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: fatigue, decreased po intake major surgical or invasive procedure: lumbar puncture history of present illness: 67 yo male, h/o stage iiib igg kappa mm s/p recent hospitalization for stem cell mobilization with high dose cytoxan (in preparation for autologous stem cell transplantation), who originally presented from home with malaise and fevers. no diarrhea/vomiting/abdominal pain. no headache/neck stiffness/urinary symptoms/difficulty breathing. in the ed, sbp was 90-100s (responded to fluids), and he was slightly tachycardic with temperature to 99.6. he was given cefepime/vancomycin (is neutropenic). ua/cx were drawn, and lp was performed. he was also noted to be hyponatremic (na=120) and started on ns. ct head was unremarkable as was cxr. he is admitted for decreased mental status and febrile neutropenia. when he arrived to the floor he was found to have decreased mental status which was concerning in the setting of severe hyponatremia and low wbc. therefore, the patient was transferred to the icu overnight for monitoring. . while in the icu, he continued to receive ns iv fluids as well as stress dose steroids (dexamethasone). a cortisol stim test was done showed somewhat decreased cortisol elevation (2-->15). additionally urine studies showed a fena of 1% and fe urea of 50%. the patient's mental status seemed to be more clear by , but on still with mild encephalopathy which may be related to steroid psychosis. given stabilization of mental status, patient was transferred back to floor on . past medical history: - dx with iiia multiple myeloma after presented with hypercalcemia and hematuria. upep w/ monoclonal protein - ct abd with lytic lumbar and sacral - bmbx with 30-50% plasma cells, elevate igg kappa- 6781 - treated with thalidomide and dexamethasone with response in - s/p high dose cytoxan past medical hx: - pituitary adenoma in , s/p transsphenoidal resection. - melanoma in situ - hypotestosterone - anemia secondary to pituitary ablation ? - hypothyroidism secondary to pituitary ablation - history of adult-onset diabetes (initially controlled with oral agents and diet but subsequently requiring insulin while on steroids) per patient has had normal glucose recently and has not needed insulin . past surgical history: transsphenoidal resection of the pituitary gland (also received post-resection radiation therapy) . social history: patient is a retired engineer. married, lives with wife in , . has one son who lives in , has close relationship with son. and his wife are avid organic gardners. - smoking: nonsmoker - etoh: does not drink etoh - ivda: none family history: maternal uncle with unknown type of cancer (patient thinks that it was myeloma) physical exam: gnl: nad, pleasant heent: perrl, anicteric, mmm cv: rrr, normal s1 + s2, no murmurs, rubs or gallops resp: clear to auscultation bilaterally, no wheezes or crackles abd: soft, nontender, nabs extremities: no cyanosis, clubbing or edema skin/nails: no rashes/no jaundice neuro: neuro: aaox3. alert and awake but responses occasionally inappropriate, circumferential and tangential with some confusion pertinent results: 07:20am blood wbc-0.2*# rbc-2.74* hgb-9.1* hct-26.3* mcv-96 mch-33.3* mchc-34.7# rdw-17.1* plt ct-183 09:53pm blood wbc-0.3* rbc-2.20* hgb-7.4* hct-20.5* mcv-93 mch-33.6* mchc-36.0* rdw-17.1* plt ct-157 06:30am blood wbc-28.1*# rbc-2.76* hgb-8.5* hct-25.3* mcv-92 mch-30.9 mchc-33.7 rdw-19.3* plt ct-299 09:00pm blood wbc-32.4* rbc-2.79* hgb-8.8* hct-24.7* mcv-88 mch-31.5 mchc-35.7* rdw-19.0* plt ct-239 07:05am blood wbc-7.1 rbc-3.33* hgb-10.1* hct-30.4* mcv-91 mch-30.3 mchc-33.3 rdw-18.0* plt ct-271 07:20am blood neuts-10* bands-0 lymphs-45* monos-15* eos-5* baso-10* atyps-10* metas-0 myelos-5* 06:05am blood neuts-85.7* bands-9.2* lymphs-0* monos-1.0* eos-0 baso-0 atyps-0 metas-0 myelos-3.1* promyel-1.0* nrbc-1* 06:30am blood neuts-77.0* bands-2.0 lymphs-1.0* monos-3.0 eos-0 baso-0 atyps-0 metas-9.0* myelos-4.0* promyel-3.0* nrbc-1* other-1.0* 06:05am blood neuts-59 bands-14* lymphs-3* monos-3 eos-0 baso-0 atyps-0 metas-6* myelos-13* promyel-2* 08:15am blood pt-14.6* ptt-35.2* inr(pt)-1.3* 07:05am blood pt-12.1 ptt-27.2 inr(pt)-1.0 06:15am blood fibrino-301 09:53pm blood gran ct-110* 07:05am blood gran ct-6230 07:20am blood glucose-171* urean-14 creat-1.1 na-120* k-4.8 cl-89* hco3-22 angap-14 07:05am blood glucose-101 urean-9 creat-0.9 na-138 k-3.4 cl-101 hco3-30 angap-10 05:21am blood alt-18 ast-21 ld(ldh)-156 alkphos-55 totbili-2.0* 07:20am blood calcium-8.4 phos-2.2* mg-2.0 07:05am blood calcium-8.1* phos-2.7 mg-2.0 06:15am