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: sulfa (sulfonamides) / allopurinol / vancomycin / ciprofloxacin / augmentin / azithromycin / linezolid / cefepime / iodine attending: chief complaint: shortness of breath major surgical or invasive procedure: skin biopsy history of present illness: 69m with aml s/p clofarabine with prolonged remission then recurrence, now on decitabine s/p completion of cycle 9 on , copd/emphysema, presenting to clinic on with worsening shortness of breath. he was noted to have a low-grade temp to 99.9f and sao2 of 92-95% on room air, up to 96% on 2l nc. he had a cxr done, which demonstrated a small lll pna. his wbc was 1.2 with 29%n for an anc of around 400, which is consistent with his recent baseline. he has multiple antibiotic allergies and intolerances, including: sulfa: unknown vancomycin: rash (morbilliform, not red man) cipro: rash augmentin: rash azithromycin: rash linezolid: subjective sob several of these, however, were questionable, due to concurrent use of other medications. he was seen by on in anticipation of this current admission, who noted that the pcn/augmentin allergy was based on an uncertain history, but recommendation had been made for desensitization to any pencillins or carbapenems. he noted, however, that the cross-reactivity for 3rd or 4th generation cephalosporins is <4%, and that a trial of such could be tried at full dose. he therefore received cefepime 2gm in clinic prior to admission, with no adverse effects. admitted for further evaluation. after admission, spiked to 103.2f. he denies any preceding sore throat, nasal/sinus congestion, and admits only a mild non-productive cough. he denies any new rash, pruritis, or oropharyngeal swelling since starting cefepime. he does endorse significant nausea/vomiting over the last day, with no abdominal pain or diarrhea. past medical history: pmh: oncologic history: patient initially presented in summer with easy bruising and dropping cell counts (pancytopenic) as well as some sob/fatigue. bmbx was consistent by report with myelodysplastic syndrome with presence of a 15-20% immature cells consistent with blasts; dr. felt the pathology was consistent with mds with excess blasts in transformation, suggesting acceleration of the disease towards acute leukemia. . pt underwent induction and reinduction with single clofarabine per protocol 07-013, last treated in 09/. since that time, he showed signs of dysplasia was dropping cell lines and bone marrow biopsy done in showed blasts occurring in small clusters occupying an estimated 20% of the marrow cellularity. cytogenetics showed deletion of the long arm of chromosome 20 and he was treated on with his first cycle of decitabine. c2 decitabine started . he has previously opted not to undergo allogeneic stem cell transplant due to quality of life desires. . past medical history: - copd/emphysema - gerd - ? angina (has been prescribed sl nitro for cp/neck pain that occurs on exertion with sob, but states the tabs do not help, and reportedly has had normal stress mibi) - degenerative joint disease/arthritis of the spine . past surgical history: - plan for port insertion next tuesday - appendectomy as a child - age 8 - submucous resection - age 12 - left meniscus repair of the knee - age 37 - right meniscus repair of the knee - age 64 - hernia repair left side - age 65 social history: personal: married 44 years; 4 children (2 sons, 2 daughters) - lives with one son's family. family involved in patient's care. - tobacco: smoked heavily ppd x 40 years, quit - alcohol: significant past alcohol intake, quit - occupation: former veteran from , ? exposure to . retired from food and beverage industry. - hobby: sports family history: his mother is deceased at age from a bowel obstruction. his father is deceased at age from prostate cancer. he has no siblings. physical exam: t: 100.2f, bp: 114/80, hr: 92, rr: 20, sao2: 96% 3l nc gen: lying in bed, shedding skin, in nad heent: sclerae anicteric, oropharynx dry neck: supple cv: rrr, s1/s2, no m/r/g chest: ctab abd: soft, nt/nd, +bs skin: exfoliative scaling on the forehead, cheeks, neck with minimal residual erythema. no mucose membrane lesions. conjunctival injected. gluteal fold, biopsy site c/d/i. 1+ edema in both le, with erythema and rbc extravasation. neuro: a&ox3 pertinent results: 1. labs on admission: 08:35am blood wbc-1.2* rbc-3.31* hgb-10.7* hct-32.0* mcv-97 mch-32.3* mchc-33.4 rdw-19.1* plt ct-153# 08:35am blood neuts-29* bands-0 lymphs-67* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-0 blasts-2* nrbc-1* 04:15am blood pt-15.0* inr(pt)-1.3* 06:01am blood gran ct-690* 08:35am blood urean-13 creat-0.9 na-136 k-4.6 cl-103 hco3-26 angap-12 08:35am blood alt-22 ast-19 ld(ldh)-164 alkphos-60 totbili-0.4 08:35am blood calcium-9.0 phos-2.9 mg-1.9 . 