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: weakness and myalgias x 2 days major surgical or invasive procedure: none history of present illness: ms. is a 64yo woman with multiple myeloma, s/p allogeneic transplant with recurrent disease and with systemic amyloidosis(cardiac), on hemodialysis for esrd who represents for malaise, weakness, and generalized body aching x 2 days. she was admitted last week /08 with hypercalcemia and treated with pamidronate 30mg, calcitonin, and dialysis. hospital course was complicated by an episode of hypotension following dialysis on . she also began treatment for myeloma and amyloidosis last week with revlimid. besides generalized pain worst in back, legs, and jaw and weakness, she also notes intermittent sob x 2 days(at home is on 2-3lnc). denies cough, fever, chills, chest pain or palpitations. she was dialyzed yesterday to dry weight of 60kg. she and her husband note poor po intake for the past several weeks. . in the ed, initial vs were: t 98.7 p 68 bp 83/43 r 22 o2 sat 99% on nrb. her lowest systolic 60s improved to the systolic in the 80s. she was transiently on peripheral dopamine w/improvement of systolic to mid 90s. restarted levophed around 0900 because tachycardia due to dopamine. labs were notable for calcium 14.2, inr of 7.2. cxr showed a worsening pleural effusion and cta chest was performed which demonstrated stable chronic changes and no pe. tte in the ed was w/o evidence of large pericardial effusion. patient was given cefepime and vancomycin. cvl was attempted, but reportedly clotted. . review of sytems: (+) per hpi (-) denied night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. no nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. does not make urine. she denies lightheadedness/dizzyness. past medical history: multiple myeloma: (per problem , reconfirmed with patient) "1. initial treatment with melphalan and prednisone, followed by vad , with autologous stem cell transplant in 01/. with relapse of her myeloma, she received thalidomide from to . 2. nonmyeloablative allogeneic stem cell transplant from a sibling donor in 11/. 3. noted for recurrent disease in the summer of and received a donor lymphocyte infusion in with relatively a stable disease after this. 4. noted for slow progression of her disease in the fall of and status post a second donor lymphocyte infusion on given at a dose of one x10 to the seventh t-cell/kg. 5. admitted on due to worsening renal insufficiency with creatinine of 3.4 and new lung mass causing right lower lobe collapse. the lung mass was biopsied and thought consistent with amyloid. 6. following , she was started on thalidomide for a short period of time, but was readmitted on due to left lower edema and new dvts. 7. received cytoxan with decadron 20mg x 4 days with no change in disease. 8. received velcade 1.3mg/m2 d1 and d4, but then admitted due to worsening lower extremity edema and increased creatinine. 9. received cycle 1 velcade/cytoxan/decadron on . cycle 2 started on . cycle 3 on with d11 velcade held. c 4 started on but admitted following morning due to dyspnea. c5 started on with d8 cytoxan held and d11 velcade held due to low counts. also on dialysis for renal failure. 10. thalidomide to start on . coumadin is anticoagulation. 11. another admission on due to increasing shortness of breath and worsening/recurrent pneumothoraces on the left side. she underwent pleurodesis and although had a reaction to the talc procedure, she was discharged home after only about a one-week stay in the hospital. she resumed her thalidomide at 50 mg daily, and she has slowly increased this to 150 mg daily as of . she was restarted on coumadin which is being adjusted to keep inr at 2-3. 13. status post dli on ." other pertinent past medical history - per and confirmed with pt - s/p 3 episodes of epiglottitis/supraglottitis requiring intubation in , , - amyloidosis - involvement of lungs, tongue, bladder, heart - ckd - thought secondary to amyloid disease progression - diastolic dysfunction - likely secondary amyloid - multiple dvt's (l ij, l popliteal, l sup femoral)-ivc filter, due to r sided dvt propagation; on coumadin intermittently (due to fluctuating platelet counts on velcade) - pulmonary emboli in the past associated with dvt's - osteopenia s/p zometa infusions - htn - s/p tonsillectomy - hx of disseminated herpes in - urge incontinence - subdural hemorrhages in in the setting of elevated inr social history: married and lives in . she has two adult children and one grandson. she uses alcohol occasionally. she denies ever using tobacco or illicit drugs. family history: notable for hypertension. no family history of malignancies or premature cardiac death physical exam: vitals: t: 97 bp: 94/49 on 0.06 levophed p: 73 r: 13 o2: sat 96% on nrb general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: bronchial bs and crackles at left base; decreased bs on left, no wheezes, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly rectal: guaiac (-) ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema; +edema on right wrist, no tenderness w/passive motion neuro: a&o x 3, cn 2-12 in tact, upper and lower extremity strength skin: no rash, warm and dry. pertinent results: images: cta chest on admission: negative for pe, stable bl lung collapse/atelactasis; stable hyperventilatory changes in rul. cxr: . ekg: nsr at 67bpm, lateral lead twf unchanged from prior dated . . 