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: mycophenolate mofetil attending: chief complaint: fever, abdominal pain, diarrhea, anorexia major surgical or invasive procedure: egd history of present illness: 55 male who is 9 months and 26days s/p a liver for hcv/hcc, with mild acute rejection and recurrent hcv infection on ribavirin and interferon, who is presenting with fever and increasing nausea/emesis/diarrhea/malaise. since discharge on patient has had intermittent nausea and vomiting, the last a couple of days ago. has had decreased po intake d/t nausea and feeling unwell. also with loose stills since discharge that he though was getting better but have now returned more recently, stooling 5-6 times per day, no melena or hematochezia. increasing lethargy over the last couple of weeks. developed a sore throat a couple of weeks ago as well in joint discomfort that has progressed now to frank swelling of feet, ankles, and hands. he relates pain/myalgias in feet, ankles, calves, ant shin, knees, hands, wrists, elbows, shoulders, forearm. developed a fever to 102.5 over last coupe of days. no sick contacts, recent travel, abnormal foods, lives alone. no dysuria, cough. abdominal pain slightly increased from his chronic baseline level. +ha but no neck stiffness, photophobia, vision changes. . ed course: presenting vital signs were t 98.5 hr 125 bp 116/88 rr 16 sat 98% ra. labs showed a mild increase in his transaminitis, as well as a leukocytosis. ceftriaxone 1gm, vancomycin 1gm, morphine 4mg iv x2, tylenol 1gm, oxycodone 10mg po. hr 137 when febrile to 101, hr fell to 125 with 3l ns. blood and urine cultures were sent. uop in ed 700cc. past medical history: # hepatitis c/alcoholic cirrhosis, c/b hepatocellular carcinoma -dx -hcc s/p radiofrequency ablation -s/p liver with hep b core ab + liver, received hbig and on daily lamivudine, last hbv viral load not detected ) -on he had a liver biopsy per 3 month protocol that showed early recurrent hcv and mild acute rejection - tacrolimus increased and 500mg x 3doses of steroids -repeat bx with fibrosing cholestatic hepatitis - - started inf , procrit , ribavirin for hepatitis c -on save the nephron study since viral hepatitis c - hcv viral load 5,750,000 (up from 3,150,000 in ) # hypertension # gerd # cholecystistitis and cholelithiasis s/p laprascopic cholecystectomy # hx polysubstance abuse # alcohol use # post dm and hypertension social history: pt lives alone in , , able to take care of his adls. monogamous sexual relationship with his partner, uses contraceptives. last hiv test in negative, partner status unknown. denies etoh use, last drink was in . prior to that did have heavy etoh. denies current ivdu, states he used heroin, barbiturates, cocaine in 70s,80s, 90s. denies current tobacco use, quit 15 years ago. family history: nc physical exam: vs- 101.1 (101.8), 113/84, 138(127-138) 20, 93%ra gen- ill appearing, in pain heent- op clear but mmm dry, perrl, anicteric, wick in place of ear neck- supple, jvp flat cor- but regular rhythm, no m/r/g chest- crackles at bases bilaterally abd- ttp in rlq, mild in ruq ext- joint swelling in hands with erythema, dorsal aspect of feet swollen, nonpitting, mildly erythematou, trace ankle edema, significant ttp in feet, ankles, calves and anterior shins bilaterally, no knee swelling or effusions, hip without ttp bilaterally, 1+ pe b ue/le, no rash other than erythema in feet and hands neuro- a&ox3, 5/5 strength b ue/le, 2+ dtr's patellar skin- multiple tatoos, scattered ecchymosis pertinent results: ct abd/pel impression: 1. no evidence of hepatic or intra-abdominal abscess. 2. new bilateral lower lobe consolidation in addition to previous atelectasis. 3. no change in adrenal and renal lesions. bilateral nonobstructing renal calculi. 4. expected appearance of liver post . tte the left atrium is normal in size. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. renal u/s impression: 1. nonobstructing renal calculi in the right kidney. comparison to the ct, there are multiple bilateral nonobstructing renal calculi which were not visualized in this examination. 2. splenomegaly u/s grayscale and doppler ultrasound of the liver: comparison is made to the prior ultrasound dated . the liver is normal in echogenicity without evidence of focal lesion or intra- or extra-hepatic ductal dilatation. portal veins, hepatic veins, and hepatic arteries are patent with appropriate waveforms. spleen measures 16 cm. there is new right pleural effusion. impression: patent vessels with appropriate waveforms. splenomegaly. new right pleural effusion. ------------------ cxr impression: 1. new right lower lobe opacification, suspicious for pneumonia in the appropriate clinical setting. adjacent small right pleural effusion. 