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: bactrim / amoxicillin / penicillins attending: chief complaint: shortness of breath major surgical or invasive procedure: cardiac catheterization cardioversion history of present illness: 77 yo male with history of hypogammaglobulinemia, lymphoma s/p chop and asthma, who presents with sob. beginning on , pt started "not feeling well." he describes sob, that became worse such that he had sob even with just slow walking, and was unable to walk upstairs without becoming sob. then weds night, sob became worse, and he was unable to sleep lying down, and had to sit up. he saw at doctor on thurs, dr. , who ordered cxr, ecg and looked at a prior echo. he says she was concerned about possible heart failure and gave him 20mg lasix to take. he took 2 doses, and thinks it helped initially. however, pt was again unable to sleep last night, had to sit straight up, endorses pnd. he normally sleeps on 1 pillow. he denies any chest pain, but has had some pressure this week, no change with inspiration, his symptoms are making him very anxious. he has also noticed some palpitations in the past few days. he denies fever, chills or cough. denies any pedal edema but did ntice increasing abdominal girth and decreased appetite. he says he has had pna before but this feels diferent. he has occasional asthma, and says albuterol has helped some, but not completely. he denies any leg swelling. he denies any long trips and does not smoke. he denies nausea, vomiting, abdominal pain, urinary syx, bloody or black stools. . pt was initially diagnosed with lbbb in . he had a tte in as part of the work-up which showed ef 40% and inferior wall hypokinesis. per his report, he was told that no further work-up was needed at that time. pt also reports several years of intermittent palpitation. he reports wearing what sounds like of hearts monitor, which did capture some events, but he was told they were due to an anti-histamine he was on and had no further workup. . on presentation, pt vital signs 97.2 89 135/79 22 100%. he received lasix 20mg iv in the ed with uop of almost 2 l. labs were significant for neg trop x1, probnp 3690, wbc 11.8 with 55% lymph, 40% neutrophils. his echo showed lvef of 20% with severe regional lv hypokinesis. pt was noticed to flip into afib in the ed with hr up to 140s, he received lopressor 25mg po. . on arrival to the floor, patient reports his symptoms have improved, though he still feels uncomfortable when lying down. he remains in afib with rates 100-120s. he is asymptomatic, no lightheadedness or dizziness. past medical history: lbbb (left bundle branch block) foot drop hypogammaglobulimemia, unspec cll/lymphoma rx'din 6 cycles of chop. the first 3 with rituxan due to a rapid rise in his blood counts. in , rx'd cvp without rituxan because of worsening disease and in rx'd with fludarabine. rx'd gamma glob for recurrent sinus and pulm infections. premed with steroids, demerol for rigors. ; restaging abd ct scan showed minimal adenopathy : chest ct showed stable small pulm nodules, small nodes. : ivig stopped as immunoglobulins normal. small igm spike : developed mild pneumonia. igg level very low. will restart ivig. colonic adenomas thyroid nodule sinusitis, unspec - chronic asthma esophagitis - reflux social history: vacations in . married. no alc, no cigs. recently moved to new house, in process of painting and fixing up house. retired phd, formerly worked in non-profit, still very active with non-profit causes, marched in 5 mile suicide prevention walk in ny earlier this year family history: f - aaa. gm - dm physical exam: admission physical exam: vs: t=afebrile bp=114/78 hr= 84 rr= 14 o2sat= 99%ra general: wdwn in nad. oriented x3. mood, affect appropriate, slightly anxious about new diagnosis and inability to sleep recently. heent: sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of 7 cm, no lymphadenopathy. cardiac: irregularly irregular, tachycardic. lungs: decreased breath sounds at bases bilaterally, crackles to midway up bilateral lung fields. resp were unlabored, no accessory muscle use. abdomen: soft, non tender, non distended, normoactive bowel sounds. no hsm or tenderness. extremities: warm and well perfused, 2+ dp bilaterally, no pedal edema . discharge physical exam: vitals: t 97.5 bp 97/53 (76-98/53-65) hr 70 (70-88) 16 100% ra i/o 1100/2975 over 24 hours general: wdwn male in nad. oriented x3. mood, affect appropriate cardiac: regular rate and rhythm, normal s1 and s2, no murmurs/rubs/gallops. lungs: decreased breath sounds at bases