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: fever major surgical or invasive procedure: hemodialysis catheter placement, pheresis catheter placement and removal history of present illness: ms. is a 54 year old female with a history of multiple myeloma s/p autologous transplant and dendritic cell fusion vaccine protocol with progression of disease in the cns and has been treated with revlimid, velcade, deacadron and cytoxan. she last received chemo last tuesday and now presents with one day history of fever to 100.4. she denies any chills or rigor. no cough, nausea, vomiting or diarrhoea. no dysuria. in ed, she was febrile to 99.7 and physical exam revealed no focal source. labs revealed wcc of 0.9. she's pancultured and started on vanco and cefepime. she's admitted for further management. past medical history: she first developed left posterior rib pain in and was found to have multiple destructive rib lesions. ct-guided biopsy showed plasmacytoma. she underwent radiation therapy, finishing in 04/. work-up at the time revealed a modest igg kappa and a question of light chain in the urine. bone marrow showed a modest increase in plasma cells without clear evidence of clonality. in she was found to have spep with monoclonal igg kappa, light chain in the urine. she had a bone bone marrow biopsy, which showed 10% plasma cells with abundance of kappa staining and evidence of plasma cell aggregates and plasmablast. the patient underwent a repeat skeletal survey, which showed new punched out lesions in the skull as well as a calcium of ~10.4-10.9. she was referred to . at , bone marrow biopsy showed plasma cells accounting for approximately 20% of the cells with kappa restriction. she also participated in the dendritic cell fusion gene protocol. she underwent 4 cycles of velcade and decadron. pt had auto-sct on "vaccination with dc/tumor cells fusion in conjunction with autologous stem cell transplantation in patients with multiple myeloma" protocol. in the patient had acute diplopia and was found to have a cns plasmacytoma and underwent radiation therapy. she is currently c1d20 on velcade. past medical history: - irregular menstrual cycles (one per year), found to have an ovarian cyst. - status post breast augmentation in () by direct silicone injection - gallstones social history: she worked in a library in periodicals but is taking a leave of absence during treatment. she has been married for 20 years. she has four children, three of whom live at home. she had smoked one pack per day and stopped approximately 25 years ago. family history: family history: she has no family history of cancer. father died of cva, mother died of speculated emphysema. she has one full brother and a half-sister. physical exam: 99.1 102/70 99 18 96% on ra gen: well appearing caucasian female, lays flat in bed, heent: perrla, op w/ mmm. no oral lesions, no sinus tenderness neck: no lad, full rom car: rrr, no murmur resp: mild rhonchi bilaterally, speaks in full sentences abd: s/nt/nd/nabs ext: no le edema neuro: a/o, cn ii-xii intact, no focal deficit. skin: no rash pertinent results: 10:00pm urine rbc-0-2 wbc-0-2 bacteria-none yeast-none epi-<1 10:00pm urine blood-sm nitrite-neg protein-25 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 10:00pm urine color-straw appear-clear sp -1.008 10:00pm plt smr-very low plt count-68* 10:00pm neuts-69.6 bands-0 lymphs-16.3* monos-8.1 eos-5.3* basos-0.8 10:00pm wbc-0.9*# rbc-2.30*# hgb-7.6* hct-22.0*# mcv-96 mch-33.1* mchc-34.5 rdw-17.0* 10:00pm urine gr hold-hold 10:00pm urine hours-random 10:00pm calcium-9.0 phosphate-6.1*# magnesium-2.3 10:00pm lipase-17 10:00pm alt(sgpt)-33 ast(sgot)-46* alk phos-68 tot bili-0.5 10:00pm estgfr-using this 10:00pm glucose-88 urea n-19 creat-2.1*# sodium-140 potassium-4.0 chloride-109* total co2-22 anion gap-13 10:05pm lactate-2.1* 10:05pm comments-green lenis : no deep venous thrombosis in either lower extremity. ct chest/abd/pelvis : 1. simple cholelithiasis without acute cholecystitis. 2. unchanged bilateral breast silicone granulomata. 3. small bilateral pleural effusions. 4. nonspecific patchy tree-in- appearance in the anterior portion of the upper lobe of the lungs, unchanged from ten days ago, could represent inflammatory or early infection. 5. multiple osteolytic lesions along the spine, left fifth rib, right scapular and pelvic and acetabulum, compatible with history of multiple myeloma. vq scan: 1. limited study due to low tracer count on the ventilation study. 2. low probablilty of pulmonary embolism echo: suboptimal image quality. left ventricular systolic function is difficult to assess given fast heart rate and poor acoustic windows but appears at least mildly depressed (lvef~40%). very small posterior pericardial effusion. resting tachycardia. chest xray : right picc terminating in the proximal svc in appropriate position. no evidence of active or inactive tuberculosis. brief hospital course: 54f with multiple myeloma s/p cytoxan, revlimid, velcade, decadron admitted for febrile neutropenia. #. febrile neutropenia: initially there was no clear source clinically and imaging and cultures were not revealing. she was started on cefepime and vancomycin. abx restarted on for recurrent temps. culture data remained non-revealing. she was treated w/ vanc/cefepime, acyclovir and voriconazole. eventually antibiotics were discontinued and she remained afebrile. #. acute renal failure: on admission she was noted to have an elevated creatinine from her baseline. it was originally thought that there may have been a pre-renal component due to reduced po intake following chemotherapy. she was