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: vancomycin / gleevec / cefepime hcl / clindamycin attending: chief complaint: chest and neck pain major surgical or invasive procedure: none history of present illness: mr. is a 28-year-old man with a history of biclonal leukemia, diagnosed in status post chemo initially and then after a relapse of his all, he underwent allo bmt transplant on , but his all relapsed in and was treated with vincristine, prednisone, and gleevec. the gleevec was discontinued because of a reaction to it. most recently he has received clofarabine after which he had an aplastic-looking marrow and received a stem cell boost. his most recent hospitalization was until during which he was noted to have pulmonary nodules, and was treated empirically with ambisome, voriconazole, and initially capsofungin and was sent home on ambisome and voriconazole. last dose of ambisome was , and he was continued on voriconazole alone with his last dose on because the the medication. he was last seen in dr. ??????s clinic on and had been doing well. he had a bone marrow biopsy performed on that day as well. the bone marrow biopsy is pending at this time. the patient presented to the ed on at 04:30 complaining of chest and neck pain. the patient states that he was in his usual state of good health until last night when he had gradual onset left neck to substernal chest pain described as "something squeezing in from my lungs," "pressure," 15/10 and pleurtic. he also complains of neck pain which is worse with movement. no associated sob or diaphoresis. has had mild nausea since his discharge without emesis. patient denies f/c, cough, abdominal pain, rash. this pain is similar to pulmonary nodule pain he has had in the past. in the ed, his initial vs were 99.2, hr 121 bp 126/78 rr 16 100% on ra. he was given morphine 8 mg iv and dilaudid 8mg iv for pain control and became hypotensive with vs 116, 78/44 while in the ed. he recieved 6 l ns with only 500 cc of dark urine output over several hours and was then started on levophed for pressure support. seen by cardiology consult who felt not consistent with cardiogenic shock. he was admitted to the micu for further work up and management. past medical history: 1. biclonal leukemia: -diagnosed -- presenting with sore throat, severe upper airway inflammation requiring intubation, and a wbc of 130,000. examination of the marrow demonstrated nearly 100%blasts, and cytogenetic examination showed t9;22 and q341.-q11.2. he was initially treated with emergent pheresis, steroids, and hydroxyurea, then was started on regimens to address both all and the aml component. he underwent hypercvad regimen without complete remission. - -- pt had matched unrelated donor allo-bmt with preceding total body radiation and cytoxan conditioning regimen. following this, he exeperienced grade 1 gvhd with rash, treated with steroid taper. he had a transaminitis at the time, but bx excluded hepatic gvhd involvement. - -- marrow bx indicated remission - -- pt developed petechiae, wbc found to be 18.4, platelets of 19, 18%blasts, and a marrow bx indicated all recurrence. he was treated with vincristine and prednisone. - -- a repeat marrow bx indicated residual leukemia, though improved from previous. - -- pt underwent donor lymphocyte infusion - -- marrow biopsy shows leukemia with 80% involvement, and pt is admitted for hypercvad, discharged . -- received clofarabine after which he had an aplastic-looking marrow and received a stem cell boost. 2. prolonged febrile neutropenia complicated by severe infections including probable fungal infection with pulmonary nodules and mesenteric mass. 3. transaminitis -- liver bx with focal pmn aggregates, no evidence of gvhd . 4. typhilitis 5. line infection social history: lives in and works as a mechanical engineer. has a girlfriend. family is supportive. no tobacco use. previous occasional etoh use, none currently. no illicit drug use. family history: nc physical exam: pe: t 100.5 hr 115 bp 76/32 - 106/58 (current) r 16 %sat 99 ra pulsus gen: fatigued, a&o x 3, appears mildly uncomfortable heent: atnc, perrla, anicteric, op clear, mmm neck: supple, no lad, chest: cta bilat, no egophany or fremitus, resonant cor: tachy, nl s1 s2 no m/r, jvp flat abd: soft, nt/nd, no hsm/m hypoactive bs ext: warm, skin: no rashes, petechiae. flat smooth 1.3 cm eschar on l medial shin pertinent results: cxr: there has been interval development of patchy opacification at the left lung base peripherally. cardiac and mediastinal contours are normal. pulmonary vasculature remains normal. the osseous structures are unremarkable. the right-sided central venous catheter is stable in position. impression: interval development of new left-sided patchy opacification, left lung base. given the patient's history of all, this is concerning for developing pnemonia. chest/abd/pelvis ct : 1) hazy opacity within the right lower lobe, a finding that could partly related to atelectasis, although is suspicious for pneumonia given its asymmetry. 2) no evidence of pulmonary embolus or aortic dissection. 3) stable small to moderate pericardial effusion. 4) decreased size of mesenteric mass, which is now not measurable, with minimal residual haziness in the mesentery. 