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: lipitor attending: chief complaint: fatigue and shortness of breath major surgical or invasive procedure: brochoscopy with hilar lymph node biopsy peripherally inserted central catheter right intravenous central venous catheter (removed ) history of present illness: mr. is a 69 y/o male with a history of esrd on hd, cll, dm2 c/b peripheral neuropathy, cad and anemia (baseline 20-23) who presented with worsening shortness of breath and fatigue. he states that symptoms started about 1 month ago. of note he was recently admitted from for weakness and fatigue in which he was inititated on dialysis. he states after his discharge he started not feeling soon thereafter. his weakness progressively got worse and noted feeling more short of breath. he notes being "stubborn" and not asking for help however is at a poit where he is needs more help. he has an associated nonproductive cough for 2 weeks and denies any abdominal pain, dysuria, or increased lower extermity swelling. he also notes that having decreased appetite. . in the ed, initial vs were: t 99.7 p 87 bp 108/59 o2 sat 99ra. patient was given 1l of ns and 1 unit prbc. . on the floor, he is comfortable in nad. he states that he is feeling better and his appetite is improved with receiving some blood. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied chest pain or tightness. denied nausea, vomiting, constipation or abdominal pain. has diarrhea which he contributes to one of his vitamins. no dysuria. denied arthralgias or myalgias. past medical history: cll/sll adult onset diabetes c/b peripheral neuropathy chronic renal failure coronary artery disease cataracts anemia social history: etoh: none smoke: prior smoking history (cigarrette and pipe), quit 40 years ago illicits: none he is a retired police officer. he lives alone, his sister lives in the apartment above him. he has four children and grandchildren who are involved in his life. his sister is currently hospitalized undergoing work-up for a valve replacement. family history: multiple relatives with dm; brother and sister both died from complications from dm. sister had fatal ovarian cancer. +cad in family. physical exam: admission physical exam vitals: t: 100.0 bp: 105/48 p: 78 o2: 93 ra general: alert, oriented, no acute distress heent: mmm, oropharynx clear, large lad r>l (posterior cervical chain) neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular with ectopy, normal s1 + s2, sem diffusely throughout, no rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 1+ pulses dp, no clubbing, cyanosis or edema neuro: cns2-12 intact, significant peripheral neuropathy pertinent results: labs upon admission: 06:20pm blood wbc-31.1* rbc-2.10* hgb-5.7* hct-19.3* mcv-92 mch-26.9* mchc-29.2* rdw-19.1* plt ct-104* 06:20pm blood neuts-4* bands-0 lymphs-81* monos-12* eos-0 baso-0 atyps-3* metas-0 myelos-0 other-0 06:30am blood neuts-16* bands-0 lymphs-64* monos-1* eos-0 baso-0 atyps-4* metas-0 myelos-0 other-15* 06:05am blood neuts-9* bands-0 lymphs-40 monos-3 eos-1 baso-0 atyps-3* metas-0 myelos-0 other-44* 06:20pm blood hypochr-2+ anisocy-3+ poiklo-2+ macrocy-2+ microcy-1+ polychr-normal spheroc-occasional ovalocy-2+ tear dr 06:20pm blood pt-14.7* ptt-27.9 inr(pt)-1.3* 04:30pm blood glucose-149* urean-16 creat-3.2*# na-141 k-4.6 cl-97 hco3-39* angap-10 06:30am blood alt-7 ast-13 ld(ldh)-258* alkphos-69 totbili-0.5 06:30am blood lipase-10 06:20am blood calcium-8.2* phos-1.7*# mg-1.5* 01:25pm blood caltibc-130* hapto-301* ferritn-1255* trf-100* 12:00pm blood pth-294* 04:04am blood cortsol-27.9* 05:08pm blood pep-no specifi igg-478* iga-24* igm-18* 10:13am blood freeca-1.01* . labs upon discharge: . 06:36am blood wbc-39.8* rbc-2.66* hgb-8.1* hct-25.1* mcv-95 mch-30.4 mchc-32.2 rdw-18.9* plt ct-72* 05:33am blood pt-13.2 ptt-32.7 inr(pt)-1.1 06:36am blood glucose-83 urean-12 creat-2.2* na-143 k-3.6 cl-106 hco3-32 angap-9 05:43am blood ld(ldh)-239 06:36am blood calcium-7.2* phos-1.6* mg-1.7 . chest x-ray : impression: no acute pulmonary process. the etiology of the blunting of the left costophrenic angle is indeterminate. conceivably, it could represent small focal anterior loculated effusion or possibly a subsegmental atelectasis. . ct abd/pelvis : impression: 1. large soft tissue lesions through the mesentery, retroperitoneum, inguinal areas and lower mediastinum concerning for large lymph nodes, presumably in setting of cll. splenomegaly. 