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: history of present illness: the patient is a 21-year-old male with a history of end-stage renal disease (on hemodialysis) secondary to reflux nephropathy, and focal segmental glomerulosclerosis who presented with fevers to 102 and a facial rash. initially, he had a temperature of 100.6 at hemodialysis unit on . there, he received vancomycin which was complicated by red man syndrome. this consisted of a fever and rash from the forehead down to his waistline. he was given benadryl and tylenol and sent home. he received hemodialysis on uneventfully. at hemodialysis on he had a temperature to 102.7. blood cultures were taken from his hemodialysis line. he was given 1 gram of kefzol and referred to the emergency department. in the emergency department, a chest x-ray showed no pneumonia. laboratories with a white blood cell count of 5.4. urinalysis had small leukocyte esterase, but no nitrites. therefore, he was started empirically on ciprofloxacin 500 mg twice per day times seven days for a possible urinary tract infection. urine culture ultimately returned negative. he began taking ciprofloxacin in the morning of . he woke up on with "dots" all over and pruritus. he took his last dose of ciprofloxacin on in the evening. his rash was not relieved with benadryl or tylenol, so he came to the emergency department for further evaluation. in the emergency department - on - he was noted to have a temperature of 98.8, his blood pressure was 128/64, his pulse was 98, his respiratory rate was 16, and his oxygen saturation was 100 percent on room air. in the emergency department, he was pan-cultured and given one dose of vancomycin intravenously and ceftriaxone intravenously. laboratories at that time showed a potassium of 6.3 with questionable peaked t waves on his electrocardiogram. therefore, he also received calcium gluconate 1 gram, 10 units of regular insulin, 1 ampule of dextrose, 1 ampule of bicarbonate, and kayexalate 60 grams. before leaving to the emergency department, he spiked a temperature to 103.6. therefore, tylenol was given. of note, he had a recent admission in after two generalized tonic-clonic seizures. at that time he was started on dilantin. also during that admission, he completed a 3-day course of ciprofloxacin for a urine culture that grew out acinetobacter. during this admission, review of systems was significant for fevers, sore throat, and generalized malaise. he denied any rigors, night sweats, or weight loss. he denied chest pain, shortness of breath, palpitations, orthopnea, or paroxysmal nocturnal dyspnea. there was no cough, wheezing, or hemoptysis. there was no dysuria, abdominal pain, or suprapubic tenderness. no nausea, vomiting, diarrhea, or constipation. no recent travel. no recent medication changes. no outdoor activities or camping. no recent vaccinations. no pets or tic exposures. no recent sexual contacts other than his longtime girlfriend with whom he is in a monogamous relationship. past medical history: end-stage renal disease (on hemodialysis) secondary reflux, nephropathy, and focal segmental glomerulosclerosis. he is dialyzed on monday, wednesday, and friday. he started hemodialysis on . reflux nephropathy resulted in recurrent ascending escherichia coli infections. he is status post placement of a right subclavian perm-a-cath on and an arteriovenous fistula was placed on . spina bifida; status post repair as an infant - complicated by bowel and bladder incontinence, with a history of straight catheterization three times daily - complicated by numbness in the soles of the feet and backs of both thighs as well as left foot weakness and hyperreflexive bilateral lower extremities. newly diagnosed seizure disorder on for two generalized tonic-clonic seizures - started on dilantin on . seizures characterized by initial head deviation toward to the right followed by generalized tonic- clonic movements. his first seizure on was felt to be secondary to hypercalcemia in the setting of a calcium level of 6. his second seizure took place on and was felt to be idiopathic. at that time, he was loaded on dilatation 300 mg three times per day. he erroneously continued on dilantin 300 mg three times per day until a follow-up appointment on . at that time, he was switched to a regimen of 300 mg in the morning and 200 mg in the evening. hypoparathyroidism. history of multiple urinary tract infections; last diagnosed in and treated with ciprofloxacin. anemia of chronic disease. allergies: the patient reports no known drug allergies. medications prior to admission: 1. dilantin 300 mg by mouth in the morning alternating with 200 mg by mouth in the evening. 2. lisinopril 10 mg by mouth once per day. 3. epogen subcutaneously every week. 4. sodium bicarbonate tablets four tablets by mouth twice per day. 5. oxybutynin 5 mg by mouth twice per day. 6. tums 500 mg by mouth three times per day. 7. calcitriol at each hemodialysis session. 