given ivf hydration with limited improvement in her creatinine. she had a large amount of bence protein in her urine and ultimately her renal failure was felt to be due to progression of her multiple myeloma. she started hemodialysis without complication, and also underwent 5 sessions of pheresis with no signs of renal recovery. she was discharged with outpatient hd scheduled at dialysis center at 11am on tues/thurs/sat schedule. #. multiple myeloma: her initial presentation and renal failure were felt to be due to progression of her multiple myeloma. she underwent 5 sessions of plasmapheresis and her igg levels decreased significantly. she also underwent high dose cyclophosphamide followed by 3 doses of velcade, although the fourth dose was held due to thrombocytopenia. given that she is now on hemodialysis, it was planned that after discharge, she would receive chemo if neccessary on dialysis days in the late afternoon, at 7feldberg if the clinic was closed. #. respiratory distress: she was initially extensively hydrated on the floor in the setting of her presenting infection. she then developed respiratory distress thought to be secondary to flash pulmonary edema in the setting of fluid overload with probable cardiac component (ef 40%, though this was poor quality on echo). she was diuresed aggresively (with metolazone and lasix). she was treated initially w/ clinda and primaquine for pcp, this was d/c'd as cxr and o2 status showed interval improvement with diuresis. on her final cxr, there was no evidence of volume overload. #. ams: she had waxing and mental status during this hospitalization. her confusion was likely multifactorial including uremia in the setting of renal failure and icu delirium. she was treated with zyprexa. she also started hd which was felt to improve her mentation. #. tachycardia: she had sinus tachycardia during this hospitalization. initially it was felt to be related to hypoxia and improved with diuresis. it subsequently worsened probably from overdiuresis. she was hydrated w/ prbc transfusion, and was then maintained with a goal of net even. other possible etiologies for tachycardia included possible infection and known malignancy. patient was started on metoprolol but this was discontinued due to low blood pressures. vq scan showed low probability for pe and bl lenis were nonrevealing for dvts. #. pancytopenia: she required multiple units of platelets and prbcs during this admission. she was intermittently on neupogen and required neupogen for the last 5 days prior to discharge. she should have her cbc checked after discharge and may require subsequent doses of neupogen. medications on admission: acyclovir - 400 mg tablet - 1 tablet(s) by mouth every eight (8) hours lenalidomide - (prescribed by other provider) - 15 mg capsule - capsule(s) by mouth once a day for 2 weeks for each cycle. zoledronic acid - (prescribed by other provider) - 4 mg/5 ml solution - once per month aspirin - (prescribed by other provider) - 81 mg tablet, chewable - 4 (four) tablet(s) by mouth once a day docusate sodium - (prescribed by other provider) - 100 mg capsule - 1 (one) capsule(s) by mouth once a day discharge medications: 1. acyclovir 200 mg capsule sig: one (1) capsule po q12h (every 12 hours). disp:*60 capsule(s)* refills:*2* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. calcium acetate 667 mg tablet sig: two (2) tablet po three times a day: with meals. disp:*180 tablet(s)* refills:*2* 4. zofran odt 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po three times a day as needed for nausea. disp:*90 tablet, rapid dissolve(s)* refills:*0* 5. compazine 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. disp:*90 tablet(s)* refills:*0* discharge disposition: home with service facility: critical care systems discharge diagnosis: primary diagnosis: multiple myeloma acute renal failure discharge condition: mental status: clear and coherent, occasionally confused level of consciousness: alert and interactive activity status: ambulatory - requires assistance or aid (walker or cane) discharge instructions: you were admitted to for fever. you were started on antibiotics and eventually your fevers resolved. you also had kidney failure during this hospitalization and were started on hemodialysis. your kidney failure is thought to be due to multiple myeloma. followup instructions: you have the following appointments scheduled: provider: . location: building, , date/time: monday, at 2:30pm phone: dialysis center , tel: outpt nephrologist: dr. dialysis appointment: tuesday, at 11:00am md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified spinal tap incision of lung hemodialysis venous catheterization for renal dialysis biopsy of bone marrow therapeutic plasmapheresis injection or infusion of cancer chemotherapeutic substance diagnoses: acidosis acute kidney failure with lesion of tubular necrosis unspecified pleural effusion congestive heart failure, unspecified toxic encephalopathy peripheral stem cells replaced by transplant acute respiratory failure other specified cardiac dysrhythmias alkalosis antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use calculus of gallbladder without mention of cholecystitis, without mention of obstruction diarrhea awaiting organ transplant status acute systolic heart failure dehydration hyperosmolality and/or hypernatremia other complications due to renal dialysis device, implant, and graft neutropenia, unspecified fever presenting with conditions classified elsewhere other specified aplastic anemias other immunoproliferative neoplasms, in relapse 

Answer: The patient is high likely exposed to