2. labs on discharge: 12:15am blood wbc-1.8* rbc-3.14* hgb-9.7* hct-30.2* mcv-96 mch-30.9 mchc-32.1 rdw-18.4* plt ct-125* 12:15am blood neuts-21* bands-0 lymphs-76* monos-1* eos-0 baso-0 atyps-2* metas-0 myelos-0 nrbc-1* 12:15am blood pt-13.0 inr(pt)-1.1 12:15am blood gran ct-372* 12:15am blood glucose-111* urean-16 creat-0.7 na-139 k-4.2 cl-104 hco3-28 angap-11 12:15am blood alt-29 ast-22 ld(ldh)-197 alkphos-61 totbili-0.4 12:00am blood ck-mb-1 ctropnt-<0.01 12:09am blood ck-mb-3 ctropnt-<0.01 06:16pm blood ck-mb-2 ctropnt-<0.01 10:04am blood ck-mb-2 ctropnt-<0.01 probnp-2307* 12:15am blood albumin-3.0* calcium-8.4 phos-1.9* mg-1.9 05:30pm blood aspergillus galactomannan antigen-negative 05:30pm blood b-glucan-negative . 3. imaging/diagnostics: - cxr: minor new left lower lobe opacity, minimal pneumonia is possible, unlikely to be bacterial. - ct chest: marked diffuse centrilobular emphysema, unchanged. no focal airspace consolidation to suggest typical bacterial pneumonia. interval resolution of right upper lobe pneumonia. mild septal thickening compatible with mild fluid overload. mild bibasilar atelectasis, left worse than right. no pneumothorax, pleural effusion, or lymphadenopathy. - video and barium swallow: mild oropharyngeal dysphagia, without evidence of penetration or gross aspiration or significant residue. normal esophageal contour without evidence of stricture. intraesophageal reflux visualized with nonspecific impairment of gastric motility as described above. no gastroesophageal reflux is visualized. - right buttock skin biospy: the histologic features are most consistent with a bullous hypersensitivity reaction, such as to a drug. - repeat ct chest: generalized ground-glass attenuation throughout both lungs and septal thickening particularly in the dependent lower lobes, increased since , likely pulmonary edema, either cardiogenic or non-cardiogenic (including drug reaction), less likelyatypical infection. severe centrilobular emphysema, stable since . - v/q scan: low likelihood ratio for acute pulmonary embolism. - bronchioaveolar lavage: negative for malignant cells - lower extremity ultrasound: no evidence of dvt in the right lower extremity. brief hospital course: 69m with aml, s/p completion of cycle 9 decitabine on , also with copd, presenting with worsening dyspnea over the last several days with non-productive cough, spiking fever in clinic, with cxr showing minor lll infiltrate. . # pulmonary opacity: on admission, patient had recent history of neutropenia. fever up to 99.9 in clinic and allergy consulted. recommended starting cefepime for empiric coverage despite penicillin allergy. patient received a total of 3 doses, but had high fever (>102) and developed rash. cefepime was stopped, and patient underwent meropenenm desensitization in the icu. desensitization was notable for breath episodes of subjective throat tightness that resolved after treatment with hydroxyzine, benadryl, and famotidine. patient never devloped respiratory compromise. ct chest showed emphysematous changes, fluid overload, but no obvious signs of pneumonia. thus, antibiotics were stopped. fever returned and patient started on aztreonam and daptomycin. bronchoscopy was done, and bal cultures were all negative. antibiotics stopped. patient remained afebrile for the remainder of the hospitalization. . # drug rash: patient developed an non-pruritis, macular, blanching, whole-body rash after receiving cefepime. allergy was consulted and given need for empiric coverage in the setting of possible pulmonary infection and neutropenia, decision was made to de-sensitize patient to meropenem. patient was also started on low dose prednisone. both antibiotics and steroids were stopped. patient began to exfoliative, from the face downward. dermatology was consulted who obtained a biopsy, the result of which is consistent with a drug-induced hypersensitivity reaction. patient was treated symptomatically for pain and discomfort. two days prior to discharge (off antibiotics), patient was noted to develop another morbiliform rash, which was consistent with drug-rash per dermatology. they did not recommend any interventions. . # shortness of breath: patient has copd at baseline and is overall deconditioned. he was able to maintain oxygen saturday of >96% on 3l ns. on room air, oxygen saturation is ~92%. ct chest showed baseline emphysematous changes. patient was kept on home regimen of albuterol inhalor throughout the hospitalization. he had two episodes of hypoxia (o2 sat 88% on 3 l ns) during coughing spells. responsive to oxygen through facemask. started on iv methylprednisone and aggressive diuresis. patient improved and steroid tapered. on discharge, patient had oxygen saturation >94% on room air sitting. on ambulation, he can drop as low as 85% but returns with rest. patient was set up for home oxygen prior to discharge. . # angina: patient had history of exertional angina treated with prn sublinguial nitro in the past. during the