8. nephrocaps once per day. social history: the patient is a sophomore at . he lives in a dormitory. he is originally from , . he denies any tobacco or illicit drug use, but he reports occasional social alcohol intake. he is in a monogamous sexual relationship with a longstanding girlfriend. family history: the patient reports no family history of seizures or kidney disease. physical examination on presentation: generally, this was well-developed, well-nourished, thin, young male. he was uncomfortable and ill-appearing, but nontoxic. vital signs revealed his temperature was 99.8, his blood pressure was 128/64, his heart rate was 98, his respiratory rate was 16, and his oxygen saturation was 100 percent on room air. head and neck examination was remarkable for normocephalic and atraumatic. the pupils were equal, round, and reactive to light. the mucous membranes were moist. the posterior oropharynx was erythematous, but there were no lesions exudates. the neck was supple with no masses or lymphadenopathy. the chest wall had hemodialysis catheter site bandaged with no evidence of edema, fluctuance or purulent discharge. the lungs were clear to auscultation bilaterally. there were no rhonchi, rales, or wheezes. cardiovascular examination revealed a regular rate and rhythm with normal first and second heart sounds auscultated. there were no murmurs, rubs, or gallops. the abdomen was soft, nontender, and nondistended. there were positive normal active bowel sounds. there was no hepatosplenomegaly. examination of the back revealed no spinal or costovertebral angle tenderness. the extremities were warm and well perfused. there was no clubbing, cyanosis, or edema. the left forearm arteriovenous fistula had some serous drainage; but no erythema, edema, or fluctuance. a bruit was auscultated over the arteriovenous fistula. his skin demonstrated erythematous, raised, maculopapular rash diffusely, but concentrated mostly on the face, abdomen, extremities, palms, and soles. the lesions were approximately 1 cm in diameter. on the face, the eyelids were spared. otherwise, the rash was confluent, pruritic, blanching, nonconfluent on the body with a questionable appearance of wheels. there were no bullae formation. no target lesions. the skin examination was also remarkable for a tuft of hair on his back and a scar overlying his previous spina bifida surgery site. neurologically, he was alert and oriented times three with no tremor or asterixis. pertinent laboratory values on presentation: a complete blood count on admission revealed his white blood cell count was 5.1 (with 61 percent neutrophils, 26 percent lymphocytes, 5 percent monocytes, 7.2 percent eosinophils - 2.9 percent on - and 0.5 percent basophils), his hematocrit was 41.6, and his platelets were 194. chemistries showed his sodium was 138, potassium was 6.3, chloride was 95, bicarbonate was 27, blood urea nitrogen was 58, creatinine was 13.5, and his blood glucose was 87. his calcium was 10.6, his phosphorous was 4.4, and his magnesium was 2.5. coagulation profile revealed his prothrombin time was 12.7, his partial thromboplastin time was 26.4, and his inr was 1.1. hemolysis studies on showed a haptoglobin of 87, his fibrinogen was 253, and his d-dimer was elevated at 2274. an additional workup for his rash and fever revealed a throat swab with culture negative for beta streptococcal infection. stool culture was negative. mono spot was negative. aso titer from demonstrated a positive aso screen with a titer positive to 200 to 400. rapid plasma reagin nonreactive. - virus titer showed the patient to be igg positive and igm negative. urine culture from was also negative for growth. brief summary of hospital course: fever issues: a concern over line source of fevers in the emergency department, the patient received a vancomycin. he was started on ceftriaxone for gram-negative coverage given his history of multiple urinary tract infections and a history of straight catheterization use. prior to antibiotic initiation, he was pan-cultured. on the night of admission, he spiked a temperature to 103.7 which decreased to 101.5 with tylenol. on the morning of he went to hemodialysis and there spiked a temperature to 105. he was cultured from his hemodialysis line and sent back to the general medicine floor. as the fever started after hemodialysis sessions and appeared to worsen with accessing his hemodialysis line, the interventional radiology service was contact for removal of the patient's tunnel catheter. initially, the interventional radiology service did not feel the catheter needed to be removed. thereafter, the patient himself refused removal. later on the day of he was dialyzed via his arteriovenous fistula with no adverse events. he was seen in consultation by the infectious disease service who recommended holding vancomycin, ciprofloxacin, and dilantin. an exhaustive workup; including pan cultures, liver function tests, mono spot, cytomegalovirus, - virus, mycoplasma, and titers, rapid plasma reagin, aso, throat swab, antineutrophil cytoplasmic antibody, rheumatoid factor, and sedimentation rate was initiated out of concern for drug fevers, viral infection, line infection, vasculitis, toxic shock syndrome, primary human immunodeficiency virus infection. the patient was covered initially with aztreonam after he spiked a fever to 107.3 in the setting of a normal blood pressure of 140/90 and a heart rate of 120. in addition to aztreonam during this temperature spike he also received 1 gram of tylenol and benadryl. he was moved from the floor to the