sinuses. there is no evidence of abnormal contrast enhancement. impression: abnormality of left calcarine cortex, possibly reflecting a meningeal process such as lymphomatous infiltration orperhaps earlier ischemia. the absence of contrast enhancement mitigates against tumor. a lesion in the left parietal lobe probably a cavernoma. see above discussion. ethmoid sinus disease. brain atrophy. mra of the circle of and its major tributaries there is no evidence of aneurysm or flow abnormality. impression: negative mra of the circle of . ct abdomen w/contrast 3:24 pm ct abdomen w/contrast; ct pelvis w/contrast reason: ?abscess ?fistula, please perform w/po and iv contrast thank field of view: 42 contrast: optiray medical condition: 75 year old man with panc head mass, lympadenopathy s/p ex lap w/takeback now w/draining wound reason for this examination: ?abscess ?fistula, please perform w/po and iv contrast thanks contraindications for iv contrast: none. indication: 75-year-old with a reported pancreatic head mass, post recent exploratory laparotomy on , now with draining anterior abdominal wound. assess for fistula. technique: mdct images of the abdomen after the administration of oral and 100 cc of iv contrast. coronal and sagittal reformatted images were obtained. comparison: and . ct of the abdomen after administration of oral and iv contrast: there are new bilateral pleural effusions with associated atelectasis. there is a new small pericardial effusion. new small amount of ascites is seen in the upper abdomen. the liver, spleen, pancreas, and adrenals are unremarkable. cysts are seen in both kidneys, unchanged from the prior study. cortical defect is seen in the mid portion of the left kidney at the site of a prior renal mass. previously noted tiny splenic hypodensities are not appreciated on this examination due to timing of contrast administration. a biliary stent is present. there has been interval placement of a percutaneous g-j tube terminating in the proximal jejunum. since the prior examination, the patient has undergone laparotomy with skin staples present. soft tissue stranding and small amount of fluid are seen anterior to the left lobe of the liver. posterior to the second staple in the upper abdomen, there appears to be a small fistula between the subcutaneous soft tissues in the anterior peritoneal cavity (series 2, image 25). another tubular-appearing area of inflammatory changes possibly representing a fistula is seen more inferiorly (series 2, image 45). a small fat-containing ventral hernia is seen near the inferior staple line (series 2, image 52). inflammatory changes and stranding are seen throughout the subcutaneous soft tissues of the anterior abdominal wall, posterior to the incisional line. no free air is seen in the abdomen, and there is no obvious a fistulous connection with the bowel. no evidence of oral contrast extravasation is seen. numerous small mesenteric lymph nodes are identified throughout the abdomen and larger paraaortic nodes, unchanged from the prior examinations. ct of the pelvis with oral and iv contrast: diverticula are seen throughout the sigmoid colon without evidence of diverticulitis. the rectum, bladder and visualized distal ureters are normal in appearance. the prostate is enlarged and contains several focal calcifications. no fluid is seen in the pelvis. deep pelvic and bilateral inguinal lymphadenopathy is unchanged from the prior study. osseous structures demonstrate mild degenerative changes in the thoracic and lumbar spine with vacuum phenomenon and osteophyte formation. multiplanar reformatted images confirm the above findings. impression: 1. interval exploratory laparotomy. there are inflammatory changes seen in the subcutaneous soft tissues extending the length of the incision. there appears to be a fistula between the soft tissues of the anterior abdominal wall and the anterior abdominal cavity posterior to the second staple. no enterocutaneous fistula is identified but ct is insensitive for excluding small fistulas. there may be a second small fistulous connection more inferiorly as described above. 2. stable appearance of mesenteric, retroperitoneal, pelvic, and bilateral inguinal lymphadenopathy. 3. no pancreatic head mass identified. 9:04 am swab site: abdomen source: abdominal incision. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive cocci. in pairs. 1+ (<1 per 1000x field): gram negative rod(s). wound culture (final ): due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for pseudomonas aeruginosa, staphylococcus aureus and beta streptococcus). gram negative rod #1. moderate growth. gram negative rod #2. moderate growth. probable enterococcus. moderate growth. . ercp impression: 1. erythema of the mucosa was noted in the stomach body and fundus. these findings are compatible with gastritis. 2. a previously placed plastic stent at the ampulla and a gj tube were visualized. both the stent and the gj tube were confirmed to be in place fluoroscopically. 3. the previously placed plastic stent was removed using a snare. 4. cholangiogram revealed a 3 cm stricture at the distal common bile duct. there was mild post-obstructive dilation of the common hepatic duct. in addition, the left intrahepatic duct did not fill with contrast very well. however, no obvious stricture, filling defects, and masses were appreciated in the intrahepatic ducts. 