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: niacin attending: chief complaint: altered mental status major surgical or invasive procedure: none history of present illness: this is a 78 year old male with pmh of blastic plasmacytoid dendritic cell neoplasm found down incontinent by wife. unable to give history given mental status, obtained from wife. was in usual state of health until a few weeks ago, starting getting progressively weak, especially in his legs and getting tired more easily when walking, doing errands. progressively weakness got worse, and patient started slurring his words but was still coherent and mental status in tact. he was seen in clinic on where it was noted that he had progression of his blastic plasmacytoid dendritic cell neoplasm from the skin to the leukemic phase. he was started on hydroxyurea on after he and his wife were made aware of his poor prognosis with leukemic transformation. . he was getting progressively weaker since his clinic visit, as above, and then night prior to admission his wife noticed he was confused, had incoherent speech and tried to stand up and fell down. he kept waking up at night and was very agitated, complaining of dry mouth, and not understanding where he was or what was going on. he was found down by ems and was incontinent of stool and urine. he was initialy brought to hospital where he was found to have no acute abnormality on head ct, cr elevated at 1.7, total bili 1.7, wbc 91.9, cxr with no acute process. he was transferred here since his oncologist, dr. , is at . . in the ed, initial vs: 98.6 98 127/71 16 99% 2l nc. he was noted to be agitated and received zyprexa 5 mg x 2. he was also noted to be in afib with rvr to 140s, for which he recieved diltiazem 10 mg iv x 1, metoprolol 5 mg iv x1, also received metoprolol 75 mg po x1. he also received 2 l of iv ns. onc was onsulted in the ed and per dr. , lp was done to assess for cns leukemia. 31 wbc noted on csf, with 66% other, suggestive of leukemia in cns. ua also positive for uti, so ceftriaxone at 2 mg iv x 1 was given, given concern for meningitis with wbc in csf as well. transfer vs: 108/61, 110, 20, 100% 2l. . on the floor, unable to assess ros due to mental status. appeared agitated and yelling at staff to get away from him. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. . past medical history: past medical history: # bladder cancer, treated with total cystectomy in . he has a reconstructed bladder. prostatectomy was apparently performed at this time, as well. # rotator cuff repair in . # chronic thrombocytopenia. # idiopathic bell's palsy arising at least 20 years ago leaving him with a r sided facial droop. # atrial flutter # hyperlipidemia # htn # rectal fissure . summary of oncologic history: blastic plasmacytoid dendritic cell neoplasm: - progressed while on pralatrexate and pentostatin - currently on gemcitabine, c5d1 on (1) he has been a patient of dermatologist dr. for 30 years, with prior basal cell cancers on the head treated by excision. with a history of sun exposure during the summers and trips to dubai to visit his daughter and her family during winter months, he first noticed a greyish pimple-like lesion on his mid-frontal scalp in -. this lesion was biopsied on by dr. . (2) he saw dr. on in follow-up, and at this time additional erythematous lesions had appeared on the back. biopsy of a back lesion was obtained revealing findings similar to the scalp lesion. (3) an extensive staging evaluation was performed by dr. of hematology/oncology including: -- cbc revealing mild anemia and chronic stable to somewhat improved thrombocytopenia. serum iron chemistries suggested borderline iron deficiency. bone marrow biopsy () showed hypercellular marrow for age with no other specific findings, including evaluation by flow cytometry. -- pet scanning () showed no abnormal fdg uptake in the skin or scalp. a "small area of patchy uptake in the anterior aspect of the right liver lobe" was of "uncertain significance." -- ct scanning () revealed left sphenoid sinus thickening and four low density lesions in the liver "suspicious for metastatic foci." follow-up hepatic ultrasound and mri were suggested. -- on , he saw an ent specialist for evaluation of the left sphenoid sinus findings. samplings revealed aspergillus and no evidence of a lymphoproliferative disorder by flow. there was no evidence