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: codeine / latex attending: chief complaint: new rash major surgical or invasive procedure: placement of plasmapheresis line placement of picc line history of present illness: 52 yof with lymphoplasmacytic lymphoma, waldenstrom's macroglobulinemia, hepatitis c, h/o hepatitis b, and cryoglobulinemia, who presented on rituxan therapy for her lymphoma with a new rash and fever. she was in her usual state of health until 3 days pta she noted "red bumps" on her legs. the following day she started lamivudine for hep b suppression concurrent with rituxan therapy. on doa she noticed the rash spreading to her arms b/l and then to her torso. the rash was never pruritic or painful with no involvement of mucus membranes. the patient also had complaints of low grade temperatures and in the ed was 100.8 and given 1 dose of cefepime. past medical history: hepatitis c (liver biopsy in as showing stage iii fibrosis) waldenstrom's macroglobulinemia/lymphoma history of ivdu depression sialolithiasis fine tremor peripheral neuropathy s/p prolonged icu stay for heroin and benzodiazepine overdose multi-lobar pneumonia (m. cattharalis) social history: engaged; prior ivda, per report last use , last cocaine ; smoked ppd x 30 years but trying to quit, on nicotine td; denies currenrt etoh use, most recently 2 months ago, when drinks she consumes glasses of wine. family history: mother had lymphoma. otherwise, noncontributory. physical exam: vs - tm: 100.3, tc: 96.4, bp: 90/60, hr: 58, rr: 16, 97% ra. gen: nad, no edivence of encephalopathy or asterixis. heent: sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. oropharynx clear. neck: supple palpable mass left submandibular area, freely mobile. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. systolic murmer ii/vi best heard over pulmonic area, non radiating. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. liver palpable 2-3cm below the costal margin. spleen palpable. no abdominial bruits. ext: +pitting edema of ankles. skin: no jaundice. morbiliform rash on lower extremities b/l with confluence. occasional "target" like lesion measureing less than 1cm. pertinent results: wbc-3.9*# rbc-4.78 hgb-13.4 hct-40.6 mcv-85 rdw-16.5* pt-14.0* ptt-34.3 inr(pt)-1.2* glucose-114* urean-10 creat-1.0 na-138 k-3.8 cl-100 hco3-26 angap-16 alt-54* ast-73* alkphos-79 totbili-0.5 calcium-9.9 phos-3.8 mg-1.8 ct-1033* servisc-1.5 cryoglb-positive cortsol-21.8* hbsag-negative hbsab-negative hbcab-positive rheufac-+ blood c4-3* hcv viral load 4,060,000 iu/ml. fibrino-395 , fdp-10-40* blood cultures - streptococcus mitis. streptococcus mitis species group not s. pneumoniae. corynebacterium species (diphtheroids). identified as rothia dentocariosa by laboratories . all following blood cultures were negative for growth 812/09 tee echo: no mass/thrombus is seen in the left atrium or left atrial appendage. overall left ventricular systolic function is normal (lvef>55%). with normal free wall contractility. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. skin, left medial calf, biopsy : superficial to mid-dermal perivascular lympho-eosinophilic infiltrate with associated endothelial swelling and erythrocyte extravasation (see note). skin, right lateral thigh, biopsy : vascular injury of small vessels, leukocytoclasia, and erythrocyte extravasation consistent with leukocytoclastic vasculitis. panorex - panorex is performed. there are multiple filling in the teeth. there are innumerable lucencies at the roots of the lower bicuspids and also incisors. this could represent erosion within the mandible secondary to infection. there is also one lucency that could represent a cavity within the left-sided bicuspid. upper level teeth appear intact. the roots are partially obscured by the maxilla and not well seen. brief hospital course: 52 yof with lymphoplasmacytic lymphoma, waldenstrom's macroglobulinemia, hepatitis c, h/o hepatitis b, and cryoglobulinemia, who presented on rituxan therapy for her lymphoma with a new rash and fever. # cryoglobulinemia: biopsy on consistent with cryoglobulinemia with leukocytoclastic vasculitis. in addition to a palpapble purpuric rash on her lower extremities that extended up to the back and chest. rash self resolved then worsened again. she was also symptomatic with arthritis and arthralgias which improved with antiinflammatory medications. treatment was initially held, given limited cutaneous involvement. however, when pt became hypotensive requiring icu care, she was dosed with methylprednisolone x2 days. steroids were d/c'd due to confirmed infection and pt received plasmapheresis qod x 4 treatments. her rash improved daily. she developed no other obvious signs of cryglobulinemia. rheumatology, gi, and dermatology were following. there was discussion of plan for interferon therapy at outpatient, when patient was stable. #bacteremia/sepsis - on , the patient was found to be hypotensive with bp 75/45, hr in 80s. she was asymptomatic, mentating, and ambulating without complaints of lightheadness or dizziness. she was given ivf without improvement in bp. labs were remarkable for a wbc count of 0.6 and hct 27.9 (down from 33.2) and plts 33 (down from 60). she was started on cefepime and vancomycin given neutropenic coverage. blood cultures were positive for strep virdans and gram postive cocci and rods. tee showed no vegetations. vancomycin trough levels were exceedingly hihg >40. cefepime was d/c'd as patient did not require additional coverage. dentistry was consulted, but pt's dentition, though poor did not reveal infection. picc line was inserted on for outpt treatment with vancomycin. . #anemia - pt's baseline throughout her admission was hct of 25. on her am hct was 20, she was complaining of abdominal pain and there was concern for gi bleed. she was given two units of prbcs. her vital signs remaining stable throughout. ct scan showed no bleed. reduced hct was considered to be dilutional as patient was moving significant volumes of peripheral edema which was notable on physical exam. she was guiac positive but with brown stool. her hematocrit was stable through the remainder of her hospitalization. . #acute renal failure - pt developed brief period