2. resolving linear left basilar opacities ------------------- abd u/s grayscale and doppler ultrasound of the transplanted liver: comparison was made to the ultrasound dated and ct scan dated . there is no focal liver lesion in the transplanted liver. there is no intra- or extra-hepatic ductal dilatation. portal vein is widely patent. there is a ring-like echogenic structure at the portal vein anastomosis. there is an anechoic tubular two-compartmental structure, which initially appeared to be bile duct, however, further scanning revealed it to be fluid accumulating along the porta hepatis at real- time scanning. normal waveforms are seen in main portal vein, main and left hepatic arteries and three hepatic veins. there is a small amount of right pleural effusion. impression: no intra- or extra-hepatic ductal dilatation in the transplanted liver. tubular -lobed fluid tracking along the porta hepatis. small right pleural effusion. patent portal veins. brief hospital course: 55 yo man with hx etoh/hcv cirrhosis s/p olt in , cmv donor +, recipient -, now admitted with abdominal pain, fever, myalgias, headache, cough and found to have cmv viremia with evidence of liver involvement course complicated by recurrent hcv seen on biopsy, multifactorial acute renal failure, microabscesses on biopsy concerning for ascending cholangitis. . # cmv viremia original cmv vl 95,800 at that time started on oral valganciclovir, biopsy results on confirmed liver involvement and he was switched to iv ganciclovir and completed a 2 week course. his cmv vl decreased to <600 copies on . he will need to complete 6 months of oral valganciclovir 450mg daily for likely 6 months, follow up with dr. was scheduled for patient. of note he had a negative opthalmologic examination for retinitis done by opthalmologist. . # transplanted liver biopsy shows trichrome stain demonstrates increased portal fibrosis with septa formation and foci of early bridging fibrosis (stage 2-3). additionally, marked centrivenular fibrosis without luminal occlusion is seen, indicative of a component of chronic venous outflow obstruction. moderate portal and lobular mixed inflammation consisting of mononuclear cells and focally prominent neutrophils (some in association with bile ducts), with microabscess formation and foci of extensive hemorrhagic necrosis, predominantly involving zone 3. scattered viral inclusions morphologically consistent with cytomegalovirus are identified within hepatocytes and rare bile ductular epithelial cells (confirmed by immunostain for cmv, with satisfactory controls). recurrent viral hepatitis c, difficult to grade in this sample. diagnostic features of acute cellular rejection are not identified. biliary findings are also likely a result of the cmv and/or cytokine-mediated, but a concomitant bacterial infection, sepsis, a drug effect or biliary obstruction remain within the histopathologic differential. given rising alkaline phosphatase concern for cholestatic fibrosis was high, he may need repeat liver biopsy in the near future given his stage 2-3 fibrosis this early into his transplantation. his bactrim prophylaxis was switched to dapone given his renal dysfunction, g6pd level was normal. . # acute kidney injury multifactorial etiology in this patient with a baseline 1-1.2, he had component of cryoglobulinemia given positive cryos on and with 3 an 2 percent crycrit respectively. he was started back on interferon and ribavirin on , ribavirin was subsequently held given rise in creatinine. his urine did not reveal proteinuria and had nonspecific granular casts. tacrolimus nephrotoxicity was considered and his goal was reduced to . his creatinine peaked at 2.1 and decreased, at discharge his creatinine was... of note he did receive fluid challenges with no improvement in renal function given that his po intake was poor. his bactrim was switched to dapone given his renal dysfunction, g6pd level was normal. . # superimposed bacterial infection had recurrent fevers while on treatment for cmv, biopsy revealed microabscesses concerning for ascending cholangitis. patient is to complete 3 week course of levaquin and flagyl on , he did not spike any fevers while on this regimen. initially was on vancomycin for possible pneumonia, susbsequent radiograph was unrevealing. patient had recurrent headache for which he had a negative lumbar puncture, all other cultures were negative. . # normocytic