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: aspirin / optiray 300 / iv dye, iodine containing attending: chief complaint: fatigue, dizziness major surgical or invasive procedure: bone marrow biopsy placement of picc line history of present illness: 64 year-old male with hx of post-polio syndrome and gout who presents with fatigue and dizziness. these symptoms have been worsening x 5-6 weeks. he developed sob with exertion over the past week though no chest pain or palpitations. notably, he has had a few episodes of spontaneous bleeding including a nosebleed and two episodes of bright red blood per rectum. he reports subjective fevers, though no sweats or chills. he did have an episode of nausea and emesis on morning of admission. he also reports that he this morning he had a right sided frontal headache and noticed some blurry vision that has resolved. he was seen by his pcp day prior to admission who ordered labs. he was referred to the ed for a hematocrit of 10. past medical history: -polio in childhood -post-polio syndrome -gout -hemorrhoids social history: single. sexually active with women. remote history of cocaine and heroin use 30 years prior. history of alcohol abuse 30 years ago. has friends from church. family history: no history of malignancy. physical exam: on admission: t: 98.1 hr: 74 bp: 121/56 rr: 16 sp02: 100% ra. general: alert, oriented, no acute distress heent: sclera pale, anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, mild tenderness in right upper quadrant, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema cn: aox3, cn ii-xii grossly intact, 5/5 strength in all 4 ext skin: petichiae along right medial groin. pertinent results: significant labs: on admission pt wbc 2.0, h/h 3.8/10.8, plts 10 anc 72 fibrinogen normal at 292 pt/ptt/inr were normal, inr 1.1 chems on admission with increased bun at 28, cr 1.1, rest of chems normal alt 14, ast 15, ldh 148, alkp 54, tbili 1.3 ck 80 trop negative x1 urates negative ferritin elevated at 855 (30-400) iron elevated 252 hbsag and igm hbc negative negative psa 0.6 nml spep without any specific abnmls igg 556 iga 110 igm 36 hiv negative ebv with evidence of past infxn hhv6 negative parvovirus positive igg negative igm hbv and hcv vl's negative cmv vl negative the pt's assay for pnh (cd55 and cd 59) showed that he did not have pnh. reports: bm bx flow cytometry diagnosis: flow cytometry report flow cytometry immunophenotyping: the following tests (antibodies) were performed: hla-dr, fmc-7, kappa, lambda and cd antigens: 2,3,4,5,7,8,10,16,19,20,23, 45 and 56. results: three color gating is performed (light scatter vs. cd45) to optimize lymphocyte yield. b cells comprise 2% of lymphoid-gated events, are polyclonal, and do not express aberrant antigens (cd5, cd10). t cells comprise 85% of lymphoid gated events, express mature lineage antigens, and have a normal helper-cytotoxic ratio of 1.6 (usual range in blood 0.7 - 3.0). natural killer cells are quantitatively normal (13%). interpretation: non-specific t cell dominant lymphoid profile; diagnostic immunophenotypic features of involvement by leukemia/lymphoma are not seen in specimen. correlation with clinical findings and morphology (see s09-) is recommended. flow cytometry immunophenotyping may not detect all lymphomas due to topography, sampling or artifacts of sample preparation. ekg sinus rhythm. non-specific inferolateral st-t wave flattening. compared to the previous tracing of no diagnostic interim change. ct head without contrast non-contrast head ct: there are foci of curvilinear high-density along the sulci along the left superior convexity (2:25, 26), right posterior temporal/parietal region (2:20, 21), and the right occipital lobe (2:70). these findings are concerning for subarachnoid hemorrhage. no intraventricular extension nor hydrocephalus is demonstrated. no evidence for large vascular territory infarction is seen. curvilinear ill-defined high density, which appears extra-axial along the sylvian fissure is along the expected course of the left mca and could represent vascular calcification; thrombosis is not completely excluded (measures 47 in density) (2:). no shift of normally midline structures or effacement of the basal cisterns is seen. coarse calcification is noted within the right parietal scalp. the orbits appear unremarkable and the skull intact. the visualized paranasal sinuses and mastoid air cells are well aerated. vascular calcifications are noted along the carotid siphons. impression: 1. left frontal, right parietal, and right occipital foci of high density along sulci concerning for acute subarachnoid hemorrhage. 