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: prinivil / keflex attending: chief complaint: elective admission for plasmaphoresis major surgical or invasive procedure: ivc filter placement () history of present illness: ms. is a lovely 84 y/o right handed woman with a pmh significant for htn, hld, atrial fibrillation (s/p cardioversion, currently on coumadin) and a diagnosis of cidp that has recently come into question and is now believed to be multifocal motor neuropathy with conduction block by her outpatient neuromuscular attending (dr. , who presents to today for a direct admission for plasmapheresis for mmncb. as a result of her neuromuscular conditon, she is currently paraplegic with no movement of her lower extremities and minimal movement of her upper extremities. she says that she "can't move, can't sit and can't turn over by herself." her symptoms began with a fall in . prior to that, she was able to live independently and conduct all of her own adls; however, she had noted some difficulty with walking and especially climbing stairs or getting up from a seated position in the previous few years prior to her first fall. the first time she fell was in the snow outside; however, her subsequent falls occurred because of loss of balance; she says her legs would give out on her and then she would fall backwards. she had 11 falls between and . in , she was able to still get around the house with a wheelchair and a walker. however, since her last fall in , she has been in a rehab facility with her lower extremity weakness. she was admitted to the neurology service in as a direct admission from clinic as she was noted to be paraplegic; she have no movement in her le at that time, though had perserved sensory findings and le reflexes. during that admission, she had an lp that showed 1 wbc, 2 rbc, protein 30, glucose 73 as well as an emg/ncs which showed conduction block and was considered to be consistent with cidp. she was then started on a 5 day course of ivig (2g/kg total dose) and discharged back to rehab. while at rehab, she remained wheelchair bound, but there was actually some improvement noted after the ivig as she and her son noted that by the middle of , she was able to stand with assistance and using the parallel bars. during this time, her upper extremity strength was mostly preserved, though she did note some left greater than right upper extremity weakness. she says that she has never noted any twitching of her muscles. in the middle of she developed a left thigh hematoma (after a fall while on coumadin) and has not been able to return to that level of lower extremity progress since. subsequent to the hematoma, she underwent what her son called aggressive ivig infusions- he had one week of ivig infusions (2 g/kg divided over 5 sessions) a month for 3 months (, and ). there was no improvement with these ivig treatments. she had a repeat emg after the last series of ivig treatments; this showed a severe chronic motor greater than sensory axonal polyneuropathy with ongoing axonal loss. the conduction block was no longer noted; sensory responses improved compared to the earlier emg but motor amplitudes decreased. this did not confirm or rule out cidp; however, it was thought that with the progressive weakness, preserved reflexes and sensation on exam (and improved sensory nerve conduction studies) and the conduction block that was no longer noted compared to previous emg (possible improvement with ivig treatment) that this may be mmncb. she was subsequently started on prednisone 60 mg daily with no improvements noted. plasampheresis had been planned for later in ; however, she said that she has been continuing to get worse-- her left arm, which has consistently been weaker than her right, has gotten much worse (she can no longer move proximal left arm against gravity and also has been having difficulty moving/using her left hand i.e. cutting food) and her right arm has been getting weaker as well. due to this weakness, her planned admission for plasmapheresis was expedited. past medical history: -cidp, on monthly ivig, received 30g infusion and -htn -hld -afib on coumadin, s/p tee/cardioversion . coumadin discontinued after admission in with left thigh hematoma -left carotid plaque (unknown severity) -aortic stenosis -remote history of dvt -asthma, ? copd -arthritis -sciatica -esophagitis -tinnitus social history: -retired funds manager of health/welfare for teamsters , lives with husband and son in . no history of tobacco, etoh, or drugs. family history: -mother with mi at 63. sister and