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: a 56-year-old gentleman with a history of igg multiple myeloma who is approximately three months following an autologous stem cell transplant admitted with progressive fatigue, shortness of breath and inability to ambulate. major surgical or invasive procedure: -thoracentesis history of present illness: 56 yo male with pmh of multiple myeloma who was recently admitted with a pericardial effusion and tamponade (pulsus reportedly 24 mmhg) s/p pericardiocentesis and balloon pericardiotomy presents with increased shortness of breath. of note during the last admission, he was also found to have a large left pleural effusion on ct chest, but refused thoracentesis at that time. since being discharged the patient has noted increased dyspnea, even with minimal activity such as getting dressed. he denies chest pain, pleuritic symptoms, orthopnea, pnd, le edema. he does report some cough productive of yellow sputum. he denies fevers, chill, sweats. of note he also reports increasing lower extremity weakness to the point that he was unable to get to his outpatient oncology appointment for his dose of . he denies bowel/bladder incontinence, urinary retention, numbness, tingling, or burning. he also reports that his back pain is unchanged and remains a decreased to /10 with oxycontin and oxycodone. past medical history: 1.plasma cell myeloma mr. is a 56-year-old gentleman who presented in with complaints of muscle pain between his shoulders and difficulty sleeping. he was seen by his primary care physician, . in late of . an x-ray performed at hospital showed a large plasmacytoma in the posterior chest wall. he was then transferred to for further evaluation. ct guided biopsy of the right posterior chest wall mass was consistent with a plasmacytoma. immunoperoxidase studies showed tumor cd-134 positive and containing monoclonal kappa and cytoplasmic immunoglobulin. mib staining showed a fraction of approximately 20%. bone marrow biopsy revealed 80% involvement with plasma cell myeloma. plasma cells represented 41% of the marrow cellularity. skeletal survey on showed no additional lytic lesions. ct of the torso demonstrated a large mass in the right posterior mediastinum and hemithorax destroying the transverse process of the vertebral body of t3 and t4 and ribs at that level. igg at that time was 8703, an spep showed an abnormal band representing 58%, and beta 2 microglobulin was 3.4. mr. was initially treated with steroids and radiation therapy, which started on . he was then seen as an outpatient following his radiation treatments. he demonstrated a fall in his immunoglobulin with igg of 5041, representing 47% of the total protein. he began doxil, vincristine, and decadron on , which he tolerated well. following his first cycle of dvd, however, mr. presented with difficulty with balance and coordination. his speech was garbled and he had poor attention span. he was admitted for further workup to rule out any neurologic developments. he was diagnosed with a polyneuralgia and was started on folic acid and vitamin b12 subcutaneous monthly. workup included an mri, which showed only prominent ventricular sulci and an lp showing no changes consistent with infection. he was negative for hsv and it was therefore felt that this was somewhat of his baseline neurologic status in the setting of medication. he was being maintained on fentanyl 75 mcg patch with oxycodone as needed for pain. he then proceeded with cycle 2 of dvd chemotherapy. mr. had initial responses to the dvd chemotherapy, but then began showing a plateauing of his igg level. he was also noted to have an increasing neck mass. a ct scan obtained at that time showed that he had some enlargement of the neck mass. he had a single chest lesion that was somewhat smaller and another one at the rib that was somewhat larger. as such, his regimen was then changed to pulse cytoxan along with pulse decadron therapy 40 mg times four days on and four days off. he was then treated with radiation therapy to his neck following an mri, which ruled him out for any spinal cord compression. mr. then was switched to chemotherapy, and received three cycles. he showed a dramatic response to the , most notably a drop in his igg level to within normal range at 789 and his spep now representing 4% of the total protein. he then stem cell mobilization with cytoxan and autologous stem cell transplant with high-dose melphalan on . he overall tolerated his high-dose therapy well but had somewhat a slow recovery of his counts with now normal levels. he otherwise had no other complications posttransplant, until the end of when he was admitted with acute pericardial tamponade and recurrent mediastinal mass. mr pericardocentesis with stabiliation of his symptoms. his pericardial fluid was negative for malignantcells. during this hospitalization, a ct scan on revealed a a large