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: ativan attending: chief complaint: hypoxia, hypotension major surgical or invasive procedure: vats bronchoscopy 3 lps bone marrow biopsy history of present illness: mr. is a 60 year old male with a history of diffuse large b-cell lymphoma diagnosed on on day 15 of cycle of mr-chop. he was recently admitted between and for febrile neutropenia. during that admission he underwent chest ct which showed a left lung nodular interstial pattern predominantly in the left upper lobe and persistent, but improved opacity of the right lung compared to . he underwent bronchoscopy on which demonstrated normal appearing airways and cultures including afb, fungal and viral cultures have been negative to date. he was treated empirically with vancomycin, cefepime, levfoloxacin and voriconazole for febrile neutropenia until his counts returned and was discharged on levofloxacin and voriconazole which were discontinued on and he was started on fluconazole and bactrim. he was admitted again from to for his final cycle of chemotherapy which he tolerated well. his counts nadired on and returned by . the patient reports that he was feeling well at home until when he developed fevers to 101.8 at home with worsening fatigue. the fever was not associated with any localizing symptoms at that time. he was not experiencing nasal congestion, rhinorrhea, chest pain, shortness of breath, nausea, vomiting, abdominal pain, dysuria, hematuria, leg pain or swelling. he was initially admitted to the service for his fevers on . chest ct performed on the day of admission showed a new interstitial infiltrate in the right upper lobe on a background of predominantly upper lobe emphysematous change compared to the ct of one month prior which was felt to be concerning for atypical infection. he was started on levofloxacin. at 1:15 am on the oncology moonlighter was called for 20 minutes of right sided sqeezing chest pain while in bed. it was not exertional but did worsen with deep inspiration. not associated with nausea, vomiting or shortness of breath. he was tachycardic at the time to 120 and was satting 93% on ra. ekg was without ischemic changes. cardiac enzymes were negative x two sets. repeat cxr showed right sided opacity which was new compared to . he subsequently triggered on the floor at 4am for decreased oxygen saturations to 87% on ra and persistent fevers. oxygen saturations improved to 97% with 2l. his antibiotics were broadened at that time to vancomycin and cefepime. he triggered again at 5 pm for hypotension to the 90s systolic with persistent fevers. pressures improved to baseline of 100s without fluid bolus. the decision was made to transfer him to the for further monitoring and possible bronchoscopy. on transfer to the he reports that he continues to have fevers and right sided chest pain which is worse with inspiration. he has a mild dry cough but no sputum production. no nausea, vomiting, abdominal pain, diarrhea, constipation, dysuria, hematuria or leg pain. all other review of systems negative in detail. no known sick contacts although he was exposed to two young children on the day of presentation. past medical history: 1. stage 4b diffuse large b-cell lymphoma diagnosed in after he was admitted to the icu with pericardial effusion s/p pericardial window for tamponade physiology. he is now s/p cycles of mr-chop. 2. strep viridans bacteremia - 1 bottle; picc-associated? - ceftriaxone/pcn/ceftriaxone x4 weeks total 3. dvts, on lovenox 4. erythema nodosum, right forearm () 5. nephrolithiasis s/p cystoscopy 7-8 years ago 6. s/p amputation of right 2nd digit after electrical accident 45 years ago the patient presented to an outside hospital in with a 30-pound weight loss over the prior 6months. he was found to have a soft tissue mass in the cardiac ventricles involving the myocardium and extending into the interatrial septum. in addition, he was noted to have multiple pulmonary nodules, bilateral pleural effusions, a pericardial effusion, large bilateral adrenal masses, and diffuse soft tissue masses involving both kidneys. due to development of tamponade physiology, a pericardial window was placed. a renal biopsy revealed involvement by diffuse large b-cell lymphoma. the proliferation fraction was 90-95%. he was diffusely immunoreactive for cd20 and co-expressed bcl-2 and bcl-6. cd43, cd5, tdt, bcl-1, s100 were negative. lmp for ebv was negative. cd10 and cd30 were weekly expressed. in addition, a bone marrow biopsy demonstrated bone marrow involvement by lymphoma. chop chemotherapy was initiated on followed high-dose methotrexate on . he has