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: no known allergies / adverse drug reactions attending: chief complaint: confusion, found to have right frontal and left parietal brain lesions major surgical or invasive procedure: stereotactic brain biopsy history of present illness: 85 yo right handed m who was in his usual good state of health until 2 weeks ago when family began to notice change in mental status - he lost his way when driving to familiar place and has not been as engaged in daily activities. he denies headache, seizures, visual changes. . patient presented electively on for stereotactic brain biopsy of his right frontal lesion. he tolerated the procedure well and was extubated in the or then transferred to the pacu for recovery. after a short period of time in the pacu he was trasnferred to the floor where he remained stable overnight. on the morning of pod#1 he was seen by physical therapy who recommended that he would need to be sent to a rehab facility. rehab screen was started on . on the evening on he grew increasingly confused and agitated, and was likely sundowning. he was given zyprexa sl x 1 and placed in a posey. he remained agitated overnight, and in the morning was more calm. a geriatric consult was obtained, and they recommended that seroquel be given for agitation, and for his dexamethasone to be tapered to 2mg . a ua and cxr were obtained on , which were both negative for an infectious process. he became increasingly difficult to arouse on in the evening, and a head ct was obtained which demosntrated no acute change. . over the weekend on and , his mental status remained confused and agitated. his morning temp was found to be 101.1 axillary, so blood and urine cultures were obtained. a chest xray was repeated, and given his wbc count to 19, coarse lung sounds, and fever, it was thought that the patient likely had a pneumonia. his was started on vanc/zosyn for coverage. in the afternoon he developed increasing respiratory distress and tachnypnea. he was transferred to the stepdown unit and diuresed with lasix. blood gas remained stable and and ekg as well as ce's were ordered. overnight he developed hypotension therefore he was tranferred to the micu. past medical history: afib, silent mi 2yr ago, r total hip, bilat cataract repair, emphasema, umbilical hernia, oa social history: lives with wife, quit smoking 20 yr ago, no etoh. daughter very involved in their care family history: non-contributory physical exam: admission exam: alert + oriented to self, month, hospital. confused at times perrl, eomi face symmetric, tongue midline no pronator drift mae's symmetrically ambulates with cane at times pertinent results: admission labs: 07:50am blood wbc-19.9* rbc-4.48* hgb-13.2* hct-39.9* mcv-89 mch-29.5 mchc-33.1 rdw-13.3 plt ct-326 07:50am blood pt-14.2* ptt-25.3 inr(pt)-1.2* 07:50am blood glucose-125* urean-46* creat-1.4* na-142 k-4.4 cl-101 hco3-29 angap-16 ct head stereotactic 1. redemonstration of right frontal and left parietal enhancing lesions with resultant surrounding edema, most likely representing metastatic disease however also could represent lymphoma. 2. no evidence of midline shift or hydrocephalus. . ct head post-op 1. mild pneumocephalus in the region around the biopsy of the right frontal lobe mass. no evidence of hemorrhage. cxr : no acute process cxr : lungs are clear. lenis: no evidence of dvt. cxr : as compared to the previous radiograph, there is a slight increase in extent of the pre-existing left pleural effusion. as a consequence, the left retrocardiac atelectasis, resulting in lung parenchymal consolidation, has also slightly increased. otherwise, there is no relevant parenchymal change. unchanged position of the right picc line. brief hospital course: neurosurgical course as above in hpi ==================================== micu course # hypotension: patient was thought to be hypovolemic from pneumonia as well as diuresis in the step down unit. he was given ivf with good result. bps came up to the 120s systolic and lactate trended down to 1.0 (from 3.4). # brain lesions: pathology result of brain biopsy revealed b cell lymphoma. oncology was consulted and recommended workup including: spep, upep, ldh, hiv test, b2 microglobulin. they also recommended consulting neuro-oncology (dr. for further treatment options which will likely include mtx and xrt. patient was initially deferred for mtx because of pleural effusion noted on cxr. # pna: given leukocytosis, fever, and increased work of breathing with lll infiltrate on cxr consistent with pna. possibly aspiration given poor ms on other services. continued vanc/zosyn for planned 8day course (to end ). leukocytosis trended down and tachypnea resolved. # ams: patient was noted to be delirious on admission to micu. this was thought infection, hypotension, and underlying brain lesions. his ms improved with ivf and resolution of his hypotension although he still remained somewhat disoriented, worsening at night. geriatrics followed the patient while admitted and continues to follow. ======================================= omed course: 85 yo m with hx of emphysema, a fib presenting with confusion, found to have diffuse large b cell lymphoma of the brain. hospital stay complicated by delirium, lll pna, hypotension and respiratory distress requiring transfer to micu. transferred to omed for continued management, and initiation of mtx. . # dlbc cns lymphoma: patient underwent stereotactic biopsy of right frontal lesion on showing diffuse large b-cell lymphoma. csf flow cytometry showed non-specific t cell dominant lymphoid profile. he was transferred to medicine-oncology service for initiation of methotrexate therapy, which he received and tolerated well except for mild mucositis. for this he is on gelclair tid. he had an eeg, which showed encephalopathy. mri spine was obtained on , read pending. he is on keppra 500 , decadron 2 mg daily, and prophylactic daily omeprazole. he will need a double lumen port placed and eye exam done prior to his next admission for chemotherapy. he will need to continue leucovorin and na bicarbonate for one day after discharge. he will need to take na bicarbonate and collect all of his urine for 24 hours prior to his next admission (roughly two weeks from his first day of chemotherapy ). . # delirium/encephalopathy: likely multifactorial in etiology infection, brain lesions, hospital environment. improved during his hospital course; however, patient remains confused, oriented to self and general location. we provided frequent re-directing