2. high-density seen along the expected course of the left mca is of uncertain etiology. thrombosis and early caclifications are considerations, the former being a greater possibility. consider cta or mra for assessment of vascular patency. cxr there is mild cardiomegaly. the lungs are grossly clear. there is no pneumothorax or pleural effusion. impression: no evidence of pneumonia. ct head non-contrast head ct: foci of subarachnoid hemorrhage are less conspicuous, with only tiny residual apparent high density in the right occipital (2:22) and right posterior temporal/parietal (2:20) regions. high density along the left sylvian fissure is also less apparent, consistent also with evolving subarachnoid hemorrhage. no new focus of intracranial hemorrhage, nor interval development of intraventricular hemorrhage, hydrocephalus, edema, mass effect, or large vascular territory infarction is seen. the soft tissues, orbits, and skull appear intact. minimal mucosal thickening is noted in the maxillary sinuses. the mastoid air cells are well aerated. vascular calcifications are noted along the carotid siphons. impression: 1. decreasing conspicuity of small foci of subarachnoid hemorrhage compared to one day prior. no interval intraventricular extension, hydrocephalus, or new intracranial hemorrhage. 2. decreased conspicuity of high density described along the sylvian fissure one day prior is consistent with also evolving subarachnoid hemorrhage. bm core bx diagnosis: specimen: bone marrow aspirate and core biopsy: diagnosis: markedly hypocellular bone marrow, see note. microscopic description peripheral blood smear: the smear is adequate for evaluation. erythrocytes are decreased, and are normochromic and normocytic with mild anisopoikilocytosis (oval macrocytes, pencil cells, and rare target cells are noted). the white blood cell count appears markedly decreased. smudge cells are noted. neutrophils with toxic granules are noted. platelet count appears markedly decreased. large forms are not seen. giant forms are not present. differential count shows 6% neutrophils, 1% bands, 1% monocytes, 88% lymphocytes, 2% eosinophils. aspirate smear: the aspirate material is inadequate for evaluation due to only rare hypocellular spicules being identified and extensive hemodilution. the m:e ratio is 4.5:1 (due to limited count and hemodilution). erythroid precursors are markedly decreased. myeloid precursors appear markedly decreased and show full spectrum of maturation. megakaryocytes are absent. a limited differential count (100 cells) was performed and shows: 0% blasts, 1% promyelocytes, 1% myelocytes, 1% metamyelocytes, 6% bands/neutrophils, 7% plasma cells, 82% lymphocytes, 2% erythroid. numerous stripped cells without discernable morphology are present. degranulated mast cells are noted. clot section and biopsy slides: the biopsy material is adequate for evaluation, and focally interrupted by areas of hemorrhage. overall cellularity is 5-8%. histiocytes, plasma cells, and stromal cells comprise the major composition of marrow cellularity. focal serous atrophy noted. focal hemosiderin laden macrophages seen. the m:e ratio estimate is decreased. a single erythroid colony is noted, but otherwise erythroid and myeloid precursors are markedly decreased in number. megakaryocytes are absent. a few small non-paratrabecular lymphoid infiltrates comprised of small lymphocytes are present and account for ~5% of the marrow cellularity. clinical: myelodysplastic syndrome (mds), anemia, leukopenia, thrombocytopenia. peripheral blood diagnosis: flow cytometry report flow cytometry immunophenotyping the following tests (antibodies) were performed: cd antigens 55, 59. results: two color gating is used to identify population(s) of interest by light scatter. interpretation note: the patient is severely granulocytopenic and is transfused heavily. a repeat study is recommended. red blood cells and granulocytes were examined for phosphatidylinositol linked antigens. rbcs and granulocytes (decreased events) express expected levels of daf (cd55) and mirl (cd59). these findings do not support a diagnosis of paroxysmal nocturnal hemoglobinuria (pnh). reference: and , blood 87(12):5332-5340, . head ct findings: there is no new acute intracranial hemorrhage. previously noted subarachnoid hemorrhage is no longer dense. the -white