of invasive aspergillosis, and expectant observation was recommended by an infectious disease specialist. (4) subsequently, he noticed a new erythematous scalp lesion, located at the right lateral hairline of his balding scalp, in association with a pigmented lesion representing seborrheic keratosis and basal cell cancer, subsequently excised. with the exception of fading erythematous lesions on his back, he had not noticed any other cutaneous findings of concern prior to his visit with us on . (5) in , he noticed progression of skin lesions. he saw us in follow-up on and began weekly oral methotrexate 2.5 mg at 8 a.m. + 2.5 mg at 8 p.m. + 2.5 mg at 8 a.m. on . on , methotrexate increased to 5 mg at 8 a.m. + 5 mg at 8 p.m. + 5 mg at 8 a.m. on . weekly mtx dosing on was held at the same level as on , and continued this weekly dose level until when his dose was increased to 7.5 mg + 7.5 mg + 7.5 mg, given questionable recrudescence in his skin lesions. (6) on , mr. reduced his weekly oral methotrexate (mtx) as follows: on tuesdays, methotrexate 7.5 mg at 8 a.m. + 7.5 mg at 8 p.m. on wednesdays, methotrexate 5 mg at 8 a.m. his last dose was on , when mtx was subsequently stopped to allow healing of a right palate ulcer, arising with a neutrophil count above 1500 per microliter and brought on by burning his palate with hot coffee. (7) off mtx, right palate ulcer resolved, but he noticed recurrence of his skin lesions on the back, increased redness of the scalp lesion, and appearance of several new lesions on the mid-anterior chest. mtx was resumed on with stabilization or regression of lesion on the following dosing schedule, which was less than his prior dosing schedule of 3 + 3 + 2: on sundays, 5 mg at 8 a.m. + 5 mg at 8 p.m. + 5 mg at 8 a.m. the following day.skin lesions improved markedly. (8) in , while visiting his family in dubai, he developed fever and was hospitalized briefly without evidence of infection by culture. due to leukocytopenia and neutropenia, mtx was held and subsequently lowered to a daily dose of 2 + 2 + 1 and 2 + 1 + 1. on lower-doses of mtx, skin lesions recrudesced. last doses of mtx were on and , when skin disease had progressed to their worst appearance since presentation in -. (9) on , began pralatrexate 30 mg/m2 with vitamin b12 1,000 micrograms im every 7 weeks and folate 1 mg daily. due to mucositis and neutropenia after a single dose, second dose reduced by 50%. mucositis recurred after second dose despite dose reduction. pralatrexate discontinued. (10) on , began cycle 1 pentostatin with doses administered on day 1, 8 and 15. after three doses, he had a mixed response. (11) on , resumed pralatrexate at a reduced dose of 15 mg/m2 weekly. due to neutropenia, pralatrexate dose further reduced on to 10 mg/m2 every other week. on the reduced dose of pralatrexate, skin lesions on torso and head became worse. pralatrexate discontinued with last dose administered on . (12) on , began gemcitabine 800 mg/m2 weekly days 1,8,15 of a 28 day cycle with response. d/t neutropenia and thrombocytopenia, gemcitabine was reduced to 500 mg/m2 on days 1 and 15. he remained on gemcitibine with improvement in his skin till he departed for in late . last dose of gemcitabine administered on . (13)while in , he consulted dr. at cancer center in who recommended xrt to his scalp lesions. no chemotherapy was administered during his stay. between and , he received a total of 2800 cgy to the l and r frontal scalp lesions under the care of dr. at proter radiation oncology in , fl. with gradual fading of his scalp lesions. he returned back to the beginning of . social history: he is married, living with wife in . he is a retired former high school principal who now works part-time as a dispatcher for transit system. he never smoked. drinks cocktails per night. no illicit substances. family history: his father died at age 73 of liver cancer. physical exam: icu admission physical exam: general: appears agitated, yelling at staff, not oriented to self, place, or date heent: sclera anicteric, dry mm, oropharynx clear, reddish patches on scalp and chest, perrla, r eye droop (chronic) neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: moves all 4 extremities, unable to cooperate with exam pertinent results: admission labs: 12:25pm blood wbc-91.9*# rbc-2.76* hgb-8.1* hct-24.1* mcv-87 mch-29.2 mchc-33.5 rdw-25.1* plt ct-43* 