prevertebral soft tissue mass with anterior displacement of the esophagus and trachea, 4 x 2.5 cm in greatest dimensions. images of the upper thorax demonstrated massive mediastinal adenopathy. a lucency in the c6 vertebral body, suggestive of a myeloma metastasis as well as an expansile lytic lesion of the right fourth rib, with extension into the right side of the t4 vertebral body. although his presentation was certainly concerning for recurrent mm, mr. refused further evaluation including bronchoscopy and biospsy, but simply wanted to be treated with more . mr , was ambulating with a cane and was discharged home with plans to followup as for outpatient . unfortunately, mr. failed to show up for his appointments c/o progressive weakness. 2. recurrent zoster. 3. history of tobacco abuse. 4. history of viral encephalitis in 12/. 5. depression. 6. siadh with hyponatremia. 7. hypertension. 8. anemia. 9. odynophagia. 10.steroid induced diabetes. 11.history of pneumonia in 02/. 12.history of general herpes. 13.mild restrictive lung disease. pfts: act pre %pred fvc 4.19 5.16 75 fev1 3.02 3.93 77 fev1/fvc 72 70 103 social history: lives on cape w/ wife who is former rn. 3 children from previous marriage. tobacco >1ppd x >20 yrs, quit . former etoh abuse, now occ. etoh. no ivdu family history: dm, htn (brother at 58yo), father deceased chf. physical exam: temp 96.5 bp 116/68 pulse 87 resp 20 o2 sat 90-93% gen - alert, no acute distress, no shortness of breath when supine heent - perrl, extraocular motions intact, anicteric, mucous membranes moist, no oropharyngeal lesion/thrush neck - no jvd, no cervical lymphadenopathy, from, difficult to appreciate jvd neck chest - decreased breath sounds throughout lung fields l>r, dullness to percussion left- way up cv - normal s1/s2, rrr, no murmurs, rubs, or gallops, pulsus ~18 mmhg abd - soft, nontender, nondistended, with normoactive bowel sounds, no hepatosplenomegaly rectal - normal rectal tone, no saddle anesthesia back - no costovertebral angle tenderness, no spinal/paraspinal tenderness (+) stage ii decub on right buttock-superficial extr - no clubbing, cyanosis, or edema. 2+ dp pulses bilaterally neuro - alert and oriented x 3, cranial nerves intact, sensation grossly intact motor ue b/l, hip flexion b/l, df/pf bilaterally, patellar reflexes 3+ skin - no rash pertinent results: 05:30pm wbc-4.9 rbc-3.22* hgb-10.7* hct-32.2* mcv-100* mch-33.3* mchc-33.3 rdw-14.3 05:30pm neuts-73.0* lymphs-19.2 monos-7.0 eos-0.5 basos-0.2 05:30pm hypochrom-1+ macrocyt-1+ 05:30pm plt count-194 05:30pm pt-14.1* ptt-24.8 inr(pt)-1.3 05:30pm wbc-4.9 rbc-3.22* hgb-10.7* hct-32.2* mcv-100* mch-33.3* mchc-33.3 rdw-14.3 : ct chest - impression: 1) stable appearance to mediastinal and hilar conglomerative nodal masses. 2) slight interval decrease in size to small pericardial effusion. 3) interval increase in size of tiny right pleural effusion, now small. also, mild increase in size of large left pleural effusion. : non contrast head ct impression: no intracranial hemorrhage or mass effect. no change from the prior study of . : mri spine: impression: diffuse bony and epidural tumor is evident on total spine mri. there is cord compression, particularly at the c6 to t4 levels and from t6-7 to t9-10. brief hospital course: the patient is a 56 year old male with pmh significant for relapsed multiple myeloma s/p auto bmt in who presents with shortness of breath and lower extremity weakness. #shortness of breath - there were 3 concerning etiologies-tamponade, increasing pleural effusion, increasing mediastinal mass. --on admission, the patient had a pulsus of 15-18 mmhg. this was concerning in the setting of his recent cardiac tamponade, a tte was done which was notable for improvement in the recent pericardial effusion and no evidence of tamponade. --on admission, a ct of the chest was done which was notable for a stable mediastinal mass, but an increasing left pleural effusion which was already cited as large on the last admission. the procedure team was consulted and a thoracentesis of the left pleural effusion was performed. the procedure was complicated by a small pneumothorax which resolved with 100% fio2 by face mask. the patient became less short of breath after the therapeutic thoracentesis was performed. he was then able to maintain an oxygen saturation of 94-97% on 2 liters (baseline on previous admission). the preliminary per pathology of the pleural fluid was positive for plasma cells. no further management of the effusion or therapy for the shortness of breath was performed. #le weakness - in the ed, the patient was seen by neurology who also noted asterixis in addition to proximal lower extremity weakness. an mri was suggested, but the patient refused to have one done on the first hospital day. tsh, b12 and lfts were sent to evaluate for metabolic causes of asterixis, all of which were within normal limits. on hd 2, the patient