05:50am blood wbc-3.3*# rbc-3.18* hgb-10.2* hct-28.6* mcv-90 mch-32.1* mchc-35.7* rdw-18.3* plt ct-118* 05:05am blood wbc-8.2 rbc-3.91*# hgb-12.1*# hct-34.4*# mcv-88 mch-31.0 mchc-35.2* rdw-16.9* plt ct-130* 08:05am blood wbc-7.1 rbc-2.68*# hgb-8.4*# hct-24.4*# mcv-91 mch-31.5 mchc-34.5 rdw-17.5* plt ct-145* 02:20am blood neuts-84.2* lymphs-9.7* monos-4.2 eos-1.6 baso-0.3 05:05am blood neuts-94* bands-0 lymphs-3* monos-2 eos-1 baso-0 atyps-0 metas-0 myelos-0 05:50am blood pt-14.1* ptt-31.8 inr(pt)-1.3 05:50am blood glucose-108* urean-17 creat-1.2 na-141 k-3.9 cl-113* hco3-22 angap-10 02:20am blood ld(ldh)-152 ck(cpk)-26* 08:05am blood ld(ldh)-83* ck(cpk)-15* totbili-0.8 dirbili-0.2 indbili-0.6 04:12pm blood ck(cpk)-23* 02:20am blood ctropnt-<0.01 08:05am blood ctropnt-<0.01 04:12pm blood ck-mb-1 ctropnt-<0.01 05:50am blood calcium-8.2* phos-2.3* mg-2.0 08:05am blood hapto-72 05:50am blood aspergillus galactomannan antigen-pnd brief hospital course: #hypotension: original ddx was early sepsis vs. narcotics related vs. cardiogenic vs adrenal insufficiency. he required levophed and aggressive fluid hydration to maintain sbp>100 and was started on fludrocotisone for possible adrenal insufficiency. pt had flat jvp and warm extremities, no evidence of tamponade. he was ruled out for mi by enzymes, and cardiology consult did not not think picture was c/w cardiogenic shock. a cortasyn stim test was performed and he was seen to respond, so we discontinued fludrocortisone and hydrocortisone. sepsis was considered and he was broadly covered on admission with ambisome, imipenem, voriconazole. he was weaned off vasopressors and ivf on hd3 and sbp's remained in the 90's but he was asymptomatic, making urine, and had normal lactate so no further intervention was made. . #id: a) pulmonary nodules: pt had history of pulmonary nodules thought to be of fungal origin without positive cultures data. he had been on empiric treatment for fungal process with ambisome and vorinazole for 3 months, then voriconazole alone since , but was off this for four days before admission. chest ct revealed no nodular infection but a rll infiltrate concerning for cap and on hd2 was started on levofloxacin. at that same time he was started on vancomycin since his allergy was questionable and he had a permanent tunneled line. he developed periorbital edema and diffuse skin etyhema, elevated lft's and eosinophilia thought initially due to vancomycin so this was stopped. vancomycin was changed to daptomycin which was stopped given blood cultures remained negative x 48 hours. infectious workup in looking for source of sepsis included urine, blood and sputum culture, fungal , afb, pcp, , mycoplasma, urine ag, galatomannan all of which were negative. pt's lft's continued to rise off of the vancomycin so the levofloxacin was changed to azithromycin which he completed a 10 day course of. he was then started on voriconazole as below for risk of recurrence of fungal infection with immunosuppressive treatment for gvhd as below. elevated lft's-pt continued to have climbing lft with a cholestatic picture initially thought to be due to drug reaction by both id and dermatology. skin biopsy showed complete separation of dermis and epidermis consistent with drug rash. alkaline phosphatase continued to rise despite rash improving so then arose concern for gvhd as had occured in the past. at this point he was started on cyclosporine dosed to trough >100 and a day later mycofenolate was added. liver team was consulted and felt this was most likely gvhd and got a liver biopsy. biopsy revealed diffuse biliary destruction consistent with gvhd although it was unclear if this was old or new. he was continued on immunosuppressive therapy as above and on was feeling well so plan was made for further workup and treatment of elevated lft's as an outpt. . #chest/neck pain: t wave changes on ekg were non-diagnostic. it didn't appear to be due to ischemia given he was ruled out for mi with serial enzymes and had no events on telemetry. cta showed no pe/aortic dissection. most likely cause of pain is pleuritic chest pain from pneumonia. he was treated with his outpatient dose of oxycontin in hospital which he responded well to. . #anemia: baseline hct was around 28 thought to be anemia of chronic diseae. hemolysis labs were negative medications on admission: acyclovir 400 mg po bid (for zoster ppx) voriconazole 200 mg po bid (unable to fill for last three days) imipenenem 500mg q 6 hour aerosolized pentamidine qmonth (for pcp last dose4/19) diphenhydramine prn oxycodone sr 60 mg po bid oxycodone 5-10 mg po q6h breakthrough lorazepam 2 mg po q4-6h prn discharge medications: 1. oxycodone hcl 20 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po q12h (every 12 hours). disp:*60 tablet sustained release 12hr(s)* refills:*0* 2. voriconazole 200 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*28 tablet(s)* refills:*0* 3. acyclovir 200 mg capsule sig: two (2) capsule po q12h (every 12 hours). disp:*120 capsule(s)* refills:*2* 4. mycophenolate mofetil 250 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 5. prednisone 20 mg tablet sig: three (3) tablet po daily (daily) for 7 days. disp:*21 tablet(s)* refills:*0* 6. 30 mg tablet sig: 1-2 tablets po qhs/prn. disp:*30 tablet(s)* refills:*2* 7. oxycodone hcl 5 mg tablet sig: 1-2 tablets po q4-6 hous/prn as needed for pain. disp:*30 tablet(s)* refills:*0* 8. oxycodone hcl 10 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po twice a day. disp:*60 tablet sustained release 12hr(s)* refills:*0* 9. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* discharge disposition: home with service facility: critical care systems discharge diagnosis: gvhd cap discharge condition: stable discharge instructions: please follow-up daily on 7 for measurement of your lft's and to continue following your rash. followup instructions: needs echo in 2 weeks. procedure: closed (percutaneous) [needle] biopsy of liver transfusion of packed cells closed biopsy of skin and subcutaneous tissue injection or infusion of oxazolidinone class of antibiotics infusion of vasopressor agent diagnoses: pneumonia, organism unspecified anemia of other chronic disease hypotension, unspecified dermatitis due to drugs and medicines taken internally complications of transplanted bone marrow other specified antibiotics causing adverse effects in therapeutic use other chronic nonalcoholic liver disease pleurisy without mention of effusion or current tuberculosis cervicalgia acute myeloid leukemia, in remission acute lymphoid leukemia, in remission 

Answer: The patient is high likely exposed to