recently completed cycles of mr-chop. social history: the patient is married and has one son. is a former engineer who recently worked as a night custodian. he has a history of smoking one and a half packs of cigarettes daily for 30 years until just prior to his diagnosis of lymphoma in , when he quit due to symptoms of profound weakness. he drinks two alcoholic drinks per month. he enjoys playing golf. he has 1 son, who is healthy (and md). family history: the patient's father died as a young man from a gunshot wound. his mother died in her 70s from diabetes and heart disease. he has two brothers one had prostate cancer. physical exam: gen: alert, oriented, nad. patch over l eye. heent: conjunctiva pink, sclera anicteric, l pupil dilated compared to right but both pupils reactive, cn vi palsy on left eye, oropharynx clear neck: supple, non-tender; no lad appreciated pulm: ctab posteriorely cardiac: regular rate and rhythm, normal s1 and s2, no murmurs, rubs or gallops abdomen: soft, non-tender, non-distended, +bs, no organomegaly appreciated extremities: warm and well perfused, 2+ pulses, no clubbing, cyanosis or edema, no calf tenderness skin: no rashes neuro: cn vi palsy on left. r pupil constricted compared to left but both reactive. except for previously described all other cn ii-xii intact. ue strength 5/5 with exception of r grip which is 4+/5. le plantar flexion 4-/5. le dorsiflexion 3-/5. sensation grossly intact. hyporeflexive in ue & le. areflexia in le. no babinski. pertinent results: imaging: eeg - impression: mildly abnormal routine portable eeg in the awake and sleeping states due to the modest slowing of the background and infrequent bursts of generalized theta slowing. these findings suggest excessive drowsiness or a mild encephalopathy due to metabolic abnormalities, medications or infection. there are no clear lateralizeded or epileptiform features. . immunophenotyping of csf - results: three color gating is performed (light scatter vs. cd45) to optimize lymphocyte yield. due to paucicellular nature of the specimen, a limited panel is performed to determine b-cell clonality. cd19-positive b-cells are extremely scant in number precluding evaluation of clonality. interpretation non-diagnostic study. cell marker analysis was attempted, but was non-diagnostic in this case due to insufficient numbers of lymphoid cells for analysis. correlation with clinical findings and morphology is recommended. . mri/mra head and neck impression: no significant change or new findings compared with . specifically no acute infarct is seen or enhancing brain lesion identified. . mra neck: the 2d time-of-flight mra of the neck vessels demonstrates no evidence of high-grade stenosis or occlusion in the carotid or vertebral arteries. the examination is slightly limited by motion. impression: slightly motion limited 2d time-of-flight of the neck demonstrates no evidence of high-grade stenosis or occlusion. . mra of the head: the head mra demonstrates no evidence of stenosis, occlusion or aneurysm greater than 3 mm in size. a tiny infundibulum is seen at the origin of right posterior communicating artery. impression: no significant abnormalities on mra of the head. comment: mild soft tissue changes are seen in both mastoid air cells. the fat-suppressed images of the neck are limited due to inadequate suppression. . - ct head - impression: no acute hemorrhage or change from . final attending comment: there is new fluid in the inferior mastoid air cells bilaterally. . - ct abdomen/pelvis 1. no evidence of bowel perforation or obstruction. 2. although evaluation of the previously identified bilateral renal and adrenal infiltrative masses is quite limited without intravenous contrast, these appear to have improved since prior as, for example, the adrenal glands demonstrate interval decrease in size. 3. small left pleural effusion with at least some of the left lower lobe demonstrating complete volume loss. recommend radiographic followup until this resolves versus dedicated chest ct. 4. cholelithiasis and bilateral nephrolithiasis. 5. unchanged 2.6-cm right common iliac artery aneurysm. 6. persistent small-to-moderate ascites. . cxr - findings: the various monitoring and support devices remain in place. again, there is no evidence of pneumothorax following chest tube removal. right apical opacification persists, unchanged. similarly, the opacification at the left base is again seen, most likely consistent with a combination of atelectasis and effusion. impression: little overall change. . cta of chest : 1. new interstitial infiltrate in the right upper lobe on a background of predominantly upper lobe emphysematous change compared to the ct of one month prior. this may represent atypical infection and clinical correlation is recommended. 