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: acute renal failure. major surgical or invasive procedure: tunnelled dialysis catheter placement. history of present illness: pcp: : , location: /east address: , e/cc-6, , phone: fax: email: . primary oncologist name: , md location: -division of hematology/oncology address: e/ks-121, , phone: fax: email: . date seen time 59 y/o m with pmhx of afib, pe and diffuse large b cell lymphoma who was recently admitted with acute on chronic renal failure and was seen in renal clinic on where he was found to have an acute rise in creatinine. pt represented to clinic and was given 2l ivf without significant improvement in creatinine. pt did have 500cc of urine output and received a single unit of prbcs for hct of 21. dr. (primary nephrology) recommended admission for further work up of acute renal failure and possible renal biopsy. . in nephrology clinc yesterday urinalysis demonstrated : specific gravity of 1.020. urine was positive for + protein (more than last time). microscopy showed a fragment of granular cast and possibly a white cell cast . recent chemotherapy administration and creatinine monitoring he received velcade/doxil c1d1 on : velcade x 3 days and doxil x 1 day. he then received zofran 8mg iv, decadron 20mg iv on . pt then received the velcade 2.6mg as an ivp over 3-5sec. his velcade was held on secondary to tcp with plt = 23. plts = 17 and received plt transfusion on . on cr = 1.7 and plt = 20. he was given 1 u plts and 500 cc ivf. on cr = 3.0 and plts= 13. pt received 1u plts and was referred to see his neprhologist on . . he also reports abdominal constriction and pain which resulted in difficulty eating. he felt bloated after eating and experienced early satiety. no emesis or nausea. no focal abdominal pain. his sx improved with defecation. . pain scale:0/10 ________________________________________________________________ review of systems: constitutional: all normal fever t with chills was 97.9 and 98.1 chills sweats fatigue malaise anorexia night sweats __11___ lbs. weight gain over 2 weeks per clinic sheets . heent: all normal blurred vision blindness photophobia decreased acuity dry mouth bleeding gums oral ulcers sore throat epistaxis tinnitus decreased hearing tinnitus other: . respiratory: all normal sob doe can't walk 2 flights cough wheeze purulent sputum hemoptysis pleuritic pain other: . cardiac: all normal angina palpitations edema intermittently since as long as he has been getting the chemotherapy without acute worsening pnd orthopnea chest pain other: . gi: all normal blood in stool hematemesis odynophagia dysphagia: solids liquids anorexia nausea vomiting reflux diarrhea constipation- pebbly abd pain other: . gu: all normal dysuria frequency hematuria discharge menorrhagia . skin: all normal recent rash on trunk now resolved pruritus . ms: all normal knee pain x 2 weeks with swelling when he walks 0.5 miles jt swelling back pain bony pain . neuro: all normal increased frequency and duration of ha but none now. on the weekend had one all day. it was not severe and he ranks it as visual changes sensory change confusion numbness of extremities- chronic neuropathy from chemotherapy since but nothing new seizures weakness dizziness/lightheaded vertigo headache . endocrine: all normal skin changes hair changes temp subjectivity . heme/lymph: all normal easy bruising easy bleeding adenopathy . psych: all normal mood change suicidal ideation other: he has occasional periods of depression but with meditation he is able to cope. . all other systems negative except as noted above. past medical history: mr. presented in early with fever, weight loss, and muscle and joint aches. he was diagnosed with pmr and started on prednisone with improvement in his symptoms. during the preceding six months, he reported a history of shoulder, neck and quadriceps pain as well as fatigue, weakness and poor appetite. he reported periodic fevers, drenching night sweats and a 25-pound weight loss also over the same six months. with initiation of his prednisone at 20 mg daily, he noted marked improvement of both his musculoskeletal and constitutional symptoms. he then presented to the emergency room on with palpitations and dizziness and was found to be in atrial fibrillation. he had a history of paf in the past. he was febrile to 101.6 with a heart rate of 126. ct scan of the chest, abdomen, and pelvis on showed multiple low-attenuation lesions within the liver, spleen, and kidneys. on , mri of the abdomen showed hypovascular masses in both kidneys and spleen of various sizes consistent with lymphoma. a ct-guided biopsy of the spleen on was nondiagnostic. mr. bone marrow aspirate and biopsy on , which showed extensive necrosis with focal involvement by high-grade b-cell lymphoma, diffuse large b-cell type. fish translocation was