had increasing lower extremity weakness and actually fell to the ground because his legs "buckled" underneath him. he agreed to an mri if he could be sedated. since weakness in his legs was worsening and conscious sedation by anesthesia could not be arranged for the same day, the patient was given 2.5 mg xanax and sent down to mri. the patient refused the mri when he got there because of pain and anxiety despite the xanax. he was started on decadron (40 mg) for possible spinal cord compression due to the mediastinal mass/cervical mass. later that evening the patient became acutely agitated/violent and then within minutes became unresponsive for a period of 20 minutes. during this time he was hemodynamically stable but exhibited no response to painful stimuli and no gag reflex. after the episode he was confused, lethargic and disoriented. he was seen by neuro who felt the presentation could be c/w a seizure and sent to the for observation. a head ct was done which was negative for an acute bleed, mass or mass effect. the following morning the patient was placed under conscious sedation for an mri of his head and spine. while the head mri was negative for masses/lesions, the mri of the spine was notable for diffuse bony and epidural tumor and cord compression, particularly at the c6 to t4 levels and from t6-7 to t9-10. the patient's dose of steroids was changed to 6 mg iv q 6 hours and he emergent xrt of the spine. the patient had xrt x 2, but became more confused prior to the third session and began to refuse all therapies, including xrt and a central line placement. he was given a second dose of . his neurologic status declined, and he continued to refuse further therapy. a family meeting was held with his wife and 2 sisters in law. it was decided to make the patient dnr/dni with comfort measures and to have the patient placed in inpatient hospice. his steroids were tapered off. #pain control - on the first few days of admission, the patient's pain was fairly well controlled with oxycontin 60 mg , with occassional oxycodone for breakthrough. the patient then started to have increasing pain, not controlled with po medication alone. he was started on a 75 mcg fentanyl patch with a fentanyl pca for breakthrough. as the patient's confusion progressed, he did not push the pca button for medication and he refused peripheral access, so his regimen was changed to an increased dose of fentanyl by transdermal patch with roxinol for breakthrough pain. he #hematuria - while the patient was in the icu, he had a foley catheter placed. on hd 6, there was no urine in the foley bag, so the foley was flushed and a clot was noted. the following morning, more clots were noted and continuous bladder irrigation was started. red urine was in the bag after irrigation so a sample was sent for cytology. the cytology was pending at discharge. #multiple myeloma - course as above. the patient received 2 doses of during this admission. a third dose was not administered as the patient was put on best supportive measures only. a follow up ct scan of his chest suggested an increase in the mediastianl mass despite the two doses of , the patient was maintained on best supportive measures. he was originally put on fentanyl patch with morphine for breakthrough pain, but his pain increased and he was eventually started on a morphine drip. the patient passed away on . medications on admission: discharge medications: 1. lopressor 50 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 2. acyclovir 400 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 3. oxycontin 20 mg tablet sustained release 12hr sig: three (3) tablet sustained release 12hr po twice a day. disp:*120 tablet sustained release 12hr(s)* refills:*0* 4. oxycodone hcl 5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*40 tablet(s)* refills:*0* 5. colace 100 mg capsule sig: two (2) capsule po twice a day. disp:*120 capsule(s)* refills:*2* 6. senna 8.6 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*2* 7. compazine 10 mg tablet sig: one (1) tablet po every 6-8 hours as needed for nausea. disp:*40 tablet(s)* refills:*0* 8. fluconazole 200 mg tablet sig: one (1) tablet po once a day for 7 days. disp:*7 tablet(s)* refills:*0* 9. clotrimazole 10 mg troche sig: one (1) mucous membrane five times a day. disp:*500 mg* refills:*2* discharge medications: deceased discharge disposition: extended care discharge diagnosis: multiple myeloma with spinal cord compression discharge condition: deceased discharge instructions: deceased followup instructions: deceased procedure: thoracentesis other radiotherapeutic procedure diagnoses: other convulsions peripheral stem cells replaced by transplant iatrogenic pneumothorax other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation multiple myeloma, without mention of having achieved remission unspecified disease of spinal cord 

Answer: The patient is high likely exposed to