matter differentiation is preserved. there is no mass effect or edema in the brain. the ventricles are normal in size. a coarse calcification is again seen within the right parietal scalp. the bones, mastoid air cells and visualized paranasal sinuses are unremarkable. impression: no new intracranial hemorrhage and no evidence of other new intracranial abnormalities. previously noted subarachnoid hemorrhage is no longer dense. ct chest/abdomen/pelvis findings: chest ct: no lymphadenopathy is seen in the mediastinal, hilar, or axillary areas. central line is seen with its tip at the superior vena cava. a small elongated pulmonary node is seen in the right lower lobe (series 2, image 44). small hiatal hernia is noted. minimal irregularities of posterior pleural surfaces are seen bilaterally. no pleural or pericardial effusion is seen. heart is within normal limits. linear atelectasis in the lingula. abdominal ct: liver is of normal size and attenuation with 1.2-cm hypodense lesion at segment - hemangioma? gallbladder is within normal limits. no intrahepatic or extrahepatic bile dilatation is seen. adrenals, kidneys, spleen, and pancreas are unremarkable. no mesenteric or retroperitoneal lymphadenopathy is seen. pelvic ct: prostate is enlarged with coarse calcifications. bilateral inguinal hernias with fat are seen. impression: 1. no evidence of lymphadenopathy or tumor in the anterior mediastinum. 2. small hypodense lesion in liver. findings: there is no evidence of acute hemorrhage or shift of normally midline structures. the ventricles and sulci are normal in appearance. there is normal -white matter differentiation. the visualized paranasal sinuses are clear. impression: no acute intracranial hemorrhage identified. findings: there is no intra- or extra-axial hemorrhage, masses, mass effect or shift of normally midline structures. the ventricles are mildly prominent and may reflect age-associated involutional changes. there are no acute major vascular territorial infarcts. punctate calcifications are noted in bilateral basal ganglia, stable. the and white matter differentiation is well preserved. there is exuberant calcification involving the anterior portion of the falx cerebri. the osseous and soft tissue structures are unremarkable. impression: no acute intracranial pathological process. : impression: 1. dilated intra- and extra-hepatic bile ducts, distended gallbladder and dilated pancreatic duct with narrowing of the distal cbd and enhancing soft tissue at the ampulla. while a papillitis is possible, the appearances are worrisome for an ampullary or a duodenal lesion. endoscopic assessment is warranted for further evaluation. 2. calculi within the distended gall bladder, but no filling defects in the dilated cbd, to suggest choledocholithiasis. the findings were added to the critical results communication dashboard at the time of dictation. : there is no evidence of acute hemorrhage, edema, mass, mass effect, or infarct. the ventricles are mildly prominent, reflecting normal changes with age, and unchanged in size and appearance compared to prior study on . the sulci are normal in configuration. there are scattered small calcium-dense foci within the basal ganglia, which are stable from prior exam. prominent calcifications along the anterior aspect of the falx cerebri are unchanged since prior exam. there are no acute fractures. included views of the mastoid air cells and paranasal sinuses are clear. : : 14 fluoroscopic spot images were obtained without presence of a radiologist and submitted for review. images demonstrate endoscopic cannulation and opacification of the biliary tree, showing dilatation of cbd. a biliary stent was placed. no filling defects or strictures seen on submitted images. . ecg: sinus bradycardia. . u/s: impression: 1. gallbladder sludge and distention, without other signs to indicate acute cholecystitis. these findings are not diagnostic for acute cholecystitis, if further concern for acute cholecystitis consider hida scan. 2. interval improvement in intrahepatic biliary ductal dilation with moderate residual central intrahepatic and cbd dilation. 3. partly seen choledochoduodenal stent is appropriately positioned within the cbd. the intraduodenal portion is not well seen. . ct abdomen/pelvis: impression: 1. the patient had a reaction to the iv contrast in the form of diffuse hives and probable mild laryngeal edema. please see above note for further details. 