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: history of present illness: this is a 24-year-old rican gentleman with a history of cml status post matched unrelated allogeneic peripheral blood stem cell transplant, whose hospital course has been complicated with severe graft-versus-host disease of skin, gi tract, and liver, who presents today with acute onset of abdominal pain. patient has been on home tpn as well as a variety of regimens for his graft-versus-host disease including photophoresis and most recently treated with cellcept mg and cyclosporin. the patient has had slowly improving liver function tests in this setting. he comes in today complaining of intermittent constipation for 10 days, and also with a relatively acute onset of localized abdominal pain in the periumbilical area. he has been afebrile with no other complaints. specifically, he denies any fevers, chills, night sweats, nausea, vomiting, diarrhea, blood in his stool, melena. past medical history: 1. chronic myelogenous leukemia diagnosed in , positive chromosome, status post mud bmt complicated by severe engraftment syndrome requiring intubation. 2. severe graft-versus-host disease of abdominal tract, skin, and liver. 3. history of clostridium difficile colitis. 4. cardiomyopathy secondary to cytoxan, ejection fraction of 40%, now resolved. 5. status post hernia repair. 6. undescended testicles. physical examination: vital signs: patient is afebrile. general: rican male, who speaks some english, cachectic. heent: normocephalic, atraumatic. pupils are equal, round, and reactive to light. oropharynx: red with sore on upper lip, no evidence of thrush. neck is supple. pulmonary: scattered crackles at right base. cardiovascular: regular, rate, and rhythm, no murmurs, rubs, or gallops. abdomen is soft with localized tenderness in the periumbilical area, no clear guarding, questionable minimal rebound, right upper quadrant epigastric or left upper quadrant tenderness. laboratories: white blood cell count of 12.2, hemoglobin of 8.4, hematocrit 23.8, platelets 143. bun 43, creatinine 1.2, alt 272, ast 93, alkaline phosphatase 750. hospital course: 1. gi: the patient received abdominal ct scan on admission which showed free air within the abdomen and a moderate amount of free fluid. there was also evidence of mild thickening of the wall of multiple distal small bowel loops, but difficult to evaluate given no oral contrast. given this ct scan finding, the patient was taken to surgery. on , he received an exploratory laparotomy with drainage of intraabdominal abscess as well as an oversew of perforated pyloric channel ulcer with omental ........... patch. after surgery, the patient was started on aggressive bowel regimen for constipation and experienced gradual resolution in his pain. the patient was placed on tpn throughout his hospitalization, but demonstrated an increasing appetite. prior to discharge, the patient had one week of formed bowel movements. a ct scan performed on prior to discharge was significant for improvement in the free air and free fluid. 2. hematology/oncology: patient admitted with a history of cml with severe graft-versus-host disease of the skin, gut, and liver. the patient was maintained on the solu-medrol, cyclosporin, and cellcept for graft-versus-host disease, with cyclosporin levels checked regularly and doses adjusted accordingly. patient was also instructed to continue use of his tacrolimus, which he used topically for his graft-versus-host disease complications of his lips. the patient's generally decreasing lfts as well as his ability to form stool indicated that his graft-versus-host disease was being sufficiently treated. 3. infectious disease: a peritoneal swab specimen obtained during surgery grew out pseudomonas and fungus, and the patient was started on fluconazole, vancomycin, and flagyl shortly after surgery. infectious disease consult team saw patient and recommended fluconazole and zosyn for seven days. the patient completed the full seven day course of fluconazole and zosyn, and when transferred back to the , these medications were not continued. the evening of his transfer to the and the following morning, the patient developed low-grade fevers. his blood cultures were sent. urine cultures were sent, and his right ij tip were sent for cultures. the patient was placed back on zosyn per id approval, and once a chest x-ray became positive for a new left basilar infiltrate consistent with pneumonia, levofloxacin was added to his antibiotic regimen. a ct scan performed on was significant for multifocal patchy pulmonary opacities in the peribronchial distribution involving mid and lower lung zones with associated bronchial obstruction of segments of the left lower lobe consistent with aspiration pneumonia versus fungal infection. given these findings, expectorated sputum and induced sputum samples were sent for culture. the cultures from the sputum samples eventually grew out aspergillus fumigatus. a ct scan performed on was significant for interval resolution of a mucoid impaction of the left lower lobe airways, however, tree ............... opacities and ill-defined peribronchial nodules and foci of consolidations were discovered primarily in the lower lobes, but also in the right middle lobe and lingula. these findings were considered consistent with worsening infection with a possibility of aspergillus infection. given these sputum culture results as well as these radiological findings, the patient was started on voreconazole per recommendation of the infectious disease team. once the patient was afebrile for several days, and demonstrated remarkable clinical improvement, zosyn was discontinued on . on the hospital day before discharge, the patient's lfts were noted to increase significantly. infectious diseases was consulted and recommended changing voreconazole to caspofungin secondary to voreconazole's effect on the liver. as a bacterial etiology to the patient's pulmonary disease, was considered treated, levofloxacin was discontinued prior to discharge. 3. cardiovascular: after transfer to the , the patient's blood pressure became gradually increased with diastolic blood pressure over 100. lopressor was started and eventually increased to 100 mg . the patient's cyclosporin levels were found to be markedly elevated given thought to be secondary to voreconazole increasing their levels. once this interaction was identified, and the patient's cyclosporin levels were decreased in half, his blood pressures were more easily manageable. the patient will be discharged with nifedipine 5 mg po prn for diastolic blood pressures over 95. condition on discharge/status: good. discharge diagnoses: 1. chronic myelogenous leukemia status post mud transplant complicated by severe graft-versus-host disease of his skin, gut, and liver. 2. status post surgery for perforated pyloric channel ulcer. discharge medications: 1. caspofungin 50 mg iv q24h. 2. cellcept mg po bid. 3. solu-medrol 50 mg iv bid. 4. ursodiol 300 mg po bid. 5. epogen 40,000 units subq q tuesday. 6. acyclovir liquid 400 mg po tid. 7. cyclosporin (3 mg/hour) start 8 pm for total, 75 mg over 24 hours. 8. protonix 40 mg po bid. 9. colace 200 mg po q day. 10. senna two tablets po q day. 11. nystatin swish and swallow qid. 12. protopic ointment . 13. nifedipine 10 mg po q8 prn dbp over 95 (take 5 mg). follow-up plans: the patient is to get daily cyclosporin levels drawn at , to present to on the day following discharge. caspofungin is to be given as an outpatient at . the patient's fingerstick glucoses will also be monitored daily. dr., 12-699 dictated by: medquist36 d: 14:37 t: 14:59 job#: procedure: parenteral infusion of concentrated nutritional substances percutaneous abdominal drainage arterial catheterization suture of gastric ulcer site diagnoses: pneumonia, organism unspecified other primary cardiomyopathies other convulsions complications of transplanted bone marrow chronic myeloid leukemia, without mention of having achieved remission nutritional marasmus acute gastric ulcer with perforation, without mention of obstruction 

Answer: The patient is high likely exposed to