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: fevers major surgical or invasive procedure: -intestinal feeding tube placement history of present illness: mr. is a 39 year old patient with nhl s/p allosct and dli , in remission but with gvhd-associated bronchiolitis obliterans and severe restrictive lung disease who was recently admitted with fever, hypoxia and respiratory distress and discharged to on . he is now being readmitted from with low grade fevers for the past three days and a fever today to 101.2 in the setting of missing iv colistin. . the patient had a prolonged hospital admission last month for pneumonia with multiple strains of highly resistant, elevated lfts, and left brachial dvt (for which systemic anticoagulation was not given for concern of recent gi bleed). his prednisone was increased during this admission for concern of gvhd but then subsequently tapered back to his prior dosage of 15mg qd. id started him on both inhaled and intravenous colistin in addition to amikacin and he became afebrile with improved wbc count on this regimen. he was supposed to continue this until . he was discharged to on . over the last week at his rehab facility he was not continued on the iv colistin for unclear reasons. he did receive inh colistin, amikacin, and trimethoprim/sulfamethoxazole. . he was noted to develop daily low grade fevers starting to 100.2. this morning his temp wa 101.2. otherwise there were no changes in his exam, no altered mental status, no increased coughing or production in sputum, no diarrhea, no urinary incontinence. over the past week his bp has been 90s to low 100s, rr high 20s to low 30s, hr 95 - 117. the patient's family reportedly were also not happy with his current care at rehab and were wanting him to be admitted. . he went to his previously scheduled clinic visit, where he was evaluated and it was decided he should be admitted for his fevers. upon arrival to the , he was hypertensive and had sinus tachycardia to the 160s. he was agitated with copious green/yellow secretions being suctioned out of his trach. he denied shortness of breath or pain, but was requesting morphine to releive his work of breathing. past medical history: past oncologic history: - p/w fevers, night sweats, and weight loss in the setting of a left inguinal lymph node. - ct scan: 15x14x10cm mass in the luq. - bx grade ii/iii follicular lymphoma. - treated with six cycles of chop/rituxan with good response, but showed evidence for relapse in and was treated with mine chemotherapy for two cycles. - : underwent stem cell mobilization with cytoxan followed by autologous stem cell transplant in - : noted for disease recurrence. he was initially treated with a course of rituxan without response followed by zevalin with - : noted progression of his disease. he was treated with one cycle of followed by one cycle of eshap. - : nonmyeloablative allogeneic stem cell transplant with a hla-matched unrelated donor with campath conditioning - six-month follow-up ct noted for disease progression. - : received donor lymphocyte infusion in , complicated by acute liver/gi gvhd grade iv, for which required a prolonged hospitalization in the summer of . - multiple gi bleeds requiring icu admissions and multiple transfusions and embolization of his bleeding. - noted to have cns lesions felt consistent with ptld and this was treated with a course of rituxan. no evidence for recurrence of the ptld. - acute liver gvhd, on cellcept, prednisone, and photophoresis. - photophoresis was d/c'd due to episodes of bacteremia and eventual removal of his apheresis catheter. - restarted photopheresis on a weekly basis on , but then discontinued this again on as this was felt not to be making any impact on his liver function tests. - undergone phlebotomy due to iron overload with corresponding drop in his ferritin. he has continued with transient rises in his transaminases and bilirubin and has remained on varying doses of cellcept and prednisone which has been slowly tapered over the time. - cellcept discontinued. - admission due to increasing right hip pain. mri revealed edema and infiltrating process in the psoas muscle bilaterally. after extensive workup, this was felt related to an infection and required several admissions with completion of antibiotics in 03/. - : last scans showed no evidence for lymphom and he has remained in remission. - : uri and treatment with course of levaquin. - completed a 4 week course of rituxan to treat his gvhd. -in , noted to have tiny echogenic nodule on abdominal . mri of the liver also showed this nodule