medical intensive care unit for further monitoring. out of continued concern for a line infection in spite of negative culture data, the patient's tunneled port-a-cath was removed on . he continued to have dialysis and was dialyzed on through his arteriovenous fistula. about one hour into that hemodialysis session, he had rigors. there was some question of whether his fevers and rigors could be secondary to a membrane issue. as all of the patient's culture data was negative, and his fevers subsided status post discontinuation of vancomycin and dilantin, it was felt that his fevers were most likely secondary to an acute drug reaction. it is therefore recommended that he avoid exposure to vancomycin and dilantin in the future. rash issues: it was unclear whether the patient's rash was drug related versus infectious in etiology. the onset occurred after therapy with ciprofloxacin and had an urticaria appearance and peripheral eosinophilia which was suggestive of a drug related process. however, in light of the high fevers ________ was maintained for infectious sources as well. an exhaustive workup (as outlined above) was undertaken in order to help delineate the source of the patient's fevers. an infectious workup was negative. for symptoms, he was continued on benadryl and an h2 blocker to decrease histamine release. he was not initially treated with steroids out of concern for infection. on he was noted to have cracking and peeling as well as a edema of his lips and a question ulcerative lesion in his oropharynx and conjunctivae. this was concerning for - syndrome. he was seen in consultation by the dermatology, infectious disease, and ophthalmology services. ophthalmology saw only mild conjunctivitis on their examination and recommended artificial tears and lacri-lube. per dermatology, the likely culprits for the patient's rash included vancomycin and dilantin. however, there was really no way to delineate which of these two agents were the cause of this. with conservative and symptomatic therapy, the patient's rash improved. end-stage renal disease issues: on the day of his admission, the patient had discontinuation of his tunneled port-a-cath. he started hemodialysis via an arteriovenous fistula. he tolerated this well with the exception of intermittent fever spikes. he was continued on nephrocaps, calcium acetate, epogen, and calcitriol per the renal team. seizure disorder issues: in light of the suspicion of dilantin as an etiologic for the patient's fevers and rash, dilantin was discontinued. he was monitored closely in the setting of fevers due to the fact that fevers can decrease seizure threshold. he was started on gabapentin after consultation with the neurology service. outpatient neurology followup was arranged as well. code status issues: the patient was a full code. condition on discharge: good - afebrile times 36 hours and hemodynamically stable. dilantin and vancomycin levels were trending down. skin rash was improving. all culture data was negative for acute infection. discharge status: the patient was discharged to home. discharge diagnoses: drug fever and reaction secondary to vancomycin or dilantin. end-stage renal disease (on hemodialysis). history of recurrent urinary tract infections. history of a seizure disorder. history of spina bifida; status post surgical repair. bowel and bladder incontinence. anemia of chronic disease. medications on discharge: 1. gabapentin 300 mg by mouth at hour of sleep. 2. lisinopril 20 mg by mouth once per day. 3. epogen injections subcutaneously at hemodialysis. 4. oxybutynin 5 mg by mouth twice per day. 5. calcium acetate 670 mg two tablets by mouth three times per day (with meals). 6. nephrocaps one capsule by mouth every day. 7. artificial tears 1 drop each eye q.2h. 8. lacri-lube one application each eye at hour of sleep. 9. benadryl 25 mg one capsule by mouth q.4-6h. as needed (for itching). 10. calcitriol. follow-up plans: the patient was instructed to call his primary care physician or visit local emergency room if he experienced recurrent fevers, shaking chills, headaches, chest pain, confusion, recurrent skin rash, or any other worrisome symptoms. he was instructed if he feels fevers and rash, the most likely reaction was medications; however, we could not ascertain whether the reaction was due to dilantin or vancomycin. we strongly suggested that he absolutely avoid both of these agents in the future. he was instructed to discontinue his dilantin and sodium bicarbonate. additionally, he had follow-up appointments with dr. in the neurology department on . he was instructed to call both dr. and dr. from the renal division for follow-up appointments after discharge. , dictated by: medquist36 d: 16:30:22 t: 22:13:09 job#: cc: procedure: hemodialysis other incision of skin and subcutaneous tissue diagnoses: hyperpotassemia other convulsions hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease dermatitis due to drugs and medicines taken internally other specified antibiotics causing adverse effects in therapeutic use other complications due to renal dialysis device, implant, and graft spina bifida without mention of hydrocephalus, unspecified region hydantoin derivatives causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to