and reassuring, was placed in a chair for his meals, and started on seroquel 37.5 mg nightly to restore his sleep-wake cycle. . # l pleural effusion: likely transudative in setting of receiving iv hydration with mtx protocol. patient remained afebrile, without leukocytosis. received iv lasix 10mg x2 with subsequent good urine output and improvement in oxygenation. he has only needed supplemental oxygen at night for the last two days. . # anemia: normocytic. hematocrit has been trending down. no signs of bleeding. stools were guaiac negative. likely a component of hemodilution secondary to ivfs. also likely marrow suppression from recent illness as retic count was 1.0. was transfused one unit of packed red blood cells on with appropriate response. this will need to be monitored in the future. . # transaminitis: likely secondary to methotrexate therapy. patient had no right upper quadrant pain. his bilirubin was within normal limits. there was no new medications coinciding with the transaminase elevation. this will need to be monitored in the future. . # acute kidney injury: resolved. baseline creatinine is 1.1. patient's creatinine bumped to 1.4 on . his fena was >1%. renal ultrasound was negative for obstruction; however, a post-void residual showed that showed he was retaining urine. a foley was placed, then discontinued two days later after finasteride was re-started. his ivfs were increased to 125 cc/hr and his creatinine trended down. this will need to be monitored in the future. . # a fib: paroxysmal. remained in sinus rhythm. metoprolol 12.5 tid was continued for rate control. coumadin was discontinued secondary to bleeding risk after brain biopsy. the patient was started on a daily aspirin. . # lll pna: received 9 days of vancomycin and zosyn for aspiration/healthcare-associated pneumonia. ended . blood cultures were final no growth. . # diarrhea: resolved. c difficile stool toxin assay was negative x 3. occurred likely secondary to antibiotics, and improved once they were discontinued. . # emphysema: continued fluticasone-salmeterol diskus (250/50) , and provided albuterol and ipratropium nebulizers as needed. . # bph: started on finasteride 5 daily two days prior to discharge. discharged on home avodart. . # code status: full code . # to do: please check cbc, chem 7, lfts in one week. medications on admission: fluticasone, toprol xl, valsartan, hctz, advair, avodart, spiriva, dilantin, lovastatin, dexamethasone, famotidine discharge medications: 1. acetaminophen 650 mg suppository sig: one (1) suppository rectal q6h (every 6 hours) as needed for discomfort/fever. 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q4h (every 4 hours) as needed for wheezing. 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. dexamethasone 2 mg tablet sig: one (1) tablet po daily (daily). 5. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. oral wound care products gel in packet sig: one (1) ml mucous membrane tid (3 times a day) as needed for mouth pain. 8. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for wheezing. 9. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 10. lovastatin 20 mg tablet sig: one (1) tablet po at bedtime. 11. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 12. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for fungal rash. 13. quetiapine 25 mg tablet sig: 1.5 tablets po qhs (once a day (at bedtime)). 14. avodart 0.5 mg capsule sig: one (1) capsule po once a day. 15. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 16. leucovorin calcium 25 mg tablet sig: one (1) tablet po every six (6) hours for 6 doses. disp:*6 tablet(s)* refills:*0* 17. sodium bicarbonate 650 mg tablet sig: five (5) tablet po every six (6) hours for 2 days: take for one day after discharge, and one day prior to next admission. discharge disposition: extended care facility: country rehabilitation and nursing center - discharge diagnosis: diffuse large b-cell cns lymphoma acute toxic/metabolic encephalopathy pneumonia pleural effusion acute kidney injury anemia transaminitis diarrhea . atrial fibrillation emphysema benign prostatic hyperplasia discharge condition: level of consciousness: alert and interactive. mental status: confused - sometimes. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , it was a pleasure taking care of you during this hospitalization. you were admitted for evaluation of increasing confusion, underwent a brain biopsy that showed lymphoma (a type of cancer), and received methotrexate chemotherapy. during your admission you were treated for a pneumonia, as well as a kidney injury. you are being discharged to a rehabilitative facility for continued strength building. . we are making some changes to your outpatient medication regimen based on what you needed in the hospital. . also, it is important that you continue to take sodium bicarbonate (3250 mg every six hours) and leucovorin (25 mg every six hours) for one day after discharge. . 24 hours before your next admission you will need to start taking sodium bicarbonate (3250 mg every six hours). you will also need to save all of your urine 24 hours prior to your next admission. followup instructions: you have no schedueled follow up appointments at this time. you will be contact regarding your next admission (roughly two weeks from your first day of chemotherapy on ). you also may be contact regarding the need to have a port placed and eye exam done. procedure: spinal tap incision of lung closed [percutaneous] [needle] biopsy of brain injection or infusion of cancer chemotherapeutic substance computerized axial tomography of head other immobilization, pressure, and attention to wound central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: acidosis anemia, unspecified unspecified pleural effusion toxic encephalopathy acute kidney failure, unspecified atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) pneumonitis due to inhalation of food or vomitus old myocardial infarction antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use other emphysema osteoarthrosis, unspecified whether generalized or localized, site unspecified diarrhea dehydration hypovolemia other specified antibiotics causing adverse effects in therapeutic use delirium due to conditions classified elsewhere nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] penicillins causing adverse effects in therapeutic use hernia of other specified sites without mention of obstruction or gangrene other malignant lymphomas, lymph nodes of head, face, and neck 

Answer: The patient is high likely exposed to