notable for c-myc and bcl-2 indicating a "double hit" lymphoma characterized by a burkitt's-like lymphoma. he then began chemotherapy. . treatment history: -- initiated treatment with dose-adjusted chemotherapy on with two doses of rituxan on and . follow up ct imaging on showed stable lymphomatous lesions in the kidney, spleen, and abdominal nodes. -- rituxan 500 mg given on with a fever that evening and admission for neutropenia. during admission, noted for atrial fibrillation with rvr and was started on digoxin at 0.125 mg daily along with metoprolol 200 mg daily. -- readmitted on for his second cycle of chemotherapy, which was delayed for two days due to hypotension and cough. a ct of the chest showed bilateral lower lobe opacities, right greater than left, concerning for infection and he was treated with a course of levaquin. -- on , received rituxan at 375 mg/m2. -- follow up pet scan on showed no evidence for lymphoma but was notable for multiple peripheral base pulmonary opacities with rims of soft tissue density and relative central lucencies most of which were new. he ct of the chest for further evaluation, which showed multiple filling defects within the segmental and subsegmental branches of the right lower lobe arteries compatible with pulmonary emboli. -- admitted on for initiation of anticoagulation with fondaparinux and began third cycle of treatment with on (dose level 2). -- received rituxan 375 mg/m2 on . -- admitted on for fourth cycle of treatment with (dose level 3). -- received rituxan 375 mg/m2 on . -- admitted on for fifth cycle of treatment with (dose level 3 with adriamycin at dose level 2. received rituxan on . -- fdg tumor imaging on showed no evidence for lymphoma with slight interval decrease in size in bilateral pulmonary infarcts. focal uptake in the posterior left kidney appears parenchymal, but may be within the collecting system and projecting over the kidney due to misregistration. focal fdg uptake in the left ischial tuberosity, without corresponding lytic or sclerotic lesion. bone marrow biopsy showed no evidence for lymphoma and no cytogenetic abnormalities, particularly no c-myc or bcl2 translocation. note was made of hypercellular marrow with maturing trilineage hematopoiesis. -- admitted on with sudden onset of a dark cover in the lower half of the visual field in his right eye, which lasted 10-15 minutes, then self-resolved. he was evaluated by neurology and ophthalmology. tee revealed thrombus at the tip of his right atrial catheter, with no pfo. ophthalmology work up was negative and the episode was attributed to possible tia. discharged on to continue his fondaparinux. -- admitted on for high dose cytoxan for stem cell mobilization. -- attempted stem cell collections with yield ~ 0.5 cd 34 cels after 4 collections with slow recovery of counts. collections stopped. -- repeat pet imaging on showed new focal mild fdg-avidities in the mediastinal region. interval worsening of fdg-avidity in the soft tissue immediately medial to the left acetabulum. persistent fdg-avidity in the left ischial tuberosity, without ct correlate. -- repeat bone marrow biopsy on showed no evidence for lymphoma with some dyspoiesis noted. no cytogenetic abnormalities, specifically no evidence for mds. -- initiated 4 weeks of rituxan on . -- noted slight increase in ldh to ~ 260. repeat ct of the torso on showed left pelvic soft tissue and expansion of the left piriformis muscle corresponding to the regions of fdg avidity for scan. small internal mammary and left juxtaclavicular lymph nodes corresponding to foci of fdg avidity. decreased size of lymphomatous renal lesions compared to with stable small retroperitoneal lymph nodes. continued evolution of pulmonary infarcts. no definite bony lesions, though there is slightly lucency in the left acetabulum in a region of fdg avidity. . other past medical history: s/p rll lobectomy in secondary to pna #. paf diagnosed in with now chronic atrial fibrillation in the past several months. he had no history of treatment with anti-arrhythmia or anticoagulation prior to his admission in , currently receiving treatment with metoprolol and digoxin. #. pulmonary embolism, fondaparinux on hold due to thrombocytopenia #. polymyalgia rheumatica diagnosed in and managed by dr. , although further treatment on hold while getting treatment for lymphoma and unclear if his symptoms were related to lymphoma and not pmr. #. remote history of syphilis, gonorrhea, and genital herpes in . #. tonsillectomy and adenoidectomy in the . #. myopia. #. recent probable tia with from thrombus on right atrial catheter tip social history: pt is married and lives in . mr. previously worked as a software engineer, but now works without pay from home contributing to open source software projects. they have two adult children, ages 21 and 28, but have minimal