blood vitb12-1865* folate-8.5 11:52pm blood hapto-148 08:03pm blood tsh-<0.02* 06:05am blood fsh-<1.0* lh-<1.0* prolact-1.4* 08:03pm blood free t4-1.4 06:05am blood testost-199* 06:05am blood freetes-2.4* 08:03pm blood cortsol-6.0 06:05am blood cortsol-0.2* 06:30am blood cortsol-1.0* igf-1 (somatomedin-c) <25.0 l 75-228 ng/ml ..... mri head findings: there is a large infiltrating enhancing mass centered in the right clivus and petrous bone, involving the right cavernous sinus, engulfing, displacing, and potentially obliterating the right cavernous carotid artery. there is enhancing, thickened dura extending from this mass, and correlation with the prior ct demonstrates hyperostosis of the right aspect of the clivus. no other enhancing lesions are appreciated within the brain parenchyma, nor focal signal abnormalities involving the remainder of the osseous structures. small calcified dural thickening vs. a calcified meningioma involving the superior falx. additionally, there is a small acute right convexity subdural hematoma, which appears new compared to the prior ct of . there is no restricted diffusion or susceptibility artifact to indicate acute infarction or hemorrhage. impression: 1) large infiltrating mass centered in the right clivus/petrous bone with contiguous thickened and enhancing dura, engulfing and potentially obliterating the right cavernous carotid artery. mr characteristics and the associated hyperostosis seen on ct favors meningioma. given the patient's history, myeloma remains in the differential but is thought less likely. despite the history of pituitary tumor resection, imaging findings are not typical for tumor recurrence or post-surgical change. 2) small, but acute right convexity subdural hematoma, new from the ct of . .... mra head: impression: 1) diminutive right proximal ica, with complete loss of signal in the cavernous portion, suggesting either occlusion or very slow flow. there is reconstitution of very faint flow in the supraclinoid portion with diminutive flow seen in the right mca, right pcom, and right ophthalmic arteries. 2) known right skull base mass not well evaluated on this study, see prior discussion from the mri brain and ct sella/orbit. ..... ct head with thin cuts through clivus: impression: 1) soft tissue mass, better delineated on the prior mri, centered adjacent to the right cavernous sinus causes extensive hyperostosis of the petrous apex, body of the sphenoid bone, and right aspect of the clivus, suggestive of a meningioma, though see differential diagnosis provided on the prior mri. as stated in prior mri, the right cavernous carotid artery is likely either displaced or occluded which could be further evaluated by dedicated mra or cta. 2) known small right frontal convexity subdural hematoma, not well visualized on today's ct. brief hospital course: assessment/plan: 67 yo m with stage iiia igg kappa multiple myeloma with decreased mental status, hyponatremia and febrile neutropenia admitted originally to icu now with improvement in ms of counts. . # mental status changes: admitted initially with hyponatremia and febrile neutropenia. have had initial ams secondary to hyponatremia as well as delirium secondary to infection. however element of mental status changes seem to be a result of low cortisol as patient improved with the administration of hydrocortisone. ct head showed tiny subdural hematoma thought to be non-contributory per neurosurgery. lp initially done did not show signs of viral infection. have sent repeat tap for cytology and flow cytometry. was briefly in icu for ams and was started on acyclovir that was discontinued. he was followed by psychiatry throughout stay and felt to have recovered completely at discharge. . # subdural hematoma/clivus mass: hematoma thought to not be clinically significant (except to preclude anticoagulation). however mass very significant as it is likely the cause of the electrolyte and other endocrine abnormalities as it is in the pituitary region. lp was done and we are waiting for cytology/cytometry but if this is negative will likely need a brain biopsy per neurosurgery. transsphenoidal biopsy frozen section showed likely meningioma. final path pending at discharge. mass is not resectable as it is obstructive of the right carotid and other right cerebral vessels. patient will be contact by neurosurgery for appointment to follow up for treatment options. . # hyponatremia- improved with ns ivf likely secondary to a combination of both hypovolemia and endocrinopathies. . # multiple myeloma: he is s/p stem cell mobilization with high dose cytoxan the collection