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: decreased right eye visual acuity, gait disturbance major surgical or invasive procedure: : right stereotactic brain biopsy : high-dose iv methotrexate history of present illness: 61 year old right handed engineer who presents today with decreased visual acuity in right eye and history of difficulty with balance while ambulating since . he has had 3 falls since due to his difficulty with balance, the last fall was this week. he has noticed his balance becoming worse over the past week and has not gone to work for the past week. significant medical history includes left testicular mass removal in that was diagnosed as malignant lymphoma, large b cell. he has been followed by the hemotology/oncology team routinely every 6 months for this. past medical history: htn, cad, s/p mi , lymphoma since -testicular mass orchiectomy (malignant lymphoma, predominantly large cell type of b-cell lineage)blepharitis,inguinal hernia repair,hyperlipidemia, stemi lad drug eluting stent,leukocytosis (leukocyte counts between 11.3-18.5) kappa restricted b-cell lymphoproliferative disorder . # dyslipidemia - the patient refuses lipid-lowering therapy. # hypertension # emphysema (per ct on ) # ?interstitial lung disease (per ct on ) # cll/sll # s/p orchiectomy of l testes with atypical cellular infiltrate initially though large b cell lymphoma but may have been transformation # blepharitis # status post inguinal hernia repair social history: lives with wife of 57 years - wife very involved. has dedicated daughter involved with her fathers care. currently works full time as engineer. (wife). daughter cell . he drinks alcoholic beverages nights per week. family history: the patient's mother died at age 45 from malignant melanoma. his father died at age 89 with a history of parkinson disease. he has no siblings. his maternal uncle died of possible lung cancer, history unclear. there is no family history of premature coronary artery disease or sudden death. physical exam: physical exam: gen: nad, pleasant, incision right forhead c/d/i neck: no lad, without neck stiffness cv:rrr, no m/r/g pulm: rhonchi, rales left lower lobe, no wheezes abd: soft, non tender, non distended, +bowel sounds skin: no bruising, jaundice. some irritation ext:multiple soft tissue swelling (present since childhood) right upper extremity, neuro: aox3, normal sensation to light touch in the upper and lower extremity, 5/5 strength deltoids, biceps, interosseous, illiopsoas, quadriceps. reflexes 2+ biceps, paltellar. down going toes. cerebellar: normal tandem gait, rapid alt movements, heel to shin cranial nerves: i: not tested ii: visual acuity diminished on right- able to make out two fingers within one foot in front of face and able to see movements. left eye with 20/30 vision based on eye chart. perrl 3 to 2 mm bilaterally. visual fields are full to confrontation. iii, iv, vi: eomi bilaterally v, vii: facial strength/sensation intact and symmetric. viii: hearing intact. ix, x: palate elevation symmetric : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. pertinent results: labs on admission: 12:45pm blood wbc-13.4* rbc-4.73 hgb-15.4 hct-41.4 mcv-88 mch-32.7* mchc-37.3* rdw-14.7 plt ct-272 12:45pm blood neuts-61.0 lymphs-32.9 monos-4.4 eos-0.8 baso-0.8 12:45pm blood pt-13.1 ptt-21.0* inr(pt)-1.1 12:45pm blood glucose-105 urean-15 creat-0.8 na-135 k-4.4 cl-101 hco3-25 angap-13 03:54am blood albumin-3.9 calcium-8.9 phos-2.9 mg-1.8 03:54am blood phenyto-10.7 . labs on transfer to heme/onc service: 03:39am blood wbc-11.2* rbc-4.23* hgb-13.9* hct-38.0* mcv-90 mch-32.9* mchc-36.6* rdw-13.6 plt ct-263 03:39am blood pt-13.4 ptt-19.5* inr(pt)-1.1 03:39am blood glucose-140* urean-13 creat-0.8 na-139 k-4.3 cl-105 hco3-26 angap-12 03:39am blood calcium-9.3 phos-2.5* mg-1.9 03:39am blood phenyto-12.5 . pertinent imaging: mri head : apprx 6.7cmx6.8cm right frontal lobe mass, with surrounding mass effect. approximatley 8mm of leftward subfalcine herniation. . post-biopsy ct of head : expected postsurgical changes s/p stereotactic biopsy . bone marrow cytogenetics: report pending . bone marrow biopsy: specimen: bone marrow aspirate and core biopsy: diagnosis: mildly hypercellular marrow with maturing trilineage hematopoiesis and persistent involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma. note: the extent of infiltration by chronic lymphocytic leukemia appears decreased in comparison with the most recent biopsy. concurrent flow cytometry demonstrates a population of lymphocytes with an immunophenotype consistent with chronic lymphocytic leukemia. . labs on discharge: wbc-12.1* rbc-4.11* hgb-13.3* hct-36.5* mcv-89 mch-32.3* mchc-36.5* rdw-12.8 plt ct-230 glucose-129* urean-19 creat-1.0 na-140 k-3.8 cl-103 hco3-27 angap-14 alt-68* ast-37 ld(ldh)-199 alkphos-92 totbili-0.6 calcium-8.7 phos-3.4 mg-2.1 mthotrx-0.03 brief hospital course: neurosurgery: the patient was admitted to the icu for q1 hour neuro checks on . he was found to have a very large right frontal mass and due to his history of lymphoma he was not placed on steroids. this was to ensure that we would have an accurate biopsy. the patient was taken off his aspirin and plavix in anticipation of surgery and was given a 6-pack of platelets prior to going to the or. he had a right steriotactic brain biopsy on . the preliminary pathology was consistent with lymphoma and he was started on dexamethasone intra-operatively. the procedure went well with no complications. the