2. probable slight increase in the amount of intrahepatic biliary dilatation. otherwise, no significant change since the prior study. 3. stable appearance of borderline size fluid-filled appendix. = details on iv contrast reaction: note on iv contrast reaction: the patient received 130 ml of optiray intravenous contrast. after the second half of the injection was given and after completion of the ct scan, the patient reported feeling warm, specially in his face. i (dr was called to evaluate the patient. the patient's nurse, , was also called as was the heme-onc fellow dr. . the patient developed widespread urticaria involving his entire body with edema of his eyelids and earlobes in addition. the patient was placed on oxygen and was hemodynamically monitored. he remained hemodynamically stable throughout the entire course. the patient also had some mild laryngeal edema, which did not worsen throughout his course. the patient was initially given 50 mg iv of benadryl followed by famotadine iv. the patient also received 125 mg of solu-medrol iv. his blood pressure remained in the 110's/70-90s during the entire time with an oxygen saturation of 99% on 8 liters of oxygen. he was initially tachycardic to the 117 but eventually settled down into the upper 90s. the patient was able to breathe and talk throughout and after discussion with dr. , it was decided that epinephrine would be be given. the patient was transferred to the icu at 6:50 p.m. for continued monitoring. pertinent labs on discharge: wbc 3.2 hb 8.7 hct 26.5 plt 28 differential: 58.5n, 28.5l, 12.0m, 0.5e, 0.2b chem: na 139 k 4.2 cl 104 hco3 28 bun 24 cr 0.8 gluc 120 tbili 1.3 lipase 56 ca 8.7 mg 1.5 phos 4.4 alb 3.2 uricacid 3.8 brief hospital course: this is a 64-year-old gentleman with a history of polio and gout who presents with fatigue and dizziness found to have aplastic anemia. #pancytopenia: patient initially presented with pancytopenia and several episodes of spontaneous bleeding with recorded platelet count at admission of 6. the initial differential dx included marrow replacement by fibrosis or tumor, myelodysplastic syndromes or various viral infections. the patient was admitted and placed on neutropenic precautions. he had been transfused 7 units of prbc's and 3 units of platelets at the time of his transfer from the micu to the floor. viral serologies were also sent. ebv serologies were c/w old infection and hiv was negative. initial chemistries showed no evidence of tumor lysis syndrome. hematology/oncology service was consulted. . on the bmt floor, the patient's bm bx from was considered non-diagnostic, and a repeat bone marrow biopsy was performed the next day which did show a hypocellular marrow consistent with aplastic anemia. allopurinol and indomethicin can cause aplastic anemia and these medicines were discontinued and should not be restarted. the patient's viral studies did not explain the etiology, including hiv, hepb and c, parvovirus, hhv6, cmv, ebv. was negative. assay for pnh was negative. no specific etiology was found. as mentioned above, the had been taking allopurinol for gout, which could be responsible, or this could also be idiopathic. . mr. went on to receive four cycles of atg, with steroids before and after, x4 days. he also started cyclosporine (dose adjusted based upon level). the pt was noted to have a temp of 103.9 at the end of his first dose of atg, treated symptomatically, and did not spike through his next 3 days of treatment. after chemotherapy, mr. was started on a prednisone taper for one month. . mr. was started on levaquin, acyclovir, and fluconazole prophylactically. his antibiotics were later adjusted. . #abdominal pain/dilated biliary ducts: on , mr. developed severe abdominal pain overnight. a ct scan showed dilation of intra/extra biliary ducts. an mrcp was confirmatory. mr. went for an and a stent was placed within cbd. patient was started on vancomycin, cefepime, and flagyl for prophylaxis of intraabdominal infection; all antibiotics were subsequently weaned. . however, despite cbd stenting, mr. continued to have abdominal pain. repeat scans showed persistent biliary dilatation. patient had a ct abdomen/pelvis on and during this had an allergic reaction to iv contrast - see below. the following day, abdominal pain improved, his bilirubin trended down, and so the team opted to consult /gi and observe the patient before jumping to another study that might involve contrast. patient's bilirubin continued to trend down until discharge, and his abdominal pain improved (but did not dissapate). on discharge, patient was comfortable, eating/drinking, ambulating, having regular bowel movements. per team, he will follow-up as an outpatient for an . . #pancreatitis: post-. patient was made npo and started on ivf and pca. his amylase and lipase resolved and abdominal pain returned to baseline. . #headache: patient initially reported left-sided headache with persistent visual changes. he underwent ct head which showed left frontal, right parietal, and right occipital foci of high density along sulci concerning for acute subarachnoid hemorrhage. neurosurgery was consulted and recommended repeat head ct in 24 hours, sbp control to < 140. repeat head ct showed improvement and neurosurgery signed off. the patient had several head cts throughout his admission, which showed improvement in the sah, with the last head ct showing resolution of hemorrhage. patient continued to have persistent headaches thought to be related to cyclosporine. medication was switched to tacrolimus without any improvement. mr. was treated symptomatically with pain medication so that he was able to tolerate the headaches. . #right eye retinal hemorrhage: ophthomology confirmed right eye retinal hemorrhage. recommendations were to keep platelets between 30-40 and assess for acute change in vision. optho revisted patient throughout admission; patient was told that visual impairment would eventually resolve and that he should follow-up with ophthalmology as an outpatient. . #constipation: the patient was noted to be constipated during his admission, an issue exacerbated by a large external hemorrhoid (see below). patient was started on a bowel regimen with good effect. . #large external hemorrhoid: mr. has a known external hemorrhoid and this was very tender and active during this admission. the pt was treated symptomatically with tuck's ointment and then steroid cream. surgery did not recommend intervention at this time. . #hypertension: patient was started on valsartan during admission and achieved appropriate blood pressure control. it was held in the setting of his allergic reaction, but then restarted with good effect. . #gout: no active issues. allopurinol was discontinued as above, due to concern as causative for aplastic anemia. . #allergic reaction to ct contrast dye: the patient developed flushing of head/neck, sob, some throat tighness, hives (he felt tightening in his throat, swelling of his ears, and nursing staff noted a diffuse erythematous rash over his trunk and extremities) after receiving iv contrast during ct a/p on . the patient received 50mg bendaryl, 125 mg of solumderol, 20 mg famotidine and was transferred to icu for monitoring overnight. the patient maintained a patent airway and remained hemodynamically stable throughout. the patient's symptoms resolved prior to transfer to icu. in the icu, he remained free of symptoms concerning for anaphylaxis; he was bolused 2l of ivfs for orthostatic hypotension. he was closely monitored overnight. the dose of benadryl was reduced, and the patient was switched to po prednisone taper. he was called out back to bmt service. allergy was consulted on regarding use of contrast in the future - please see omr note for full details. patient had no further sequelae of allergic reaction following this event. he was breathing comfortably on room air at discharge. medications on admission: allopurinol 150 mg daily colchicine prn gout pain indomethicin prn gout pain discharge medications: 1. cyclosporine modified 100 mg capsule sig: one (1) capsule po every twelve (12) hours. disp:*60 capsule(s)* refills:*2* 2. cyclosporine modified 25 mg capsule sig: three (3) capsule po every twelve (12) hours. disp:*180 capsule(s)* refills:*2* 3. prednisone 5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 4. fluconazole 200 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. lorazepam 0.5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for nausea. disp:*60 tablet(s)* refills:*0* 6. morphine 15 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. disp:*90 tablet(s)* refills:*0* 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day): hold for diarrhea. disp:*60 tablet(s)* refills:*2* 8. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). disp:*120 tablet, chewable(s)* refills:*2* 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day) as needed for constipation. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 10. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for heart burn. 12. docusate sodium 100 mg capsule sig: two (2) capsule po tid (3 times a day). disp:*180 capsule(s)* refills:*2* 13. hydrocortisone 2.5 % cream sig: one (1) appl rectal prn (as needed) as needed for hemorrhoidal pain. 14. lidocaine hcl 5 % ointment sig: one (1) appl topical prn (as needed) as needed for hemorrhoidal pain. 15. acyclovir 400 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 16. lisinopril 10 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnoses: 1. aplastic anemia of unknown etiology 2. subarachnoid hemorrhage 3. retinal hemorrhage 4. large external hemorrhoid 5. anaphylactoid reaction to iv contrast discharge condition: by the time of discharge, the pt had received a 4 day course of atg chemotherapy with dexamethasone before and after, and also cyclosporine and prednisone, his hematocrit and platelet count were stable, was no longer constipated, was taking good po, vital signs were stable, was ambulating, and was medically clear for discharge. discharge instructions: it was a pleasure taking care of you in the hospital, mr . when you go home please throw away your allopurinol and indomethicin as they may have caused the low blood counts that you were admitted to the hospital with. please tell any doctors that you have contact with in the future that one of these medicines may have caused you to have this reaction. you were admitted to with fatigue and increased bleeding, and found to be pancytopenic, meaning all the cells in your blood were low. you were admitted and a bone marrow biopsy showed an empty marrow, meaning that the stem cells for these blood cells were very low. on presentation you also had a subarachnoid hemorrhage (a bleed in your head) and right eye blurriness from a hemorrhage in the back of your eye. these were followed and found to be stable. you were given a 4 day course of chemotherapy called atg, and you also received steroids and an immunosuppressant called cyclosporine. you are being discharged on the steroids and the cyclosporine (take both of these medications twice a day). while in the hospital you had an allergic reaction to the iv contrast that was given to you during a ct scan; you were treated with medications to counteract this allergic reaction, and you were monitored in the icu overnight. the allergic reaction subsided. while in the hosptital you had abdominal pain, this was treated with pain medicine and it decreased in discomfort. you will follow-up with a gastroenterologist as an outpatient regarding this pain and regarding the stent in your bile tract. after discharge please do not take any more of the allopurinal or indomethacin. you were given pentamidine on . you will get your neupogen at outpatient appointments you have an appointment here in 7 on sunday at 9:30a. you will need to come to have your cyclosporine level checked at this appointment. therefore, do not take your cyclosporine that morning. you will have your blood counts drawn and may be given neupogen. your valsartan was stopped and you were started on lisinopril please return to the hospital if you experience fevers, chills, night sweats, bleeding problems, worsening abdominal pain, severe fatigue, changes in your vision, changes in the character of your headaches, or any other concerns. followup instructions: 7 on sunday . at 9:30am provider: 2-hem onc 7f hematology/oncology-7f date/time: 11:30 provider: 2 (st-4) gi rooms date/time: 8:00 provider: , md phone: date/time: 8:00 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances biopsy of bone marrow biopsy of bone marrow endoscopic insertion of stent (tube) into bile duct injection or infusion of cancer chemotherapeutic substance diagnoses: unspecified essential hypertension long-term (current) use of steroids gout, unspecified subarachnoid hemorrhage other complications due to other vascular device, implant, and graft other constipation external hemorrhoids with other complication obstruction of bile duct acute pancreatitis retinal hemorrhage late effects of acute poliomyelitis other drugs and medicinal substances causing adverse effects in therapeutic use allergic urticaria dermatophytosis of foot uric acid metabolism drugs causing adverse effects in therapeutic use antirheumatics [antiphlogistics] causing adverse effects in therapeutic use antimycobacterial antibiotics causing adverse effects in therapeutic use other specified aplastic anemias drug induced headache, not elsewhere classified 

Answer: The patient is high likely exposed to