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: fever major surgical or invasive procedure: none history of present illness: 44 y/o m with hx of hiv, scleraderma and ipf who presented to the er with sudden onset fevers and chills at 11am the morning prior to admission. he was in his usual state of health until he started rigoring, had body aches, mild headache and a fever. he has a cough at baseline that he says has not changed. he has no productive sputum. his headache is mild and only started once rigoring. he denied photophobia, vision changes, neck stiffness, weaknes, numbness or tingling in his extremities. . in the ed, initial vs were t 100.4, p 107, bp 111/67, r 16, 95% on ra. patient was given vanco 1 gm, ceftriaxone 2 gm, acyclovir 900 mg. he had an lp that showed 3 wbcs with 10% polys, 90% lymphs. glucose was 60, protein 38. a head ct was normal. he was also given levofloxacin 750 mg and bactrim iv. he had a chest ct that showed progression of his ild, and could not rule out infiltrative process. . during his time in the ed, his blood pressure dropped. he was initially with sbps in the 120s and then around 4 am after breaking a fever to 101, his sbps were in the 70s-80s. he had received about 3l at that time, and received another 3l ns with a slight increase to sbps in the 80s-90s. throughout his hypotension, he was mentating and feeling well. he did note that his eyes turned red while in the ed with some watery drainage. no pus drainage, so pain, vision changes, or eye pain with movement. he is tachypneic, although asymptomatic. this is new for him. . of note, he has just started bactrim two days ago and has taken one pill. he is compliant with his hiv meds and has been on them for a long period of time. there were no other new meds. he does not know his most recent cd4 count. . on the floor, he continues to feel well without specific complaints. past medical history: hiv (dx 4-5 years ago). currently on haart and pcp . hypothyroidism pulmonary fibrosis mgus social history: lives in , ma with brother. with juvenile delinquents in a detention center. occasionally uses marijuana. no smoking or alcohol use. not currently sexually active. contracted hiv from homosexual partner. family history: brother has scleroderma. otherwise nc physical exam: (per admitting resident) vitals: t: afebrile, bp: 101/52, p: 98, r: 23, o2: 95% on 2l general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, 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 gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs 06:18pm blood wbc-10.3 rbc-5.17 hgb-13.6* hct-41.7 mcv-81* mch-26.3* mchc-32.6 rdw-16.0* plt ct-166 06:18pm blood neuts-86.6* lymphs-9.4* monos-2.9 eos-0.7 baso-0.4 06:18pm blood glucose-109* urean-14 creat-1.7* na-133 k-8.2* cl-99 hco3-25 angap-17 06:18pm blood alt-25 ast-100* ld(ldh)-1130* alkphos-105 totbili-3.1* 06:18pm blood lipase-31 06:22pm blood lactate-1.6 discharge labs 05:30am blood wbc-5.4 rbc-4.43* hgb-12.1* hct-36.0* mcv-81* mch-27.4 mchc-33.7 rdw-16.3* plt ct-149* 05:30am blood glucose-90 urean-12 creat-1.0 na-138 k-4.3 cl-105 hco3-24 angap-13 05:30am blood calcium-8.2* phos-2.9 mg-1.7 other labs 05:26am blood tsh-1.7 04:30am urine color-yellow appear-clear sp -1.013 04:30am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg csf studies 11:15pm cerebrospinal fluid (csf) wbc-3 rbc-0 polys-10 lymphs-90 monos-0 11:15pm cerebrospinal fluid (csf) totprot-38 glucose-60 microbiology: -csf gram stain negative, culture with ngtd (final results pending) -c. difficile: negative -influenza a/b: negative -legionella antigen: negative -monospot: negative -cvm igg+, igm- -ebv igg+, igm- (final results pending) -galactomannan and beta-glucan, pending - multiple blood cx and respiratory cx with ngtd (final results pending) ========================== imaging: ct chest: ct chest without iv contrast: there is increase increase in nodular opacities in both lung apices since , concerning for acute infectious etiology in this setting. there is an overall progression of pre-existing fibrotic changes with predominance in the lower lobes bilaterally and in the right middle lobe. post-surgical change is also seen in the right middle lobe at a site of prior vats, with suture material seen. traction bronchiectasis is again seen at both lung bases. extensive mediastinal lymphadenopathy is again seen, which also appears somewhat increased since . the pulmonary arterial size is borderline, but not changed since the prior study measuring 3.3 cm (2:26). the esophagus demonstrates changes consistent with known scleroderma. there is again thymic hypertrophy, unchanged. osseous structures appear unremarkable. impression: 1. multiple findings related to known history pathologically proven uip in the setting of progressive systemic sclerosis. 2. right greater than left lung apex increase in nodular opacity suggestive of superimposed acute infectious etiology. ct head: findings: there is no acute intracranial hemorrhage, mass effect, edema, or major vascular territorial infarct. the ventricles and sulci are normal in size and configuration. there is no shift of normally midline structures. the -white matter differentiation is well preserved. the visualized paranasal sinuses and mastoid air cells are clear. there is no acute fracture. impression: no acute intracranial process. cxr () - impression: stable lower lobe interstitial lung disease as previously described. since the prior exam, there are persistent bilateral pleural effusions, right greater than left. please note, not mentioned above, there are chain sutures identified in the lower right hemithorax consistent with prior resection. cxr () - bilateral opacities are present in both bases which were not seen on the prior chest x-ray of . bilateral effusions are present and the overall pattern more suggests failure rather than pneumonia. cxr () - increasing hazy opacification of the mid and lower lungs, superimposed on chronic fibrotic changes in the lung bases could be due to developing atypical infection. early follow-up is recommended. cxr () - impression: generalized clearing with persistent chronic changes. brief hospital course: 44 y/o m with hx of hiv, systemic scleroderma, ild with uip and hypothyroidism who presents with fevers, rigors admitted to the micu for hypotension #hypotension: he was found to be hypotensive in the emergency department with sbps in the 70s with limited improvement to fluid boluses and so was transferred to the micu for further management. the hypotension was thought to be due to a distributive process