04:47am blood wbc-104.7* rbc-2.60* hgb-7.6* hct-23.2* mcv-89 mch-29.2 mchc-32.7 rdw-23.4* plt ct-37* 12:25pm blood neuts-3* bands-0 lymphs-4* monos-0 eos-0 baso-0 atyps-1* metas-0 myelos-0 blasts-92* nrbc-1* 12:25pm blood hypochr-1+ anisocy-1+ poiklo-normal macrocy-1+ microcy-1+ polychr-normal schisto-occasional acantho-occasional 04:47am blood hypochr-2+ anisocy-3+ poiklo-2+ macrocy-2+ microcy-normal polychr-normal ovalocy-1+ target-1+ burr-2+ ellipto-occasional 12:25pm blood pt-17.0* ptt-27.7 inr(pt)-1.5* 12:25pm blood plt smr-very low plt ct-43* 04:47am blood pt-18.2* ptt-29.2 inr(pt)-1.6* 04:47am blood plt ct-37* 12:25pm blood ret aut-1.6 12:25pm blood glucose-107* urean-39* creat-1.7* na-139 k-4.4 cl-111* hco3-18* angap-14 04:47am blood glucose-107* urean-42* creat-1.8* na-140 k-4.6 cl-114* hco3-12* angap-19 12:25pm blood alt-15 ast-24 alkphos-81 totbili-1.7* 04:47am blood totprot-5.5* calcium-9.0 phos-3.5 mg-1.8 12:25pm blood calcium-9.4 phos-2.7 mg-1.8 uricacd-6.3 pathology pending micro pending chest (portable ap) study date of 2:31 pm findings: single frontal view of the chest was obtained. the lungs are clear without focal consolidation. no pleural effusion or pneumothorax is seen. cardiac and mediastinal silhouettes are unremarkable. impression: no acute cardiopulmonary process. brief hospital course: 78 year old male with pmh of blastic plasmacytoid dendritic cell neoplasm found down and incontinent by wife with recent leukemic conversion of malignancy, uti, afib with rvr, wbc in csf. . # altered mental status: pt had elevated 31 wbc in csf, with 66% other suggesting blasts, likely leukemic infiltration given recent increase in wbc and leukemic conversion. was started a few days ago on hydroxyurea by oncology service, however wbc continued to increase. also concern wbc could suggest meningitis, although less likely considering differential in csf. could also be related to uti. started on ceftriaxone. however, after further discussion with family about disease prognosis w/onc att, family felt that it was appropriate to transition pt to dnr/dni and later transitioned to comfort measures. abx were stopped and care focussed on ensure pt comfort. . # afib: rate now in 110s after receiving iv metoprolol and diltiazem in ed and dose of po metoprolol. was not taking po medications, and appeared to be volume down which may be related to tachycardia. ivf and dilt were given. had planned to restart metoprolol when able ot take po but pt was transitioned to comfort measures and all not essential, non-comfort meds were stopped . # : cr elevated to 1.7 from 1.2-1.4 baseline, likely pre-renal. renally dosed meds. pt was transitioned to comfort and labs were stopped. pt was allowed to drink which he did, frequently asking for water. . # hld: initially held fibrate and niacin while npo; d/c'ed when cmo . # anemia: likely due to leukemia/bone marrow process. . # htn: held lisinopril while npo; d/c'ed when cmo medications on admission: 1. fenofibrate 160 mg tablet sig: one (1) tablet po daily (). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. cyanocobalamin (vitamin b-12) 500 mcg tablet sig: two (2) tablet po daily (daily). 6. metoprolol succinate 75 mg tablet extended release daily 7. niacin 500 mg tablet sig: one (1) tablet po once a day. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. hydrocortisone 2.5 % cream sig: one (1) appl rectal (2 times a day). 10. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po twice a day as needed for constipation. 11. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po 1-2 times daily. 12. senna 8.6 mg tablet 13. bisacodyl 5 mg tablet, delayed release (e.c.) 14. allopurinol 300 mg daily (started ) 15. hydroxyurea 1000 mg daily (started ) 16. lorazepam 1 mg q6-8h prn anxiety 17. oxycodone 5-10 mg q4h prn pain . discharge disposition: expired discharge diagnosis: na discharge condition: na discharge instructions: na followup instructions: na procedure: spinal tap incision of lung diagnoses: urinary tract infection, site not specified unspecified essential hypertension other and unspecified hyperlipidemia personal history of malignant neoplasm of bladder bell's palsy do not resuscitate status encephalopathy, unspecified anemia in neoplastic disease acute leukemia of unspecified cell type, without mention of having achieved remission 

Answer: The patient is high likely exposed to