2. partial interval resolution of right upper lobe anterior opacity. 3. enlarged right hilar lymph node measuring up to 10 mm in shortest axis diameter, likely reactive. 4. cholelithiasis without evidence of acute cholecystitis, partially imaged. 5. t8 wedge deformity consistent with compression fracture, age indeterminate. this finding is unchanged compared to the ct of . . ekg (): sinus rhythm at 77. left axis deviation. non-diagnostic repolarization abnormalities . 2 views of pelvis : there is no fracture or abnormal alignment. there is no suspicious lytic or sclerotic lesion although evaluation is somewhat limited by overlying bowel gas. the sacroiliac and pubic symphysis joints are within normal limits. there is mild superolateral joint space narrowing and subchondral sclerosis consistent with mild osteoarthritis. . ct pelvis : findings: there is a linear lucency in the posterior left iliac bone compatible with previous bone marrow biopsy aspiration tract. this is new since the previous ct. the appearance of the left iliac bone is otherwise without significant change. there is no evidence of focal bone lesion, fracture or mass. review of remainder of the osseous structures show a subcentimeter bone island in the right femoral neck. there is mild sclerosis in the acetabulum bilaterally compatible with degenerative change. there is degenerative change in the lumbar spine with small amount of gas seen at the l4-5 disc space. calcification is noted in the abdominal aorta. the common iliac arteries are dilated measuring 2.8 cm on the right and 2 cm on the left without gross change since the previous study. there is no evidence of bulky adenopathy or ascites. there is a small soft tissue density seen overlying the skin of the right buttock probably external to the patient. there are small dependent bladder calculi. a tiny focus of gas is seen in the bladder which may be due to recent instrumentation. suggest clinical correlation. prostate calcification compatible with bph. impression: no suspicious focal bony lesion or fracture is identified. . ct head without contrast : impression: no evidence of hemorrhage or significant change from prior study. . mri orbit with and without contrast : 1. no acute intracranial abnormality and no significant change in the overall appearance of the brain since the recent study. 2. mild atrophy and evidence of old lacunar infarct involving the left basal ganglia. 3. no pathologic focus of enhancement, with unremarkable appearance to the orbits, cavernous sinuses and remainder of the skull base, bilaterally. labs on discharge: . echo : the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). transmitral doppler and tissue velocity imaging are consistent with normal lv diastolic function. 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. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. an eccentric, posteriorly directed jet of mild (1+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . lenis : impressions: 1. peripheral filling defect and decreased compressibility of right superficial femoral and popliteal veins, consistent with chronic thrombus that has recanalized since the prior study in . 2. on the left, normal flow, but decreased compressibility in the left popliteal vein, suggesting the possibility of a small amount of chronic thrombus. 3. no acute dvt identified in either leg. . mri l-spine with and without contrast: impression: 1. no evidence of metastatic disease. 2. unremarkable appearance of the sacral plexus. 3. mild narrowing of the left l3/4 neural foramen without evidence of nerve root impingement. . bone marrow biopsy done : -final report pending at time of discharge . 12:00a na 136 cl96 bun9 glc131 k3.7 co2 34 creat0.7 ca: 8.4 mg: 2.0 p: 2.3 wbc2.8 hgb9.6 plts100 hct28.1 gran-ct: 1176 brief hospital course: mr. is a 60 year old man with history of diffuse large b-cell lymphoma s/p six cycles of mr-chop who presented on with fevers and new right upper lobe infiltrate transferred to the for worsening oxygen requirements and hypotension. icu course: on admission to the there was no evidence of end organ dysfunction and the patient was making good urine output. he was noted to have a right upper lobe infiltrate with worsening oxygen requirements and hypotension. his blood pressures were in 90s systolic without the need for ivf boluses. he was felt to have pulmonary process based on ct scan/ cxr. he was started on vancomycin and cefepime. given that he was