2. cholelithiasis. 3. bilateral small pleural effusions and bibasilar opacities, could be atelectasis. 4. no evidence of abdominal aorta dissection. moderate atherosclerotic changes in the abdominal aorta and its branches. 5. diffuse osseous sclerosis, could be seen in the renal osteodystrophy or related to cll. . pet ct scan: impression: 1. large soft tissue lesions through the neck, mesentery, retroperitoneum and inguinal areas concerning for large lymph nodes, presumably in setting of cll since no fdg uptake above normal tissues is seen. 2. increased fdg uptake in several hilar lymph nodes, subcarinal lymph node and soft tissue at the left lung base near the mediastinum (difficult to tell if mediastinal lymph node or within the lung); concerning for focal transformation. 3. splenomegaly. 4. cholelithiasis. 5. bilateral moderate pleural effusions and bibasilar opacities, could be atelectasis in setting of pulmonary edema. 6. diffuse osseous sclerosis, could be seen in the renal osteodystrophy or related to cll. note: there is suggestion of metabolic imbalance; we are not seeing uptake in the kidneys and there is decreased uptake in the brain. also, due to diffuse anasarca and third spacing, the resolution on low-dose ct is particularly poor. . cxr : findings: ap single view of the chest has been obtained with patient in sitting semi-upright position. comparison is made with the next preceding similar study of . a previously described right internal jugular central venous line remains in unchanged position. a new right-sided picc line is identified and the tip is seen to terminate in almost similar position as the other line, i.e. in the mid-to-lower portion of the svc. no pneumothorax has developed. the picc line is difficult to identify on the native chest examination, however, a special contrast-enhanced copy conclusively demonstrates termination point close to the previously existing line as described. . tissue immunophenotyping : immunophenotypic findings consistent with involvement by a kappa light chain restricted monotypic b-cell lymphoproliferative disorder, consistent with patient's known chronic lymphocytic leukemia/ small lymphocytic lymphoma. review of the concurrent blood smear reveal increased prolymphocytoid cells; atypical larger lymphoid cells with irregular nuclear contours and prominent nucleoli are noted, suggestive of transformation. clinical correlation and bone marrow biopsy study is recommended. . tissue immunophenotyping : pending brief hospital course: mr. is a 69 y/o male with a history of esrd on hd, cll, dm2 c/b peripheral neuropathy, cad and anemia (baseline 20-23) who presented with worsening shortness of breath and fatigue, transferred to micu for hypotension, improved with aggressive iv hydration, then transferred to the floor where he was dialyzed and was evaluated for possible cll/sll conversion to lymphoma. . # hypotension: he triggered the night after admision () for hypotension with sbp in the 70's, was started on vanco/ transferred to micu. there he was extremely fluid responsive with >10l ivf given. norepinephrine was initially used, then weaned. working diagnosis included hypovolemic shock vs distributive shock, although no infectious source was identified. antibiotics continued for 3 days. he was gradually restarted on beta blocker and alpha blocker while on the floor. he had no recurrences of hypotension while on the medical . . # esrd: hd schedule is mon, wed and fri. he was dialyzed as per schedule with additional ultrafiltration to help diurese the large fluid load he received due to hypotension. sevelamer was stopped due to low phosphorus. continued on nephrocaps. lasix held because per recs from his outpatient providers. he will resume darbopoetin weekly upon discharge. at discharge, he is still hypervolemic, but anasarca has significantly improved and pulmonary edema has significantly improved (no oxygen required). . # anemia: multifactorial etiologies including renal failure, dilution and potentially cll/sll. he received 4 units prbc total during admission with appropriate response in hematocrit. there was no evidence of hemolysis. he will resume darbopoetin weekly upon