but was not as concerning on review and he is due to have a repeat mri imaging in early . -- gi varices and attempts at banding have been unsuccessful due to difficulty with passing the necessary instruments. he has been on a low dose beta blocker as well as simvastatin, which was started on to help with medical management of his varices. -on , worsening cough and was noted to have a small new pneumothorax in the left apical area. this has essentially resolved over time - issues with weight loss (followed by dr. ); multiple tests done with no etiology found; question malabsorption related to gvhd - has on and off respiratory infections and has been treated with antibiotics (now colistin inhaled and iv) for resistant pseudomonas. question underlying exacerbations of pulmonary gvhd in setting of his uris. - currently receives ivig every month. . other past medical history: 1. non-hodgkin's lymphoma s/p allo sct 2. grade 4 acute gvhd of gi/liver following dli with gi bleed, chronic transaminitis, portal htn with esophageal varices (not able to band) 3. history of intracranial lesions felt consistent with ptld. 4. extensinve chronic gvhd of lung, liver, skin, mucous membranes. 5. grade ii esophageal varices, intollerant to beta blockade. 6. hsv in nasal washing (completed course of valtrex) 7. hypothyroidism 8. hx of psoas muscle infection social history: smoke: never etoh: none currently; occassional use prior to nhl dx drugs: never born in and moved to the u.s. for college (). married in and lives in . no children. stays at home and writes (currently writing a book on being diagnosed with cancer at young age). family history: no lymphoma or other cancers in the family. father had cad s/p pci. physical exam: 99.9 157 169/120 96% on ventilator gen: cachectic male (appears less so since last admission), +trach present, + ngt small caliber, distressed due to suctioning of airway heent: sclera anicteric cv: tachycardic, no m/r/g pulm: coarse breath sounds bilaterally, no wheezes, crackles abd: soft, nt, nd, bowel sounds present ext: no peripheral edema pertinent results: microbiology urine urine culture- negative blood culture blood culture, routine-pending blood culture blood culture, routine-pending stool clostridium difficile toxin a & b test- negative mrsa screen mrsa screen-final inpatient urine urine culture-final inpatient blood culture blood culture, routine- negative 3:56 pm sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (preliminary): rare growth commensal respiratory flora. pseudomonas aeruginosa. sparse growth. of two colonial morphologies. colistin sensitivity testing requested by ami # . sent to for colistin sensitivity . sensitivities: mic expressed in mcg/ml _________________________________________________________ pseudomonas aeruginosa | amikacin-------------- 16 s cefepime-------------- 8 s ceftazidime----------- 8 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem------------- 4 s piperacillin/tazo----- =>128 r tobramycin------------ =>16 r . imaging ecg probable sinus tachycardia given patient's age but very rapid rate raises consideration of possible atrial tachycardia. slight st-t wave changes are non-specific. since the previous tracing of tachycardic rate is faster. otherwise, probably no significant change . chest xray impression: persistent pulmonary abnormalities with some more prominent patchy infiltrates in the right upper lobe area. lateral pleural effusion also progressing slightly since next preceding study of . . abdominal impression: 1. collapsed gallbladder with slight wall thickening may be due to third spacing. no stones identified within the gallbladder. no biliary ductal dilatation. 2. slight increased area of echogenicity within the left lobe of the liver, incompletely characterized. ct could be performed for further evaluation. 3. small amount of intra-abdominal ascites. 4. increased echogenicity to the spleen, which appears small . -intestinal tube placement impression: post-pyloric tube placement. . lower extremity doppler conclusion: there is no evidence of deep venous thrombosis of the right lower extremity . chest xray tracheostomy tube is in standard position. feeding tube tip is either in the antrum or first portion of the duodenum. cardiomediastinal contours are normal. small to moderate bilateral pleural effusions, larger on the left side, are stable. right upper lobe patchy opacities are unchanged as does bibasilar opacities, greater on the left side. in the bases, the opacities could be a combination of pleural effusion and atelectasis. . abdominal impression: 1. stable 1.1 cm hyperechoic focus. this is most consistent with a hemangioma. differential diagnosis includes focal fatty infiltration. 