son with dm2. physical exam: on admission: mental status: awake, alert, orientedx3. attentive- able to backwards rapidly. able to perform simple calculation and follow midline and axial commands. registration and recall at 5 minutes. no evidence apraxia or neglect. language: clear, fluent, nondysarthric. no paraphasic errors. intact naming/repetition/comprehension. cranial nerves: cn ii-xii intact. perrl 3-->2 ml. vff. eomi without nystagmus. facial sensation intact. face symmetric. palate elevates symmetrically. tongue protrudes in midline. motor: decreased muscle bulk le b/l. no tremor. unable to assess drift secondary to weakness. occasional ue fasiculations. delt bic tri wre ffl fe io ip quad ham ta edb l 2 4- 4- 4- 4- 4- 4- 0 0 0 0 0 0 0 r 2 4 4 4 4 4 4 0 0 0 0 0 0 0 she has hx of a right foot drop. dtrs: tri pat ach l 2 2 2 1 0 r 2 2 2 1 0 unable to assess plantar response (toes mute and atrophied tensor fascia ) sensory: intact light touch. intact proprioception in great toe b/l but not fifth toe b/l. decreased vibration ue b/l and no vibratory sense at feet and knees. diminished pin prick sensation proximally in b/l ue and distally in b/l le. no extinuishing to dss. coordination: unable to assess secondary to weakness. gait/romberg: deferred as she is paraplegic . on discharge vs: afebrile, 97.6, 150/60 (147-176/60-80), p69, rr18 sa0298% ra general: overweight elderly female laying supine in nad heent: tube in place perrl, no pharyngeal erythema, mucous membranes moist chest: cta anteriorly no wheezes, no crackles, no rhonchi cv: holosystolic blowing murmur at llsb no gallops abd: non-distended, bs normoactive, soft, non-tender ext: ecchmosis overlying right postrior forarm, left anticubital fossa, right gleutual ecchymosis extending ~20x30cm. warm, well perfused, + scds & multipodus boots neuro: aaox3 cranial nerves: cnii-cnxii intact bl, motor 0/5 bl in lower extremities, triceps bl, left biceps in upper extremities with l>r weakness. pertinent results: 12:45pm blood wbc-9.5# rbc-4.27 hgb-14.0 hct-42.5 mcv-99* mch-32.7* mchc-32.9 rdw-14.4 plt ct-162 05:50am blood wbc-7.9 rbc-3.83* hgb-12.7 hct-37.2 mcv-97 mch-33.2* mchc-34.2 rdw-14.4 plt ct-152 05:25am blood wbc-7.2 rbc-3.29* hgb-11.1* hct-32.8* mcv-100* mch-33.7* mchc-33.8 rdw-14.5 plt ct-160 05:20pm blood wbc-11.5*# rbc-2.63* hgb-8.6* hct-26.0* mcv-99* mch-32.8* mchc-33.3 rdw-13.8 plt ct-183 02:04am blood wbc-12.1* rbc-3.56*# hgb-11.3*# hct-31.8* mcv-89# mch-31.7 mchc-35.5* rdw-16.4* plt ct-112* 03:15am blood wbc-9.2 rbc-2.85* hgb-9.1* hct-25.4* mcv-89 mch-32.0 mchc-35.9* rdw-16.8* plt ct-103* 05:10am blood wbc-9.3 rbc-2.46* hgb-7.9* hct-22.5* mcv-92 mch-32.3* mchc-35.2* rdw-16.6* plt ct-111* 02:20am blood wbc-8.8 rbc-3.01* hgb-9.7* hct-26.9* mcv-89 mch-32.1* mchc-36.0* rdw-16.9* plt ct-106* 05:08am blood wbc-7.7 rbc-3.08* hgb-9.7* hct-27.8* mcv-90 mch-31.5 mchc-35.0 rdw-16.8* plt ct-117* 05:34am blood wbc-8.0 rbc-3.12* hgb-10.1* hct-28.9* mcv-92 mch-32.4* mchc-35.1* rdw-16.3* plt ct-149* 06:38am blood wbc-7.3 rbc-3.01* hgb-9.6* hct-27.9* mcv-93 mch-32.0 mchc-34.6 rdw-16.5* plt ct-156 05:54am blood wbc-7.4 rbc-3.08* hgb-9.8* hct-28.8* mcv-94 mch-32.0 mchc-34.2 rdw-16.8* plt ct-175 04:32am blood wbc-7.9 rbc-3.15* hgb-10.1* hct-30.0* mcv-95 mch-32.0 mchc-33.6 rdw-16.5* plt ct-194 12:45pm blood pt-24.6* ptt-21.7* inr(pt)-2.4* 03:10pm blood pt-25.5* ptt-21.6* inr(pt)-2.5* 05:50am blood pt-26.5* ptt-150* inr(pt)-2.6* 08:40am blood pt-24.7* ptt-75.6* inr(pt)-2.4* 08:28pm blood pt-20.4* ptt-45.2* inr(pt)-1.9* 04:30am blood pt-19.4* ptt-71.7* inr(pt)-1.8* 06:40pm blood pt-17.3* ptt-59.7* inr(pt)-1.6* 01:47am blood pt-16.8* ptt-71.7* inr(pt)-1.5* 05:25am blood pt-16.1* ptt-74.1* inr(pt)-1.4* 05:20pm blood pt-15.2* ptt-48.0* inr(pt)-1.3* 02:04am blood pt-13.3 ptt-20.8* inr(pt)-1.1 02:04am blood pt-13.3 ptt-20.8* inr(pt)-1.1 03:15am blood pt-11.9 ptt-18.9* inr(pt)-1.0 05:34am blood pt-11.2 ptt-18.9* inr(pt)-0.9 06:38am blood pt-11.0 ptt-19.7* inr(pt)-0.9 05:54am blood pt-10.8 ptt-18.7* inr(pt)-0.9 04:32am blood pt-10.9 ptt-18.3* inr(pt)-0.9 05:20pm blood ck(cpk)-15* 02:04am blood ck(cpk)-46 05:20pm blood ck-mb-3 ctropnt-0.02* 02:04am blood ck-mb-4 ctropnt-0.01 03:15am blood tsh-0.51 06:58pm blood type-art po2-30* pco2-48* ph-7.36 caltco2-28 base xs-0 . ............imaging.......................... echo : the left atrium is elongated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no left ventricular outflow obstruction at rest or with valsalva. a mid-cavitary gradient is identified. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). there is mild aortic valve stenosis (valve area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. trivial mitral regurgitation is seen. there is no pericardial effusion. . history: known spontaneous right gluteal/posterior thigh hematoma. evaluate for findings of active extravasation. . comparison is made to ct examination from one day prior. . technique: mdct-acquired axial images were initially obtained through the pelvis and lower extremities through the knees without contrast. post-contrast sequences were then attempted; however, there was extravasation of contrast through to patient's indwelling iv with instillation of approximately 100 cc of optiray contrast. repeat scout tomogram was obtained demonstrating contrast within the subcutaneous tissues extending from the antecubital fossa superiorly to the mid humerus. the patient was examined by dr. from radiology and no significant paresthesias or loss of pulses was identified. dr. was notified immediately after the exam was completed via telephone and a plastic surgery consult was recommended given the volume of contrast extravasated. . ct of the pelvis/lower extremities without contrast: there has been continued interval evolution of the known hematoma in the right gluteal region with decreased size to the collection and increased density. for example, where the collection previously spanned 6.4 cm and currently spans only 4.3 cm (4:27). no new sites of hemorrhage are identified and there are no internal low-attenuation regions within the collection to suggest ongoing active hemorrhage, although evaluation is suboptimal without intravenous contrast administration. no other new findings are noted from the exam completed one day prior, other than some mild degenerative changes also present within the knees and there is suggestion of an old fracture with slight stepoff and sclerotic fracture line involving the medial distal left femoral condyle, which appears little changed from the prior radiograph. moderate osteoarthritic changes are noted bilaterally, slightly greater on the left including osteoarthritic changes involving the hips bilaterally as well. . impression: . 1. interval organization and decreased size to right gluteal/posterior thigh subcutaneous hematoma. no findings of increased size to the collection are noted to suggest continued bleeding. 2. degenerative changes involving both hips and knees with suggestion of an old fracture involving the medial left femoral condyle. brief hospital course: ms. is an 84 y/o woman who presented as a direct admission for plasmapheresis for what is believed to be multifocal motor neuropathy with conduction block and developed hypotension and was admitted to the intensive care unit. # glueteal hematoma: on admission, coumadin for a-fib, which was held, and heparin drip started while inr normalized. on , inr had trended from 2.4 t to 1.4 and she had a plasmaphresis line placed by interventional radiology, that day, she went for plasmaphoresis and became unresponsive, and hypotensive. ct scan showed large gluteal hematoma and she was admitted to the icu. on icu day 1 she was transfused 4 units prbc and had 2 more units over the course of her stay. throughout stay in the icu, nif was measured at 28-30, vc 0.55-0.66l, she did not require ventilatory support. she failed speech and swallow and was placed and tube feeds initiated. given history of dvt, and immobility secondary to paralysis and inability to resume anticoagulation in the face of recent bleed, an ivc filter was placed. her hematocrit remained stable throughout the remainder of her hospitalization and she did not require further transfusion. . # multifocal motor neuropathy: patient has a history of an incompletely described progressive motor weakness involving her extremities. on admission, she had lower extremity paralysis and partial bilateral upper extremity paralysis, retaining 3/5 l>r motor strength in the biceps. as an outpatient, she had been on prednisone 40mg x 3 weeks. she was admitted for plasmaphoresis which was not initiated due to hypotension and gluteal bleed. given her long term steroid use, she was started on bactrim ds for pcp . in her hospital course she noted worsening upper extremity weakenss. it was determined that the disease was progressing despite prednisone therapy and a taper was initiated which will be complete three weeks after discharge. she is being discharged to rehabilitation with follow up with dr. who will initiate therapy with rituxan. . # hx of dvt: patient was admitted on on coumadin and transitioned to heparin drip which