hospitalization, patient had one episode of chest pain with st-depression on ekg. three sets of cardiac enzymes were negative. cardiology was consulted and recommended no catherization or medical interventions given low platelet count. recommends followup with outpatient cardiologist. medications on admission: albuterol sulfate - 2.5 mg/3 ml (0.083 %) solution for nebulization - 1 vial inhaled via nebulizaiton every 4 to 6 hours as needed for shortness of breath or wheezing doxycycline hyclate - 100mg po bid (chronic) advair diskus 250 mcg-50 mcg - 1 disk(s) inhaled twice a day ipratropium-albuterol - 103 mcg (90 mcg)-18 mcg/actuation aerosol - 1 (one) inhaled four times a day lorazepam - 0.5mg po q6h as needed for nausea metoprolol tartrate - 25mg po twice a day nitroglycerin - 0.4 mg tablet, sublingual - 1 tablet(s) sublingually once a day as needed for chest pain, tightness ondansetron hcl - 8mg po every eight (8) hours as needed for nausea prochlorperazine maleate - 10mg po every eight (8) hours as needed for nausea lansoprazole 15mg po once a day discharge medications: 1. lorazepam 0.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea or anxiety. 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. lansoprazole 15 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 4. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. 5. ondansetron hcl 8 mg tablet sig: one (1) tablet po every eight (8) hours. 6. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual once a day as needed for chest pain. 7. advair diskus 250-50 mcg/dose disk with device sig: one (1) inhalation twice a day. 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation every 4-6 hours as needed for shortness of breath or wheezing. 9. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: one (1) inhalation four times a day. 10. voriconazole 200 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*60 tablet(s)* refills:*0* 11. home oxygen 2l o2/min continuous for portability and pulse dose system discharge disposition: home with service facility: vna of southeastern mass. discharge diagnosis: primary: pneumonia allergic pneumonitis drug-induced rash discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , you were admitted to the hospital because you had fever and increasing shortness of breath. we did a chest x-ray and a ct scan to look at your lungs. it looked like you might have had a pneumonia. given that you were neutropenic recently, we decided to treat you for possible infection. we asked the allergy specialist to help us choose an antibiotic for you. you were started on cefepime, and also got de-sensitized to meropenem. you developed a body rash and high fevers, which we thought might have been related to the antibiotcs. we asked the dermatologist to look at your rash and they did a biopsy, the result was consistent with a drug rash. we took you off the antibiotics and you felt better. you had chest pain one night, with changes in your ekg. we checked lab tests and you did not have signs of heart damage. we also asked the cardiologist to come see you and they did not recommend any interventions. you had a video swallow and barium swallow done. the results showed that you were not aspirating and did not have gastric reflux. you started having fevers again, so we placed you back on antibiotics. we also asked the lung doctors to and they did a bronchoscopy, which did not show any abnormalities. the culture from the fluid they collected did not show any growth. during one episode of coughing spell your oxygen level dropped. we gave you steroid and also lasix to remove fluid from your lungs. you got better. we tapered the steroids and stopped the antibiotics. you improved and at the time of discharge you were able to ambulate on your own. . we added cefepime to your allergy list. we made the following changes to your medications: started: - acyclovir 400 mg by mouth three times a day - voriconazole 200 mg by mouth every 12 hours . stopped: - doxycyclin 100 mg by mouth twice a day followup instructions: provider: , md phone: date/time: 11:30 provider: , : date/time: 11:30 please make an appointment and follow up with your outpatient cardiologist in the next month. procedure: closed [endoscopic] biopsy of bronchus closed biopsy of skin and subcutaneous tissue diagnoses: pneumonia, organism unspecified esophageal reflux unspecified pleural effusion need for desensitization to allergens pulmonary collapse other and unspecified angina pectoris other emphysema dermatitis due to drugs and medicines taken internally neutropenia, unspecified cephalosporin group causing adverse effects in therapeutic use other specified disorders of skin other specified erythematous conditions fever presenting with conditions classified elsewhere acute myeloid leukemia, in relapse unspecified allergic alveolitis and pneumonitis 

Answer: The patient is high likely exposed to