anemia multifactorial due to chronic disease, likely small oozing from cmv colitis (not biopsied or colonoscopy), had egd showing gastric erosion consistent with gastritis, no cmv. on multiple myelosuppressive medications. he was transfused for hematocrit<21. hematology reviewed smear and was not concerning for ttp. he is on epogen during his hcv treatment. . # inflammatory arthritis seen by rheumatology who tapped his swollen right knee, there was no evidence of infection and the fluid was inflammatory. this was attributed to cryoglobulinemia and his myalgias and arthralgias resolved throughout his hospital course. . # hypertension his metoprolol was increased to 75mg with good effect. . # communication: daughter (hcp): . medications on admission: lamivudine 100 mg daily pantoprazole 40 mg daily - not taking bactrim single strength cellcept 1 gram insulin on a sliding scale (occ) metoprolol 50 mg twice a day. klonopin 0.5 mg as needed. pegylated interferon alpha-2a 180 mcg subcutaneously weekly (fridays) - patient has not taken this recently, unclear for how long filgrastim 300 mcg subcutaneously weekly - not taking recently gabapentin 300 mg twice a day. iron 150 mg twice a day. epogen 40,000 units subcutaneously weekly - not taking recently prograf 3 mg twice a day. ribavirin 200mg percocet seven and a half pills as needed for pain - per pt, but not on dr. med list discharge medications: 1. gabapentin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 2. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. hexavitamin tablet sig: one (1) cap po daily (daily). 6. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 4 days. disp:*12 tablet(s)* refills:*0* 7. mycophenolate mofetil 250 mg capsule sig: two (2) capsule po twice daily (). 8. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days. disp:*4 tablet(s)* refills:*0* 9. lamivudine 100 mg tablet sig: 0.5 tablet po daily (daily). 10. epoetin alfa 10,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 11. peginterferon alfa-2a 180 mcg/ml solution sig: one (1) subcutaneous 1x/week (sa). 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 13. tacrolimus 0.5 mg capsule sig: three (3) capsule po q12h (every 12 hours). 14. dapsone 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 15. valganciclovir 450 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 16. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). 17. outpatient lab work please check cbc, chem-10, ast, alt, total bilirubin, ldh, inr, pt and have results faxed to dr. at (. these labs should be checked on monday . 18. oxycodone 5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. disp:*15 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: olt disseminated cmv microabscesses in liver hcv acute kidney injury normocytic anemia hypertension discharge condition: stable vss discharge instructions: you were admitted and found to have an extensive cmv infection in your liver as well as recurrent hepatitis c. you also had renal failure and your kidney function on discharge was still elevated. you will need to take your medications exactly as you are instructed to do so. this is really important given your is in danger. you have been scheduled appointments with dr. and dr. of infectious diseases. take all of your medications as indicated and inform the clinic if you have any issues obtaining your medications. if you develop any fever>101.5, abdominal pain, bleeding or any worrisome symptoms call the clinic or present to the emeregency room. followup instructions: provider: mri phone: date/time: 3:15 provider: clinic phone: date/time: 10:20 provider: , md phone: date/time: 10:30 you will be contact by dr. office to set up an additional appointment. if you are not you should call them by the end of this week. you should also have your labs checked on friday to make sure your blood cell counts and kidney function are stable. md procedure: spinal tap incision of lung closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: anemia, unspecified esophageal reflux unspecified essential hypertension other specified disorders of pancreatic internal secretion acute kidney failure, unspecified unspecified viral hepatitis c without hepatic coma abscess of liver dehydration complications of transplanted liver personal history of malignant neoplasm of liver surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cholangitis cytomegaloviral disease unspecified gastritis and gastroduodenitis, without mention of hemorrhage other specified inflammatory polyarthropathies 

Answer: The patient is high likely exposed to