contact with them. mr. is a nonsmoker. he drinks alcohol on occasion. he denies any history of illicit drugs. family history: father had an mi in his 70s and his paternal grandfather had an mi in his 40s. his mother is status post aortic valve replacement. his younger brother had probable schizophrenia and died from suicide at age 18. there is no family history of cancer. physical exam: admission physical exam: vital signs: 98.6, 142/70, 74, 20, 100% on ra glucose: na pain score 0/10 general: very pleasant male laying in bed. he is nad. nourishment: at risk. grooming: good mentation: good, he is a very good historian eyes:nc/at, perrl, eomi without nystagmus, no scleral icterus noted ears/nose/mouth/throat: mmm, no lesions noted in op neck: supple, no jvd or carotid bruits appreciated respiratory: lungs cta bilaterally without r/r/w cardiovascular: rrr, nl. s1s2, no m/r/g noted gastrointestinal: soft, mildly distended/nd, normoactive bowel sounds, no masses or organomegaly noted. genitourinary: deferred skin: no rashes or lesions noted. no pressure ulcer extremities: + pitting edema present b/l lymphatics/heme/immun: no cervical lymphadenopathy noted. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. -cranial nerves: ii-xii intact -motor: normal bulk, strength and tone throughout. no abnormal movements noted. psychiatric: very thoughtful and contemplative. appropriate access: piv cvl site ______ foley: present none trach: present none peg:present none site c/d/i colostomy: :present none site c/d/i pertinent results: admission labs ================ 10:25am blood wbc-1.4* rbc-2.33* hgb-7.0* hct-21.4* mcv-92 mch-30.0 mchc-32.6 rdw-21.1* plt ct-21* (neutrophil ct approx 1000) 10:25am blood neuts-81.7* lymphs-11.1* monos-6.4 eos-0.6 baso-0.3 02:00pm blood urean-63* creat-4.7* na-140 k-5.5* cl-110* 10:25am blood urean-65* creat-4.7*# na-139 k-5.5* cl-106 hco3-22 angap-17 10:25am blood alt-38 ast-32 ld(ldh)-518* alkphos-69 totbili-0.3 10:25am blood albumin-3.4* calcium-8.1* discharge labs ================ 06:00am blood wbc-3.3* rbc-3.07* hgb-9.7* hct-27.2* mcv-89 mch-31.8 mchc-35.7* rdw-18.0* plt ct-50* 06:00am blood neuts-90* bands-1 lymphs-7* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-0 06:14am blood pt-12.2 ptt-26.8 inr(pt)-1.0 06:00am blood glucose-114* urean-67* creat-4.0* na-138 k-4.3 cl-101 hco3-26 angap-15 06:30am blood calcium-7.9* phos-4.0 mg-1.8 06:30am blood alt-37 ast-40 ld(ldh)-460* alkphos-62 totbili-0.2 06:00am blood hbsag-negative hbsab-positive hbcab-negative 06:00am blood hcv ab-negative . ppd negative brief hospital course: a 59 year old man with dlbcl, not responding to primary curative chemotherapy, on palliative chemotherapy with gemcitabine, liposomal doxorubicin (doxil), and bortezomib (velcade) is admitted for acute on chronic renal failure and found to have lymphomatous invasion of the kidney. he required hemodialysis and decided after a family meeting for home hospice care while continuing outpatient dialysis. a tunnelled hemodialysis catheter was then placed. tested for the outpatient dialysis unit prereq, a ppd was negative. . # acute on chronic renal failure: patient was admitted from renal clinic after cr trended up sharply from 1.7 to 4.7 over five days. creatinine did not trend down after fluid challenge, suspicion for lymphomatous infiltration of the kidney was high. he was admitted to the icu for renal biopsy (high bleeding risk given thrombocytopenia). renal biopsy of the left kidney confirmed lymphomatous invasion. given progressive renal failure, acidosis, hyperkalemia and hyperphosphatemia, a hd catheter was placed and dialysis was initiated. after deciding to continue dialysis indefinitely, a tunnelled catheter was placed. ppd was negative (prereq for outpatient hd). . # hyperkalemia: admitted with k 5.5 related to acute renal failure, ekg did not show peaked t waves. he was treated with kayexylate with k trending down to 5.0. as above, dialysis was initiated. . # pancytopenia: related to chemotherapeutic effect and bone marrow involvement by dlbcl. he was transfused to maintain hct >21 and platelets >10. . # diffuse large b cell lymphoma: given "double hit" highgrade lymphoma with translocation of c-myc and bcl-2, prognosis was grim and he had been on palliative chemotherapy. after the discovery of lymphomatous involvment of the kidneys causing renal failure, he was offered experimental chemotherapy which he declined, preferring to focus on quality of life. . # afib s/p cardioversion and htn: metoprolol had been held during previous admission for bradycardia to the 30s. he was maintained on telemetry and bursts to ventricular rate of 130 were noted. metoprolol was resumed with improved rate control. continued amiodarone. given a recurrence of bradycardia, the metoprolol dose was minimized and furosemide, per nephrology, was added for