bilaterally, mild bibasilar crackles l>r. resp were unlabored, no accessory muscle use. abdomen: soft, non tender, non distended, normoactive bowel sounds. no hsm or tenderness. extremities: warm and well perfused, 2+ dp bilaterally up to knees, no pedal edema, r cath site with small hematoma, mild tenderness to palpation, no bruit or ecchymosis pertinent results: admission labs: 10:05am blood wbc-11.8* rbc-3.75* hgb-13.6* hct-37.6* mcv-100* mch-36.2* mchc-36.1* rdw-13.6 plt ct-167 10:05am blood neuts-39.8* bands-0 lymphs-55.1* monos-3.5 eos-1.0 baso-0.7 10:05am blood glucose-122* urean-15 creat-1.0 na-135 k-4.3 cl-101 hco3-24 angap-14 10:05am blood probnp-3690* 10:05am blood ctropnt-<0.01 06:40pm blood mg-2.0 iron-86 06:40pm blood ferritn-79 06:40pm blood tsh-5.1* . discharge labs: 05:09am blood wbc-17.9* rbc-2.71* hgb-9.8* hct-27.1* mcv-100* mch-36.3* mchc-36.4* rdw-13.0 plt ct-208 05:09am blood pt-15.9* inr(pt)-1.4* 05:09am blood glucose-94 urean-21* creat-0.9 na-136 k-3.1* cl-105 hco3-23 angap-11 05:09am blood calcium-6.7* phos-3.6 mg-1.6 . misc labs: 10:14pm blood alt-14 ast-24 ld(ldh)-244 alkphos-48 totbili-0.4 05:42am blood vitb12-475 folate-12.4 06:40pm blood ferritn-79 11:49am blood triglyc-53 hdl-34 chol/hd-3.7 ldlcalc-82 06:17am blood t3-130 free t4-1.4 06:40pm blood tsh-5.1* 06:18am blood cortsol-27.3* 06:17am blood hiv ab-negative 01:39pm blood free kappa and lambda, with k/l ratio-pnd . urine labs: 07:17am urine hours-random urean-1320 creat-168 na-47 k-65 cl-15 07:17am urine osmolal-775 12:35pm urine hours-random urean-1404 creat-156 na-30 k-85 cl-19 12:35pm urine osmolal-979 12:46pm urine hours-random urean-1149 creat-160 na-44 k-77 cl-74 12:46pm urine osmolal-739 05:52am urine hours-random creat-100 na-33 k-45 cl-43 05:52am urine osmolal-425 . imaging: echo () left atrium: mild la enlargement. right atrium/interatrial septum: mildly dilated ra. small secundum asd. left ventricle: normal lv wall thickness and cavity size. severe regional lv systolic dysfunction. no lv mass/thrombus. no resting lvot gradient. no vsd. right ventricle: normal rv chamber size. mild global rv free wall hypokinesis. aorta: mildy dilated aortic root. aortic valve: mildly thickened aortic valve leaflets (3). no as. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. no mvp. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. mild pa systolic hypertension. pulmonic valve/pulmonary artery: pulmonic valve not visualized. no ps. physiologic pr. pericardium: very small pericardial effusion. the left atrium is mildly dilated. a small secundum atrial septal defect is present. left ventricular wall thicknesses and cavity size are normal. there is severe regional left ventricular systolic dysfunction with hypokinesis of the inferior wall and akinesis of the anterior wall, septum and apex (most consistent with multivessel cad). the inferolateral/lateral segments contract normally (lvef = 20%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size is normal. with mild global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a very small pericardial effusion. impression: severe regional left ventricular systolic dysfunction, c/w multivessel cad. mild aortic and mitral regurgitation. mild pulmonary hypertension. small secundum asd. . cxr: bilateral small pleural effusions with associated atelectasis. no focal consolidation is seen. prominence of the bilateral hila which may be due to underlying lymphadenopathy, or be suggestive of pulmonary arterial hypertension. . cardiac cath comments: 1. selective coronary angiography of this right dominant system revealed no angiographically apparent disease. the lm, lad, lcx and rca are free of angiographically significant disease. 2. limited resting hemodynamics revealed mildly elevated left and right sided filling pressures of 19 and 13mmhg respectively. there mildly elevated pulmonary artery systolic pressure with a pasp of 32mmhg. there was mildly reduced cardiac index of 2.02l/min/m2. there was reduced systemic arterial pressure of 95/56mmhg. final diagnosis: 1. coronary arteries are normal. 2. non-ischemic dilated cardimyopathy. 