5. a 6 cm by 10 fr cotton biliary stent was placed successfully across the common bile duct stricture. clear bile was seen draining into the duodenum subsequently. recommendations 1. repeat ercp in two months. consider placement of metal wallstent if patient's prognosis is poor as a result of progression of castleman's disease. brief hospital course: patient was admitted to the general surgery service and iv hydration was administered. he was restarted on his home medications and kept npo. he was found to have bilateral inguinal lymphadenopathy and on hd2 a r inguinal lymph node biopsy was performed. there were no complications and the patient returned to the floor from the recovery area. the patient was allowed to eat a regular diet as he wished, a picc line was placed for home tpn. on hd 3 the patient was transferred to the hematology/oncology service. . on , a code stroke was called for this patient. he was noted to have acute onset of a primarily motor aphasia, with anomia, inability to repeat, and only intermittently fluent speech. also has a mild r facial droop and perhaps some evidence of a field cut on the r. he was perseverative and inattentive. he had a ?left mca territory stroke without bleed. he was seen emergently by neurology and it was decided to give him tpa. patient was transferred to , then neuro-icu. repeat head ct done for worsening headache was negative. language and rest of deficits returned to . he began eating so tpn was stopped. patient was transferred to neurology floor on . he underwent carotid dopplers which were negative and had head mri, official read pending (prelim read negative for stroke). eeg showed left temporal slowing. he also had a lp which showed 2wbc, 1rbc, prot 32 gluc 73, cytology was also sent. patient thought to have ?embolic cva vs seizure d/o. transferred back to bmt service for further workup. . after transfer to bmt service patient waited while lymph node biopsy from inguinal node results were pending, these were inconclusive and he was transferred to surgery for ex-lap washout, ccy, gj tube, and more biopsies. a peri-portal lymph node biopsy showed atypical lymphadenopathy with findings consistent with multicentric castleman's disease, hhv8 negative. or cultures grew out hafnia alvei, serratia marcescens, and enterococcus sp. he was started on vancomycin and levofloxacin. his jp drain was pulled on pod 7. he continued to have fevers post-operatively which improved with antibiotic use. his abdominal incision was draining serosanginous fluid, frequently saturating his dressings. at this time his tube feedings were held and he was made npo due to nausea and vomiting. as bowel function improved, tube feedings were advanced to goal. an abdominal ct was performed to assess the wound drainage and it appeared to be a fistula between the soft tissues of the anterior abdominal wall and the anterior abdominal cavity posterior to the second staple. dressing changes continue and the drainage slowed gradually. he was transferred to the heme/onc service for steroid treatment of his castleman's disease. . on transfer to the bmt service, lft's were found elevated. gi service was reconsulted and ercp was performed. on a new stent was placed on the common bile duct obtaining drainage to the duodenum. patient should have a repeat ercp in 2 months. patient also had delirum in this setting, with + hallucinations and agitation. neurology was consulted who felt that it was not consistent with a seizure like activity, no focal findings, and felt that a metabolic etiology was more likely. all possible mental stauts changes medications were discontinued. treatment was also started with rituxan. on , patient's mental status cleared returning to his baseline. . for the treatment of his castleman's disease patient was given rituxan and steroids. he received his dose of retuxan on and also iv steroids. patient was given a second dose of rituxan on day of discharge. he will continue on high dose steroids for two weeks 50 mg prednisone until . patient will be seen in clinic on to decide further course. he tolerated this therapy well. . after physical therpay evaluation, it was decided that he was safe to be discharged home. medications on admission: metoprolol 50', enalapril 10', prozac discharge medications: 1. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 3. enalapril maleate 10 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. terazosin 1 mg capsule sig: one (1) capsule po hs (at bedtime). disp:*30 capsule(s)* refills:*2* 5. prednisone 50 mg tablet sig: one (1) tablet po daily (daily) for 9 days: last dose . disp:*9 tablet(s)* refills:*0* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* discharge disposition: home with service facility: vna - discharge diagnosis: -pancreatic head mass -bilateral inguinal lymphadenopathy -anorexia discharge condition: -stable discharge instructions: -please come to the emergency room if you have fever >101.4f, nausea or vomiting, shortness of breath, severe or persistent abdominal pain or bleeding or persistent redness around your surgical site -do not drive while taking pain medications -take a stool softener while taking pain medications -you may shower normally but keep your surgical site clean and dry followup instructions: -please follow up with dr. in weeks after discharge. call for an appointment. provider: , md phone: date/time: 4:00 ** please have your pcp send referral to dr. ** provider: suite gi rooms date/time: 10:00 provider: . phone: date/time: 10:00 procedure: venous catheterization, not elsewhere classified spinal tap incision of lung parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent cholecystectomy reopening of recent laparotomy site division or crushing of other cranial and peripheral nerves regional lymph node excision percutaneous (endoscopic) jejunostomy [pej] excision of inguinal lymph node open biopsy of liver endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct injection or infusion of biological response modifier [brm] as an antineoplastic agent open biopsy of pancreas diagnoses: other postoperative infection unspecified essential hypertension long-term (current) use of steroids other convulsions cerebral embolism with cerebral infarction dehydration chronic pancreatitis enlargement of lymph nodes obstruction of bile duct delirium due to conditions classified elsewhere unspecified gastritis and gastroduodenitis, without mention of hemorrhage immune thrombocytopenic purpura unspecified disease of pancreas persistent postoperative fistula other suppurative peritonitis other specified disorders of gallbladder anorexia polyclonal hypergammaglobulinemia 

Answer: The patient is high likely exposed to