of acute renal failure, prerenal in etiology, after her septic episode which resolved without intervention. #neutropenia/pancytopenia - pt has generally low levels of pancytopenia. her white blood cell count improved with neupogen, and neupogen was subsequently discontinued. she received 2 units of platelets for placement of a phoresis catheter. but otherwise cell counts remained stable. . #ms changes - pt had a brief period of confusion and worsening of her baseline resting tremor. she had no focal neurological signs. concern for toxicty of antibiotics. vancomycin levels and cefepime were dose adjusted given the changing renal function. confusion improved within 24 hrs. # hepatitis c: lfts slightly elevated, likely from hcv (hcv viral load of 4million). during her hospitalization, there was discussion of whether or not to begin treatment for hep c. she was discharged with outpt gi follow up. . # h/o hepatitis b: will likely require suppression therapy given recent tx with rituxan. hepatology was following. . # lymphoplasmocytic lymphoma: rituxan held. some concern that her isease course may have been initiated by rituxan. plan to continue rituxan was deferred to her primary oncology team. medications on admission: albuterol 90 mcg 1-2 puffs q4-6h:prn cough,wheezing klonopin 2 mg po bid fluticasone 50 mcg 1-2 puffs nu daily lamivudine 100 mg po daily morphine 15 mg po qid:prn morphine (ms contin) 15 mg po daily vitamin c calcium carbonate + vitamin d3 ginkgo mvi nicotine patch 21 mg/24 hours -> taper to 14 mg after 6 weeks selenium vitamin e discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every 4-6 hours as needed for sob, wheezing. 2. nicotine 7 mg/24 hr patch 24 hr sig: one (1) patch transdermal once a day for 2 weeks: it is dangerous to smoke when on the patch. disp:*14 patch* refills:*0* 3. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po q12h (every 12 hours): you can not drive or do anything requiring a fast reaction time while on this medication. disp:*30 tablet sustained release(s)* refills:*0* 6. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day): you can not drive or do anything requiring a fast reaction time while on this medication. disp:*60 tablet(s)* refills:*0* 7. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 9. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for itching. disp:*1 bottle* refills:*1* 10. triamcinolone acetonide 0.1 % cream sig: one (1) appl topical (2 times a day) as needed for itching. disp:*1 tube* refills:*1* 11. citalopram 20 mg tablet sig: three (3) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 12. outpatient lab work please check vancomycin trough on and on with goal of trough level between 15 and 20. please fax information to dr. fax:(, phone: ( 13. vancomycin 1,000 mg recon soln sig: 1000 (1000) mg intravenous once a day for 5 days: please start on . instruction to check vanco trough levels attached. please fax results as directed to dr . last day of vancomycin . disp:*qs qs* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: primary: cryoglobulinemia . secondary: lymphocytic lymphoma, hepatitis b, hepatitis c, acute renal failure, staph aureus bacteremia, staph aureus sepsis, delirium discharge condition: afebrile, stable, with picc discharge instructions: it was a please to care for you during your stay at . you were admitted for evaluation and treatment of a rash, which was discovered to be due to cryoglobulinemia. you were started on treatment for cryoglobulinemia with high dose steroids followed by 4 treatments of plamapheresis. you tolerated the procedures well. during your stay you developed severely low blood pressure requiring transfer to the intensive care unit. this low blood pressure was due to an infection of the blood. the type of infection you had is often due to bacteria in your mouth or intravenous drug use. you require a full 14 day course of antibiotics and therefore will continue taking them after your discharge. during your admission rituxan and lamivudine therapies were stopped. please discuss how treatment for your lymphoma, hepatitis b and hepatitis c should proceed with your primary oncologist and by your gastroenterologist. new medications started during your visit include the antibiotic vancomycin, which requires iv administration, which you will continue for 5 more days after discharge. you were also started on celexa for depression, and several creams for symptom relief for your rash. please return call your doctor or return to the emergency deparment if you develop new fevers to 100.4, chills, nausea, vomiting, worsening tenderness around the site of the peripheral line, dizziness, confusion, loss of consciousness, blood in the stool, black stool, diarrhea, abdominal pain, or any other concerning symptoms. ensure followup instructions: the following appointments have been made for you: it is very important that you follow up with your dentist within the next five days. if you cannot make an appointment please call your oncologist. dr. (. please make an appointment within the next two weeks. (. please make an appointment within the next two weeks. , m.d. phone: date/time: 12:15 xus (c4) tcc phone: date/time: 1:15 , md phone: date/time: 12:30 md, procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart injection of steroid therapeutic plasmapheresis closed biopsy of skin and subcutaneous tissue closed biopsy of skin and subcutaneous tissue diagnoses: acute kidney failure, unspecified hyposmolality and/or hyponatremia unspecified viral hepatitis c without hepatic coma depressive disorder, not elsewhere classified sepsis hypotension, unspecified antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use other specified disorders of biliary tract dermatitis due to drugs and medicines taken internally accidents occurring in other specified places fever, unspecified streptococcal septicemia chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta other paraproteinemias hip joint replacement neoplasm related pain (acute) (chronic) macroglobulinemia other specified hypersensitivity angiitis other named variants of lymphosarcoma and reticulosarcoma, unspecified site, extranodal and solid organ sites 

Answer: The patient is high likely exposed to