2. small amount of ascites and small right pleural effusion unchanged. . upper extremity doppler impression: dvt involving one of the left brachial veins. the extent is unchanged compared to . . brief hospital course: mr. is a 39 year old man with nhl, s/p allo complicated by multi-organ gvhd and bronchiolitis obliterans. he is s/p trach and recent hospitalization for multi-drug resistant pseudomonas pneumonia. he presented from with fever x 3 days. he remains ventilator dependent. # fever: on admission mr. had low grade temperatures. he was restarted on the antibiotics that he was discharged on. this included both iv and inhaled colistin. id was consulted on arrival. he was also continued on acyclovir, bactrim, voriconazole, and meropenem. he was initially placed on vancomycin, but this was stopped shortly after arrival as there was no evidence of a gram positive infection. his amikacin was stopped on . sputum grew pseudomonas strain that was less resistant than his prior pseudomonas. his iv colistin and meropenem were stopped on and he remained afebrile until discharge. his new antibiotic regimen which should be continued indefinitely includes colistin 75 mg (inhaled) mwf, voriconazole 200 mg po q 12, acyclovir 400 mg po q 12, bactrim ds 1 tab mwf. he will follow up with dr. in /infectious disease on , at 2 pm( 7 ). # ventilator dependent: mr. initially had difficulty weaning off of the ventilator for even short periods of time. he was initially kept on pressure support, but then was able to tolerate trach collar for small periods of time a day (up to 2 hours). he should continue to have daily face mask trials off the vent. . # acute renal failure: had arf with creatinine bump from 0.6 to 0.8. he was hydrated with ivf boluses and improved. a twelve hour creatine urine collection revealed a creatinine clearance of 52. pharmacy was contact and all of his medications were appropriately renally dosed. . # elevated lfts: likely from gvhd of the liver. ruq on showed no biliary obstruction, however did show area of hypoechoic liver that would be best characterized by ct, but due to fear of damaging kidneys with contrast he had a repeat that showed a stable lesion. . # anemia: hct stable. no evidence of blood loss. . # leukocytosis: chronically elevated white count. currently at baseline. # clogged feeding tube: mr. received creon through his feeding tube shortly after admission. this resulted in clogging his feeding tube. he had a new one placed under fluoroscopic guidance. creon was stopped. he had no further issues with his feeding tube. . # tachycardia: ekg's showed a sinus tachycardia on admission. this gradually improved. he was given morphine for dyspnea/pain and normal saline boluses on admission. . # nhl s/p allo c/b gvhd ?????? gvhd is underlying cause for patient??????s liver dysfunction and bronchiolitis obliterans. during this admission we continued prednisone and mycophenolate. we also continued bactrim, voriconazole, and acyclovir for prophylaxis. lft's were trended and followed daily. he has a follow up appointment with dr. in on , at 11 am. . # hypothyroidism: continued levothyroxine at his normal dose. . # upper extremity dvt: mr. was diagnosed with an upper extermity dvt on his previous admission (). the decision was made not to treat the dvt given his previous history of a significant gi bleed (). he had a repeat which showed a stable thrombus. the decision to anticoagulate was discussed with , primary oncology, and micu team. it was decided to change him to once daily fondaparinux 2.5 mg subq which is the lowest dose available given his low body weight. fen/gi: tube feeds were continued at the regular rate. . access: picc line was in place from a previous hospitalization. it was not removed. # prophylaxis: mr. was continued on prophylactic doses of subcutaneous heparin until discharge when the decision was made to change his anticoagulation to fondaparinux as above. . # code: mr. was a full code. this was confirmed on admission. . # dispo: mr. was discharged to rehab. medications on admission: current medications at : colistin 75 mg inh amikacin 700 mg iv q day morphine 2 mg q2 prn levothyroxine 125 mcg m, t, w,r tylenol 650 mg q6 prn simethicone 80 mg tid prn senna 5 ml prn ondansetron 8 mg q8 prn lorazepam 0.5 mg q4 prn ascorbic acid 500 mg q day zinc 220 mg q day lansoprazole 30 mg qam amylase/lipase/protease 1 q day guaifenesin 200 mg q 6 prn ferrous sulfate 300 mg