due to concern for infection. in the icu, he remained hemodynamically stable off vasopressors, with intermittent episodes of hypotension that responded to fluid boluses. once called out the floor, the patient did not have any further hypotensive episodes. # fever: there was concern for an infectious process in this immune compromised patient. the only localizing symptom was a chronic cough. chest ct was concerning for pulmonary process although difficult to interpret in the setting of his ild. sputum and blood samples were obtained and was started on vancomycin, ceftriazone, and levaquin for possible pneumonia. pcp was considered given immune compromised status and elevated ldh although this was felt to be less likely given cd4 count in the 600s; however, pcp was negative 2. b-glucan and aspergillus studies were sent. he remained intermittently febrile in the icu, which resolved with anti-pyretics. meningitis was considered although lp and ct were normal. he was started on tamiflu emperically, which was discontinued when nasopharyngeal viral studies returned negative for influenza. the patient improved clinically, and antibiotics were narrowed to po levaquin. once called out the floor, the patient was weaned off of o2. he did spike one temperature on the floor. at the time of discharge, he had been afebrile for over 24 hours. he was given a prescription for levofloxacin to continue for 5 days after his last fever. given that none of his infectious work-up revealed anything, it seems that his presentation was likely related to a viral infection. of note, at the time of discharge, several infectious studies, including final results of his csf, sputum, and blood cx as well as his galactomannan and beta-glucan, were still pending. these should be followed up by his pcp. # elevated lft's: pt noted to have increased lft's, etiology unclear. bilirubin was predominately indirect. labs were relatively stable at discharge but should be followed up as an outpatient. of note, the patient did have a significantly elevated ldh on admit. pcp was considered but was negative x 2. ldh was downtrending at discharge. # acute renal failure: his creatinine was elevated to 1.8 (baseline 1-1.3). fena was 0.5% suggesting pre-renal etiology. his medication was renally dose and nephrotoxic medications were held. his renal function improved back to baseline following administration of ivf. #conjunctivitis: patient with clear discharge without pain or change in visual function most consistent with viral conjunctivitis. he was started on saline eye drops and his symptoms improved over 24-48 hours. # interstitial lung disease: the ild appeared to be stable reviewing ct scan has stable honeycombing in the peripheries and more ground glass infiltrates consistent with different process, likely infectious as discussed above. he was continued on on home nebs. # hiv: he was continued on his home regimen of antiretrovirals. # anemia: there was a hematocrit drop from the low forties to mid thirties in the setting of vigorous intravenous fluid resuscitation. there was no evidence of bleeding. his hematocrit was trended and remained stable. #thrombocytopenia: he has a history of itp in after a lung biopsy. he was treated with ivig and improved. steroids were avoided at that time in order to prevent a possible scleroderma steroid induced renal crisis. platelets on admission were below his new normal baseline of around 160s, and they began to improve at the time of discharge. # gout: there was no evidence of an active gout flare. his allopurinol was initially held in the setting of renal failure. it was restarted at discharge. # hypothyroidism: he was continued on his home dose of levothyroxine. medications on admission: levothyroxine 200 mcg daily combivent 1 neb qid prn epzicom 600-300 mg daily reyataz 300 mg daily norvir 100 mg daily percocet 5-325 mg q4hr prn allopurinol (unknown dose) bactrim (unknown dose) - just started; has taken one pill so far discharge medications: 1. levothyroxine 200 mcg tablet sig: one (1) tablet po once a day. 2. combivent 18-103 mcg/actuation aerosol sig: one (1) neb inhalation every six (6) hours as needed for shortness of breath or wheezing. 3. epzicom 600-300 mg tablet sig: one (1) tablet po once a day. 4. reyataz 300 mg capsule sig: one (1) capsule po once a day. 5. norvir 100 mg capsule sig: one (1) capsule po once a day. 6. percocet 5-325 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain. 7. allopurinol oral 8. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 3 days: last day is . disp:*3 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary - respiratory viral illness secondary - human immunodeficiency virus - interstitial lung disease - systemic sclerosis - immune thrombocytopenic purpura discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital with shortness of breath, fever, nausea, and vomiting. because your blood pressure was slightly low, you were intially admitted to the icu. you were started on antibiotics and your symptoms improved. you had labwork sent to look for infection, but none of it revealed any source of infection. likely, your symptoms were related to a viral illness. changes to your medications: - start levofloxacin 750 mg daily. you will take this for three more days (ending on ). - stop taking the bactrim that you had started prior to your admission. - continue all of your other medications as you were taking them previously. it was a pleasure taking part in your medical care. followup instructions: you have the following follow-up appointment scheduled with your pcp: : , m. location: associates of health address: , 2nd fl, , phone: appt: at 10am you also have the following upcoming appointments: department: dermatology when: thursday at 11:15 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: medical specialties when: wednesday at 1 pm with: mala , md building: sc clinical ctr campus: east best parking: garage department: rheumatology when: tuesday at 11:00 am with: , md building: lm bldg () campus: west best parking: garage procedure: spinal tap incision of lung diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified anemia, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism gout, unspecified hypotension, unspecified unspecified viral infection postinflammatory pulmonary fibrosis immune thrombocytopenic purpura asymptomatic human immunodeficiency virus [hiv] infection status nonspecific abnormal results of function study of liver systemic sclerosis other viral conjunctivitis 

Answer: The patient is high likely exposed to