06:50am ck-mb-9 06:50am ctropnt-0.80* 08:23am lactate-2.8* 06:50am pt-60.7* ptt-41.7* inr(pt)-7.2* . liver us 1. no evidence of biliary obstruction. 2. cholelithiasis, no evidence of acute cholecystitis. gallbladder wall thickening is likely secondary to ascites and also be seen in the setting of chronic liver disease. 3. splenomegaly. . echo the left atrium is elongated. there is mild symmetric left ventricular hypertrophy. the myocardium appears bright which may be due to renal failure; an infiltrative process cannot be excluded. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). transmitral doppler and tissue velocity imaging are consistent with grade ii (moderate) lv diastolic dysfunction. the right ventricular free wall is hypertrophied. right ventricular chamber size is normal. with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a small pericardial effusion. brief hospital course: 64yo woman with multiple myeloma, s/p allogeneic transplant with recurrent disease and with systemic amyloidosis(cardiac), esrd on hemodialysis s/p recent hospitalization for hypercalcemia and supratherapeutic inr who represents for the same issues as well as hypotension. pt was started on broad spectrum abx for concern for sepsis resulting in hypotension. she was also treated for hypercalcemia, supratherapeutic inr, chronic renal failure, tachycardia. however on night of , pt had an episode of bradycardia, hypotension and she passed away within a few seconds to a couple of minutes. . # hypotension: it was in the setting of poor po intake, likely due to hypovolemia. she was started on empiric vancomycin and levofloxacin for borad spectrum coverage. blood cultures were sent. echo showed normal ef. she was on very small doses of levophed to maintain a map of 55-60. we couldnt give a lot of fluids as she was on dialysis. . # hypercalcemia: it was in the setting of diffuse, recurrent mm c/b amyloidosis. she received iv pamidronate x 1 and calcitonin 100 u sc x 1. gentle iv fluids were given. hd was continued. serum ca came dwon from about 14 on admission to 9.8 on . . # respiratory: pt has chronic oxygen requirement due to amyloidosis involvement of the lungs. also has h/o pes and is s/p pleurodesis. cta was negative for pe. ct and cxr w/stable chronic findings. no suggesition of pna at this point. we tried to wean oxygen as tolerated to home level 2-3 l. . # tachycardia: pt had 2 episodes of tachycardia with drop in her bp. initially it was thought to be ventricular tachycardia and hence pt was loaded with amiodarone. cardiology was consulted who thought that it was atrial fibrillation and not vtach. hence amio was discontinued. . #elevation in liver enzymes: pt had severe rise in alt, ast and ldh. we thought that might be from starting the amio. however liver team was consulted and did not think that amio had enough time to cause the rise in lfts. liver us didnt show any acute changes. . # coagulopathy: pt initially presented supratherapeutic at prior admission, had been subtherapeutic on and coumadin dose was increased. she came in supratherapeutic. hence we held her coumadin and gave her vitamin k x 1 dose. her inr came down from about 7 to 4 over the hospital course. . # multiple myeloma: recurrent; c/b hypercalcemia and amyloidosis. hem/onc was consulted and management was as per their recs. . # esrd on hd: management per renal team. medications on admission: sevelamer hcl 800 mg po tid w/meals pantoprazole 40 mg po q24h trimethoprim-sulfamethoxazole 160-800 mg po 3x/week (mo,we,fr) lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for nausea. docusate sodium 100 mg po bid senna 8.6 mg po bid as needed b complex-vitamin c-folic acid 1 mg po daily lenalidomide 5 mg po three times weekly the day of dialysis. warfarin 4 mg po days(,mo,tu,we,th,fr,sa) medications: none disposition: expired diagnosis: pt deceased on condition: dead instructions: none followup instructions: none procedure: venous catheterization, not elsewhere classified diagnoses: end stage renal disease renal dialysis status bone marrow replaced by transplant acute respiratory failure hypotension, unspecified multiple myeloma, without mention of having achieved remission hypercalcemia other amyloidosis 

Answer: The patient is high likely exposed to