q day fluticasone 1 spray q day prednisone 15 mg q am trazodone 25 mg hs prn heparin 500 units sq acyclovir 400 mg voriconazole 200 mg acetylcysteine q 12 albuterol 4 puffs q2 prn mycophenolate mofetil 250 mg bactrim 20 ml mwf colistin 125 mg (started ) ergocalciferol 5000 units qwed **note changes between actual meds given and meds on previous discharge: . pt did not get colisimethate sodium 150 mg iv bid (it was ordered 125 mg ) patient did not get colisimethate sodium 75 mg inh until pt received 250 mg of mycophenolate mofetil instead of 500 mg pt received 400 mg acyclovir instead of 500 mg pt was given 700 mg amikacin a day (dosage not clear on d/c summary) . discharge medications: 1. morphine sulfate 2 mg iv q2h:prn pain 2. levothyroxine 125 mcg tablet : one (1) tablet po 6x/week (mo,tu,we,th,fr,sa). 3. acetaminophen 650 mg/20.3 ml solution : one (1) po q6h (every 6 hours) as needed for pain/fever. 4. simethicone 80 mg tablet, chewable : one (1) tablet, chewable po tid (3 times a day) as needed for indigestion. 5. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 6. ondansetron 8 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 7. lorazepam 0.5-2 mg iv q4h:prn anxiety 8. ascorbic acid 500 mg/5 ml syrup : one (1) po daily (daily). 9. zinc sulfate 220 mg capsule : one (1) capsule po daily (daily). 10. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 11. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup : ten (10) ml po q6h (every 6 hours) as needed for cough. 12. ferrous sulfate 300 mg (60 mg iron)/5 ml liquid : one (1) po daily (daily). 13. fluticasone 50 mcg/actuation spray, suspension : one (1) spray nasal daily (daily). 14. prednisone 10 mg tablet : 1.5 tablets po daily (daily). 15. trazodone 50 mg tablet : 0.5 tablet po hs (at bedtime) as needed for insomnia. 16. fondaparinux 2.5 mg/0.5 ml syringe : one (1) subcutaneous daily (daily). 17. acyclovir 400 mg tablet : one (1) tablet po q12h (every 12 hours). 18. voriconazole 200 mg tablet : one (1) tablet po twice a day. 19. acetylcysteine 20 % (200 mg/ml) solution : one (1) ml miscellaneous q2h (every 2 hours) as needed for thick secretions. 20. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : six (6) puff inhalation q2h (every 2 hours) as needed for sob. 21. mycophenolate mofetil 250 mg iv bid 22. sulfamethoxazole-trimethoprim 800-160 mg tablet : one (1) tablet po 3x/week (mo,we,fr). 23. ergocalciferol (vitamin d2) 50,000 unit capsule : one (1) capsule po 1x/week (sa). 24. colistimethate sodium 150 mg recon soln : seventy five (75) mg injection please give , wednesday, and friday twice a day.: do not give injection. please give this formulation inhaled. give via nebulizer twice a day on , wednesday, and friday. discharge disposition: extended care facility: hospital - discharge diagnosis: primary diagnosis: graft versus host disease bronchiolitis obliterans upper extremity dvt discharge condition: mental status: clear and coherent. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: thank you for allowing us to take part in your care. you were admitted to the hospital with fevers. while you were in the hospital, we made several adjustments to your antibiotics. we also started treating you for a blood clot in your arm. these are the following changes to your medications: **stop "iv" colistin (however, you will remain on the "inhaled" colistin twice a day on , wednesday, and friday). ** stop amikacin ** stop heparin injections ** start fondaparinux followup instructions: please go to the following appointments: id/ , md phone: date/time: 2:00 pm dr. , md. date/time: at 11:00 am you also have the following appointment already scheduled: provider: , m.d. phone: date/time: 2:30 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances diagnoses: anemia, unspecified unspecified pleural effusion acute kidney failure, unspecified unspecified acquired hypothyroidism other malignant lymphomas, unspecified site, extranodal and solid organ sites peripheral stem cells replaced by transplant other specified cardiac dysrhythmias pneumonia due to pseudomonas other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation complications of transplanted bone marrow other diseases of lung, not elsewhere classified chronic respiratory failure tracheostomy status dependence on respirator, status other specified alveolar and parietoalveolar pneumonopathies nonspecific abnormal results of function study of liver chronic venous embolism and thrombosis of deep veins of upper extremity chronic graft-versus-host disease 

Answer: The patient is high likely exposed to