post-op head ct showed no hemorrhage. the patient was kept in the icu overnight for q 1 hour neuro checks. his exam remained unchanged. he continued to have very poor vision in the right eye but otherwise he was neurologically intact. the patient was changed to q4 hour neuro checks on . since the patient was neurologically stable and there was no further neurosurgery that could be offered the patient was transferred to the on the oncology service for urgent treatment for brain lymphoma. transfer - medicine : pt is a 61 yo male with hx of large b cell lymphoma of the testis and cll/sll by bm biopsy who presents with decreased visual acuity and difficulty with balance since of this year. mri with 7x7cm mass in right frontal lobe s/p stereotatic brain biopsy. preliminary pathology -lymphoma. . #right frontal lobe brain mass/lymphoma: on transfer to medicine patient was continued on dexamethasone 4mg q6hrs, dilantin 100mg tid, and q4hour neurologic exams. on transfer the patient's only neurologic deficit was decreased visual acuity in the right eye. patient underwent bm biopsy and ct torso to stage disease. pt then started on iv hd methotrexate. patient tolerated the methotrexate well. during this time the patient's asa/plavix was held. patient's neurologic exam throughout hospitalization remained unchanged - with the only deficit being decreased visual acuity in the right eye. the patient was re-started on asa (but at lower dose of 81mg daily instead of 325mg daily) but the plavix continued to be held (given concern for decreasing platelets in the setting of mtx therapy), as per the neurosurgical note and email discussion with the patient's primary cardiologist at . once the mtx level had decreased substantially in the patient, he was discharged, with close oncologic follow-up. patient was switched from dilantin to keppra (keppra to be titrated up over 2 week intervals) d/t dilantin's interaction with mtx. patient tolerated keppra well. patient had hiccups, treated with thorazine. due to concern with patient's balance, pt walked patient and felt that he could be discharged home safely without rehab. pt with neurosurgery appointment as outpatient for suture removal. . #cad: initially asa/plavix held. patient continued on lisinopril & metoprolol. patient had no chest pain while hospitalized. asa restarted, plavix continued to be held, as per above. . #htn: patient continued on lisinopril 20 mg daily. hydralazine was provided to maintain sbp<150 post operatively. hydralazine was stopped on post operative day 3. blood pressure was well controlled during hospitalization with metoprolol and lisinopril. . #hyperlipidemia: patient continued on atorvastatin. medications on admission: atorvastatin 80 mg tablet 1 tablet(s) by mouth once a day clopidogrel 75 mg tablet 1 tablet(s) by mouth once a day lisinopril 20 mg tablet 1 tablet(s) by mouth once a day metoprolol succinate nitroglycerin 0.3 mg tablet, sublingual 1 tablet(s) sublingual every 5 minutes as needed for chest pain aspirin 325 mg tablet 1 tablet(s) by mouth once a day discharge medications: 1. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 2. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 3. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 4. dexamethasone 4 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*14 tablet(s)* refills:*1* 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. disp:*20 capsule(s)* refills:*1* 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. disp:*20 tablet(s)* refills:*1* 7. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*28 tablet(s)* refills:*1* 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*1* 9. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day) for 10 days. disp:*20 tablet(s)* refills:*0* 10. levetiracetam 1,000 mg tablet sig: one (1) tablet po twice a day for 14 days: after completing the 10 days of the 500mg twice a day dose of this medication, start with this prescription for 1000mg twice a day dose. disp:*28 tablet(s)* refills:*0* 11. levetiracetam 500 mg tablet sig: three (3) tablet po twice a day: after 500mg twice a day for 10 days, and then 1000mg twice a day for 14 days, then start this dose of 1500mg twice a day and continue to take this. disp:*84 tablet(s)* refills:*1* 12. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily) as needed for htn. 13. leucovorin calcium 5 mg tablet sig: eight (8) tablet po every six (6) hours for 3 days: please discuss with dr. on friday () at your appointment with him, whether to continue this medication, based upon your methotrexate level at that appointment. disp:*96 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: right frontal lobe brain mass b-cell lymphoma cll hypertension coronary artery disease discharge condition: neurologically stable. afebrile. ambulating. discharge instructions: changes to your medications include: -keppra (levetiracetam) (to prevent seizures); dose to be increased as follows: 500mg twice a day for 10 days, then 1000mg twice a day for the following 14 days, then 1500mg twice a day after that. -leucovorin (to prevent toxicity from the chemotherapy); to take at least until you see dr. on friday , and then based upon your methotrexate level you should discuss with him whether to continue this medication. -do not take your plavix for now (the chemotherapy can affect your platelet number and so taking plavix could put you at an increased risk of bleeding); after the chemotherapy, consideration could be given to restarting plavix - that should be discussed with your oncologist and your cardiologist -dexamethasone (steroid) (to be discussed with dr. how to taper this dose down, do not stop it suddenly without a taper as instructed by dr. -famotidine (to protect your stomach while taking the steroid) -colace, senna (to prevent constipation, take them if needed) -aspirin dose decreased from 325mg daily to 81mg daily . you have sutures in your scalp from a biopsy done by neurosurgery. you have an appointment tomorrow to have the sutures removed. until then, please keep your incision clean and dry.do not apply any lotions, ointments, shampoo or other products to your incision. do not drive until after you have been seen at the appointment. do not lift objects over 10 pounds until approved by your physician. directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc, as this can increase your chances of bleeding. . after the biopsy: the first few weeks after you are discharged you may feel tired or fatigued. this is normal. you should become a little stronger every day. activity is the most important measure you can take to prevent complications and to begin to feel like yourself again. in general: ?????? follow the activity instructions given to you by your doctor and therapist. ?????? increase your activity slowly; do not do too much because you are feeling good. ?????? you may resume sexual activity as your tolerance allows. ?????? if you feel lightheaded or fatigued after increasing activity, rest, decrease the amount of activity that you do, and begin building your tolerance to activity more slowly. ?????? do not drive until you speak with your physician. ?????? do not lift objects over 10 pounds until approved by your physician. ?????? avoid any activity that causes you to hold your breath and push, for example weight lifting, lifting or moving heavy objects, or straining at stool. . when to call your surgeon: with any surgery there are risks of complications. although your surgery is over, there is the possibility of some of these complications developing. these complications include: infection, blood clots, or neurological changes. call your physician immediately if you experience: ?????? confusion, fainting, blacking out, extreme fatigue, memory loss, or difficulty speaking. ?????? double, or blurred vision. loss of vision, either partial or total. ?????? hallucinations ?????? numbness, tingling, or weakness in your extremities or face. ?????? stiff neck, and/or a fever of 101.5f or more. ?????? severe sensitivity to light. (photophobia) ?????? severe headache or change in headache. ?????? seizure ?????? problems controlling your bowels or bladder. ?????? productive cough with yellow or green sputum. ?????? swelling, redness, or tenderness in your calf or thigh. . call 911 or go to the nearest emergency room if you experience: ?????? sudden difficulty in breathing. ?????? new onset of seizure or change in seizure, or seizure from which you wake up confused. ?????? a seizure that lasts more than 5 minutes. . important instructions regarding emergencies and after-hour calls ?????? if you have what you feel is a true emergency at any time, please present immediately to your local emergency room, where a doctor there will evaluate you and contact us if needed. due to the complexity of neurosurgical procedures and treatment of neurosurgical problems, effective advice regarding emergency situations cannot be given over the telephone. ?????? should you have a situation which is not life-threatening, but you feel needs addressing before normal office hours or on the weekend, please present to the local emergency room, where the physician there will evaluate you and contact us if needed. . please avoid vitamin c (ascorbic acid) in your diet, as this interacts with the chemotherapy you took. . if you developed fever, chills, chest pain, difficulty breathing, abdominal pain, change in vision, change in balance, confusion, or other symptoms that concern you, please call your doctor or return to the hospital. . your oncologist is dr. and his clinic's phone # is or . followup instructions: ??????you have an appointment for suture removal tomorrow on in dr. office which is located in the , . please call if you need to change this appointment. . you have an appointment with your oncologist, dr. , md: friday at 9am. or . he will check your methotrexate level, your blood counts, your platelets (especially given that you are taking aspirin), and your liver function tests during this appointment. he should also consider how to taper down the steroids that you are on. . the radiation oncologists (dr. and her team) will call you to set-up an appointment for friday, . their contact info is: . . you are scheduled to come into the hospital on friday , to building, , for another round of methotrexate chemotherapy treatment, with dr. , md. . . you have a brain clinic follow-up appointment with dr. , md phone: date/time: 9:30 am. this is on 8 on the . procedure: biopsy of bone marrow closed [percutaneous] [needle] biopsy of brain injection or infusion of cancer chemotherapeutic substance diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension compression of brain other and unspecified hyperlipidemia other malignant lymphomas, unspecified site, extranodal and solid organ sites old myocardial infarction postinflammatory pulmonary fibrosis other emphysema chronic lymphoid leukemia, without mention of having achieved remission 

Answer: The patient is high likely exposed to