was held in the setting of her hematocrit drop and gluteal bleed. an ivc filter was placed and anticoagulation was not resumed due to bleeding risk. . # afib: throughout admission, home regimen of amiodarone and metoprolol was continued and she remained rate controled and in sinus rhythm. coumadin was discontinued due to bleeding risk, and was not restarted given history of bleeds and sinus rhythm. . medications on admission: amiodarone 200 mg daily amlodipine 5 mg daily metoprolol 12.5 mg colace 100 mg senna one tab prednisone 60 mg daily vit d 50,000 units weekly x 4 weeks (this is week 1) ranitidine 150 mg hctz 25 mg daily miralax 17 gm daily rosuvastatin 5 mg daily coumadin 4.5 mg daily tylenol 500 mg tid lidocaine patch 5% one patch topically as needed for back pain ultram 500 mg q4h prn pain ipratropium nebs q6h prn sob celexa 20 mg daily calcium 600 with vitamin d discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily at 9pm (). 2. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 4. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 6. prednisone 10 mg tablet sig: five (5) tablet po daily (daily): take three tablets daily then change to 2 tabs daily on ; then change to 1 tab daily on ; then change to 0.5 tabs daily , then discontinue . 7. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po 1x/week (fr) for 3 weeks. 8. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 9. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 10. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) g po daily (daily). 11. rosuvastatin 5 mg tablet sig: one (1) tablet po once a day. 12. acetaminophen 500 mg tablet sig: one (1) tablet po tid (3 times a day): do not exceed 4000mg acetaminophen in one day. 13. lidoderm 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) topical once a day: apply to affected area on back. 14. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath. 15. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 16. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po 3x/week (mo,we,sa) for 3 weeks. 17. insulin lispro 100 unit/ml solution sig: one (1) unit subcutaneous asdir (as directed): 71-100 mg/dl =0 units. 101-150mg/dl = 2 units. 151-200mg/dl = 4 units. 201-250mg/dl = 6units. 251-300 mg/dl = 8units. 301-350mg/dl = 10 units. 351-400 mg/dl = 12 units. >400 mg/dl notify m.d. . 18. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection prn (as needed) as needed for catheter maintenance: 1000 unit dwell prn catheter maintenance 1000 units /1cc . 19. calcium 600 + d(3) 600-400 mg-unit tablet sig: one (1) tablet po twice a day. 20. miconazole nitrate 2 % powder sig: one (1) application topical twice a day: apply to affected area in skin folds. discharge disposition: extended care facility: - discharge diagnosis: primary - cidp vs seconadry - gluteal hematoma - paroxysmal a-fib - hyperlipidimia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: ms. were admitted for plasmapharesis. you have a progressive neuromuscular disease that is causeing your weakness. we believed that plasmapharesis may help with this. during the course of organizing this you developed a gluteal hematoma that required acutly a transfusion of 4 units of packed red blood cells. you were monitored in the icu for this. we disconitinued your warfarin because you have had multiple bleeding events and have not been in atrial fibrillation. because of your risk for developing clots and your bleeding issues you had an ivc filter placed to prevent pulmonary embolisim. after leaving the intensive care unit, your blood level remained stable and you did not show any other signs of bleeding. - dr. that you follow up with him to initiate therapy with rituxan after discharge. he will contact you to set up the appointment. - we made the following changes to your medications - stop warfarin - continue prednisone tapering as directed - continue bactrim for 3 three weeks after discharge followup instructions: dr. will contact you at rehabilitation to schedule an appointment for rituxan treatment procedure: interruption of the vena cava enteral infusion of concentrated nutritional substances central venous catheter placement with guidance diagnoses: other iatrogenic hypotension unspecified essential hypertension long-term (current) use of steroids atrial fibrillation long-term (current) use of anticoagulants personal history of venous thrombosis and embolism nontraumatic hematoma of soft tissue quadriplegia, unspecified history of fall other inflammatory and toxic neuropathy 

Answer: The patient is high likely exposed to