uncontrolled hypertension. not anticoagulated given thrombocytopenia. . # hx of pe: diagnosed with pe in and previously anticoagulated with fondaparinux, anticoagulation was stopped prior to admission for thrombocytopenia and not resumed. . # goals of care: given poor prognosis and progressive renal failure, he decided to focus goals of care on comfort, and declined experimental chemotherapy. he was discharged home with hospice while continuing outpatient hemodialysis. medications on admission: confirmed with patient on admission acyclovir 400 mg tablet - 1 tablet(s) by mouth every twelve (12) hours allopurinol 100 mg by mouth daily (daily) amiodarone 200 mg by mouth once a day famotidine 20 mg tablet by mouth once a day filgrastim - 300 mcg/0.5 ml syringe - 1 syringe(s) once a day as directed- not currently taking fondaparinux - (on hold from to unknown per order of , for low platelets) - 7.5 mg/0.6 ml syringe - 7.5 syringe(s) once a day lorazepam - 0.5 mg tablet - 1 to 2 tablet(s) by mouth every eight (8) hours as needed for nausea metoprolol succinate - (prescribed by other provider) - 50 mg tablet extended release 24 hr - 1 tablet(s) by mouth once a day- toprol recently d/c'ed at last d/c oxycodone - 5 mg tablet - tablet(s) by mouth every four (4) hours as needed for pain prednisone - 10 mg tablet - 1.5 (one and a half) tablet(s) by mouth daily for 2 days, then 1(one) tablet daily. prochlorperazine maleate - 10 mg tablet - 1 (one) tablet(s) by mouth every eight (8) hours prn nausea. can causedrowsiness sulfamethoxazole-trimethoprim - 800 mg-160 mg tablet - 1 tablet(s) by mouth mwf (-wednesday-friday) discharge medications: 1. acyclovir 400 mg tablet sig: one (1) tablet po q12h (every 12 hours). 2. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 3. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 4. lorazepam 0.5 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for nausea. 5. oxycodone 5 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. 6. prochlorperazine maleate 5 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for nausea. 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 8. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 9. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. disp:*30 tablet extended release 24 hr(s)* refills:*2* 10. dexamethasone 4 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 11. nephrocaps 1 mg capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*2* 12. furosemide 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: hospice care of discharge diagnosis: 1. acute kidney failure. 2. non-hodgkins lymphoma. 3. pancytopenia (low blood counts). 4. bradycardia (slow heart rate). 5. hypertension (high blood pressure). discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for acute kidney failure. kidney biopsy revealed this was due to lymphoma in the kidney. because your kidneys are not functioning, you will continue to need dialysis. for this reason, a tunnelled dialysis catheter was inserted. your next dialysis will be at dialysis in . also during your hospitalization, you needed blood and platelet transfusions because all of your blood counts are low. this is probably due to the lymphoma and past chemotherapy. because your white blood cell count is low, you should call a physician for any symptoms of infection, especially a fever. you should also seek urgent medical attention for any bleeding considering your platelets are low. . medication changes: 1. nephrocaps once daily. 2. toprol xl 25mg daily for blood pressure (decreased from old prescription of 50mg due to slow heart rate). 3. furosemide (lasix) 40mg daily diuretic for blood pressure. 4. dexamethasone (decadron) 8mg daily. 5. stop prednisone (replaced by dexamethasone). followup instructions: department: west clinic when: wednesday at 3:00 pm with: , md building: de building ( complex) campus: west best parking: garage . department: pft when: friday at 10:00 am . department: pulmonary function lab when: friday at 10:00 am with: pulmonary function lab building: gz building (felbeerg/ complex) campus: east best parking: main garage procedure: hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis closed [percutaneous] [needle] biopsy of kidney diagnoses: hyperpotassemia polymyalgia rheumatica congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation depressive disorder, not elsewhere classified chronic kidney disease, unspecified constipation, unspecified antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use personal history of venous thrombosis and embolism personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diarrhea accidents occurring in residential institution neoplasm related pain (acute) (chronic) other malignant lymphomas, lymph nodes of multiple sites other specified aplastic anemias 

Answer: The patient is high likely exposed to