occurred on . >5.8 million cells were collected. he was transfused for hct < 25, and plt < 10 or bleeding. . # diabetes: the patient has a history of adult onset diabetes previously controlled with diet which has been exacerbated by decadron administration. per patient now again controlled by diet as outpatient. however, has needed insulin sliding scale while inpatient. patient had small requirements for insulin sliding scale at discharge. if patient continues long term on prednisone, he should have his hgba1c checked and consider treatment. . # anemia: thought to be secondary to patient's multiple myeloma. he was transfused for hct < 25. . # h/o pituitary microadenoma/endocrinology: patient is s/p transphenoidal resection of the pituitary gland and s/p post-resection radiation therapy. endocrine was involved in his care. we continued levothyroxine, testosterone patch. he had a cortisol stimulation test which showed adrenal insufficiency. patient will be discharged on prednisone 5mg po bid with instructions to call doctor with any illness for stress dose steroids. patient would like to find an endocrinologist near his home, but if unable was given the clinic number here to follow up. . # vertebral fractures: no pain currently. will treat symptomatically. . # fen: very low phosphate, calcium and sodium. was repleted aggressively in icu and maintained on sliding scales while inpatient. medications on admission: on transfer from icu: acyclovir 700mg q8h calcium carbonate cefepime 2g q8h cosyntropin for stim on dolasetron mesylate docusate sodium filgrastim 300mcg fluconazole 200 levothyroxine sodium potassium phosphate lactulose heparin sc tid vancomycin hcl discharge medications: 1. levothyroxine 137 mcg tablet sig: one (1) tablet po daily (daily). 2. fluconazole 200 mg tablet sig: one (1) tablet po bid (2 times a day). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. testosterone 2.5 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal q48h (every 48 hours). 5. levothyroxine 137 mcg tablet sig: one (1) tablet po daily (daily). 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). 7. prevacid 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 8. prednisone 5 mg tablet sig: one (1) tablet po twice a day: call the doctor if you are ill. you will likely need more of this medication. . disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: febrile neutropenia hyponatremia cerebral mass multiple myeloma diabetes hypertension discharge condition: good. stable. discharge instructions: you were admitted for fever and mental status changes. you were treated with antibiotics and steroids. you also had your stem cells collected. . please call your doctor if you have any nausea, vomiting, fever, chills, chest pain, shortness of breath, passing out or any other concerning symptoms. . if you have any illness (cold/diarrhea/etc) or have lightheadedness, please call your doctor (dr. immediately. you will likely need a higher dose of prednisone. followup instructions: please follow up with dr. in on thursday at 1pm: provider: , md phone: date/time: 1:00. . you will be contact by the neurosurgeons (dr. for an follow up appointment this week. if you do not get a call, please call them at . . you need to make an endocrinology appointment. if you cannot find an endocrinologist near you, and would like to follow up in clinic at the please call . procedure: venous catheterization, not elsewhere classified spinal tap incision of lung spinal tap incision of lung excision of lesion or tissue of cerebral meninges transfusion of packed cells other immobilization, pressure, and attention to wound other therapeutic apheresis biopsy of pituitary gland, transsphenoidal approach operations on clitoris diagnoses: unspecified essential hypertension long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia hyposmolality and/or hyponatremia sepsis pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin long-term (current) use of other medications benign neoplasm of cerebral meninges multiple myeloma, without mention of having achieved remission bell's palsy dehydration encephalopathy, unspecified stricture of artery subdural hemorrhage personal history of irradiation, presenting hazards to health anemia in neoplastic disease pathologic fracture of vertebrae unspecified condition of brain neutropenia due to infection neoplasm of unspecified nature of endocrine glands and other parts of nervous system other specified acquired hypothyroidism carcinoma in situ of skin, site unspecified family history of unspecified malignant neoplasm 

Answer: The patient is high likely exposed to