discharge. his hematocrit should be checked every 3 days at rehab until it has stabilized. . # cll/sll: ct abdomen showed large intra-abdominal lymphadenopathy, initially concerning for syndrome. flow cytometry was sent which was consistent with known cll/sll, although there was some concern over prolymphocytes seen on smear. he subsequently received a pet ct which showed fdg avid uptake in hilar nodes but not intra-abdominally. ldh remains normal, which suggests against conversion to lymphoma. however, because hilar nodes were concerning on pet ct, he received bronchoscopy with hilar lymph biopsy . there were no immediate complications to the procedure. the pathology and immunophenotyping will be followed by hematology/oncology and the patient has follow up scheduled with dr. to discuss results and initiate treatment should this be lymphoma. . # hypertension: his blood pressure have been stable since ivf resuscitation. restarted metoprolol in exchange for nebivolol on day of transfer from micu. also restarted doxazosin which he has tolerated well. . # weakness/fatigue: multifactorial in etiology, related to anemia, hypovolemia, and deconditioning. evaluated by pt and will receive pt at rehab. . emergency contact: the patient was dnr/dni for this admission. medications on admission: 1. gabapentin 100 mg capsule sig: one (1) capsule po twice a day. 2. darbepoetin alfa in polysorbat 150 mcg/0.3 ml syringe sig: one (1) injection qwednesday. 3. doxazosin 1 mg tablet sig: two (2) tablet po bid (2 times a day): please hold this medication on dialysis days. 4. lasix 80 mg tablet sig: one (1) tablet po once a day: please discuss continuation of the medication with your physicians. 5. nebivolol 5 mg tablet sig: one (1) tablet po once a day: please hold this medication on dialysis days. 6. pioglitazone 15 mg tablet sig: one (1) tablet po once a day. 7. nephrocaps 1 mg capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*2* 8. renagel 800 mg tablet sig: two (2) tablet po tid with meals. disp:*180 tablet(s)* refills:*2* discharge disposition: extended care facility: northeast - discharge diagnosis: hypovolemic shock chronic kidney disease stage v, on hemodialysis diabetes mellitus type 2 chronic lymphocytic leukemia and small lymphocytic leukemia anemia of chronic disease bph hypertension left lower extremity superficial venous ulcer discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you came to the hospital because of shortness of breath and fatigue. you were found to have a very low blood pressure, requiring care in the intensive care unit where you received a large amount of intravenous fluid and improved. you received a pet scan followed by biopsy of nodes in your chest. the results of this biopsy are pending and you will follow up with dr. for these results. . we made the following changes to your medications: - stop lasix - stop renagel (sevelamer) - stop pioglitazone - stop nebivolol - start metoprolol 50mg twice daily - change gabapentin to 200mg to be on hemodialysis days - start insulin sliding scale as directed - start heparin 5000 units subcutaneous injection 3 times daily, this can be stopped once you are able to walk regularly - start miralax 17g daily - start senna 8.6mg twice daily as needed for constipation - start dulcolax 5-10mg daily as needed for constipation . you will be discharged to a rehab facility. when leaving that facility, please schedule an appointment with your primary care doctor and kidney doctor for follow up within 1-2 weeks. . it was a pleasure caring for you. we wish you a speedy recovery. followup instructions: department: hematology/bmt when: wednesday at 10:00 am with: , np building: sc clinical ctr campus: east best parking: garage department: hematology/bmt when: wednesday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage md procedure: venous catheterization, not elsewhere classified fiber-optic bronchoscopy hemodialysis biopsy of lymphatic structure diagnoses: anemia in chronic kidney disease end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) other shock without mention of trauma chronic lymphoid leukemia, without mention of having achieved remission venous (peripheral) insufficiency, unspecified other lymphoid leukemia, without mention of having achieved remission 

Answer: The patient is high likely exposed to