3. mildly elevated left and right sided filling pressures. ct chest noncontrast findings: the airways are patent to the segmental level. the right middle lobe bronchus is narrowed without evident masses adjacent to it. nodular -apical scarring is partially obscured by pleural effusion. discrete lung nodules in the right apex measure up to 8 mm (4:25). there are other multiple more elongated opacities in the right apex measuring up to 5 mm; they are seen mainly in the periphery. in the right apex, there is also a peripheral lateral subpleural triangular opacity that could be atelectasis or scarring. there are moderately large bilateral non-hemorrhagic pleural effusions. increased in number axillary bilateral lymph nodes, measure up to 16 mm on the right side. mediastinal lymph nodes measure up to 8 mm in the right upper paratracheal station, 11 mm right lower paratracheal station, and 12 mm in the subcarinal station. smaller lymph nodes are elsewhere in the mediastinum. evaluation of hilar lymphadenopathy is limited due to the lack of iv contrast. cardiac size is mildly enlarged. the left atrium is enlarged. there are tiny calcifications in the lad. the aorta is normal in caliber. this examination is not tailored for subdiaphragmatic evaluation. there is sludge in the gallbladder. hypodense lesions in the upper pole of the both kidneys and in the mid portion of the right kidney are incompletely imaged and characterized in this study and should be evaluated by ultrasound. there is a non-obstructing stone in the right kidney. there are scattered increased in number borderline lymph nodes in the mesentery. there are no bone findings of malignancy. impression: moderately large bilateral pleural effusions with adjacent atelectasis. -apical scarring, multiple nodular and geographic opacities in the right apex; should be followed in three months with contrast-ct to assess stability. brief hospital course: 77 yo male with history of hypogammaglobulinemia, low grade lymphoma and asthma, who presents with sob, pnd, orthopnea with cxr consistent with pulmonary edema and chf exacerbation. . active issues: # acute decompensated systolic chf: pt admitted with acutely decompensated chf, tte revealed ef of 20% with regional wall motion abnormalities suggestive of ischemic cardiomyopathy. however, on cardiac catheterization, no evidence of angiographically evident coronary perfusion defects were seen. thyroid function tests, iron studies and hiv test were sent as part of work-up for new onset cardiomyopathy. tsh was found to be mildly elevated, with normal t4. this should be followed up as an outpatient. hiv and iron studies were normal. kappa and lambda light chains were also sent and pending at time of discharge. he was started on low dose beta blocker and low dose ace inhibitor. he was initially treated with lasix po, however pt did not respond with adequate urine output. therefore this was changed to po torsemide with significant improvement in urine output. his potassium dropped with torsemide so he was discharged on potassium supplementation . # metabolic encephalopathy due to hyponatremia: pt was found to have profoundly altered mental status, with confusion, amnesia and aphasia. a code stroke was called. ct non-contrast and cta/ctp were performed stat, which did not reveal intracranial hemorrhage or ischemia. the cause of his mental status change was attributed to metabolic changes, most likely hyponatremia. . # hyponatremia/siadh: pt gradually developed hyponatremia to 121 in three days from 135 in the setting of diuresis. after ruling out stroke, we felt hyponatremia could be an important contributor to his altered mental status. pt was slowly corrected with 3% saline, which he tolerated well. his mental status improved significantly after the correction of hyponatremia. of note, pt had normal free cortisol, slightly elevated tsh, but normal t3, t4. his hyponatremia was thought related with chf vs siadh. work-up for siadh included chest ct which showed no changes from previous ct. pt sodium had normalized by time of discharge and urine osm decreased from 900s to 400s on torsemide. . # a fib: pt was in and out of atrial fibrillation during hospitalization. pt likely has long history of paroxysmal a fib given his self report of palpitations in the past, though this has never been diagnosed. he was started on metoprolol for rate control, however because he developed symptomatic hypotension, he was cardioverted and started on amiodarone. pt is currently being loaded with amiodarone with plans to decreased to maintenance dose over the next several weeks. he was started on lovenox for anticoagulation with bridging to coumadin. inr was still subtherapeutic at time of discharge. . chronic issues: # lymphoma: pt had history of low grade lymphoma, s/p chop in 90s. given the suspicion of siadh, a chest ct was performed, which did not reveal significant interval changes. . # asthma: well controlled at home with albuterol qid. we continued his albuterol. . # hypogammaglobulinemia: currently receiving ivig monthly, last dose . pt remained afebrile with no indication of active infection. . transitional issues: pt is full code. # pt will need frequent monitoring of potassium due to initiation of torsemide. he is being discharged home with potassium chloride 20meq daily. # pt should have sodium monitored as well, given that no clear source of siadh has been identified. his sodium was stable at time of discharge. # inr will need to be monitored. bridging with lovenox can be stopped once inr is therapeutic (>2.0) # pt is currently being loaded with amiodarone 400 mg tid. this should be decreased over the next several weeks to maintenance dose of 200mg daily. # mr. was found to have slightly elevated tsh, normal t3 and t4. this should be repeated as an outpatient # free kappa and lambda pending at time of discharge. this was sent as part of work-up for etiology of chf. medications on admission: lasix 20mg started yesterday albuterol prn discharge medications: 1. enoxaparin 80 mg/0.8 ml syringe sig: one (1) syringe subcutaneous (2 times a day) for 3 days. disp:*6 syringe* refills:*0* 2. amiodarone 200 mg tablet sig: two (2) tablet po three times a day: take 400 mg three times a day for 1 week, then 200 mg twice a day for 2 weeks, then 200mg daily - or as directed by your cardiologist. disp:*180 tablet(s)* refills:*0* 3. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po bid (2 times a day). disp:*60 tablet extended release 24 hr(s)* refills:*0* 4. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. disp:*30 tablet(s)* refills:*0* 5. torsemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. warfarin 6 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 7. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 8. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day. disp:*30 tablet, er particles/crystals(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: primary: congestive heart failure (chf) exacerbation atrial fibrillation hyponatremia siadh - syndrome of inappropriate antidiuretic hormone discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you at . you were admitted for a heart failure exacerbation. you had a cardiac catheterization which showed there were no blockages. you were found to have a rapid heart rate so you were cardioverted back into normal rhythm. you also had low sodium which caused you to become confused. you were in the icu for treatment of this. we started you on several new medications to control your sodium level and to control your fluid balance please make the following changes to your medications: 1. start metoprolol xl 25mg twice a day 2. start coumadin 6 mg daily 3. start amiodarone 400mg three times a day for 2 weeks, then decrease to 200mg twice a day for 2 weeks, then decrease to 200mg daily - or as directed by your cardiologist 4. start torsemide 20mg daily 5. start lisinopril 2.5 mg daily 6. start potassium chloride 20meq daily 7. give lovenox shots 80mg twice a day until inr is theraputic () please call your physician if you gain 3 pounds in 1 day or 5 pounds in 1 week followup instructions: name: dr. location: - address: , , phone: appointment: tuesday 10:00am *this is a follow up appointment of your hospitalization. you will be reconnected with your primary care physician after this visit. name: , md location: address: , , phone: appt: at 11:10am name: , md specialty: nephrology location: - address: , phone: **we are working on a follow up appointment with dr. within 1-2 weeks. you will be called at home with the appointment. if you have not heard from the office within 2 days or have any questions, please call the number above.** md procedure: combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart atrial cardioversion central venous catheter placement with guidance diagnoses: other primary cardiomyopathies anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified atrial fibrillation asthma, unspecified type, unspecified mitral valve insufficiency and aortic valve insufficiency anxiety state, unspecified alkalosis long-term (current) use of other medications other left bundle branch block long-term (current) use of anticoagulants metabolic encephalopathy acute on chronic systolic heart failure other disorders of neurohypophysis personal history of antineoplastic chemotherapy epistaxis unspecified sinusitis (chronic) other acquired deformities of ankle and foot nontoxic multinodular goiter chronic lymphoid leukemia, in remission hypogammaglobulinemia, unspecified 

Answer: The patient is high likely exposed to