immunocompromised, it was felt he would benefit from bronchoscopy for tissue specimen especially to evaluate for fungal infection. he underwent intubation and bronchoscopy. bronchoscopy revealed no organism growth. he was ultimately treated with an empiric course of vancomycin, ciprofloxacin, flagyl, and meropenem (14 day course). he was on caspofungin, them ambisone which resulted in renal insufficiency, so he was switched to voriconazole. antifungals were discontinued when tissue fungal culture remained negative for one week. he then underwent vats procedure with thoracic surgery which was complicated by a penumothorax which resolved with a chest tube. pathology from lung tissue showed organizing pneumonia, however given that no organisms were growing on culture patient was started on steroids for possible boop. legionella antigen, beta-glucan, galactomannan, histoplasma, cryptococcus, toxoplasma were all negative. his final lung diagnosis was likely to be cop (cryptogenic organizing pneumonia). he was placed on po prednisone on . he was extubated on . he was initially going to be started on lasix as noted to be net positive over nine liters since micu admission, however patient began autodiuresing himself. in the end of he was doing well without oxygen requirement. . post icu: # hypoxic respiratory failure/cop: he was thought to have cop (cryptogenic organizing pneumonia) and was started on steroids on which were tapered off and ultimately stopped on . . # afb cx positive: his tissue biopsy from his lung was positive for afb on . he was unable to get an induced sputum after 9 separate tries. he was placed in a negative pressure room. on the dna probe grew back mac. id was following the patient and felt the result was likely a contaminant and that he did not require treatment . # neuro ?????? the patient had waxing & mental status with intermittent confusion/confabulation/hallucinations. however since the beginning of he has been a&o x 3 but has poor memory for medical details. he had bilateral upper & lower extremity weakness and weakness greater on the right than his left. his strength is improving and his weakness is likely related to his long hospital and icu course. his weakness has improved during the course of his hospitalization but his lower extremities have lagged in terms of gaining back strength. his dorsiflexion of the feet is 3-/5 and his plantarflexion is 4-/5. he has no le reflexes and in hyporeflexive in the ue. a mri of the lumbar sacral plexis showed no metastatic disease, unremarkable appearance of the sacral plexus, and mild narrowing of the left l3/4 neural foramen without evidence of nerve root impingement. . in late his right pupil was noted to be more constricted than his left pupil. his ct was negative. mri/mra neck as above without acute pathology. neurology was consulted and recommended emg, eeg, lp, and neuro-optho consultation. lumbar puncture x 2 negative for meningitis, including lymphomatous meningitis. neuro-optho was consulted on and they diagnosed him with horner's syndrome. his horner??????s syndrome has improved since. an eeg was done which showed no seizure activity. his emg was canceled as the patient's muscle strength was slowly improving. the patient had dysphagia and was on tpn but his diet was advanced on by speech and swallow. he is now tolerating a regular diet. . on the patient fell overnight in the setting of getting both a pain medication and a sleeping medication. he was examined by a hospitalist and found to be fine. the next morning he was reporting new double vision. neurology and opthomology were consulted and he was found to have a new left cn vi palsy. a ct of the head was negative for bleed. an mri with particular attention to the cavernous sinuses, orbits, and brain stem was normal. the patient also received an lp on which showed one atypical cell. the following day he began to experience nausea, emesis, and headache and a repeat ct head was negative. the emesis still occurs occasionally and was felt to be secondary to his double vision. neuro-onc was consulted on and believed the cn vi palsy was traumatic and likely secondary to his fall. he should follow up with opthomology as an outpatient as he may benefit from prism glasses or corrective surgery. in the meantime i have provided him with shields to place over his left eye. in addition, he needs to follow up with dr. as an outpatient. . # paroxysmal atrial fibrillation: he had intermittent atrial fibrillation which apparently is a new diagnosis on this admission. while the patient was in the unit he was loaded on amiodarone and then continued on maintence po. he was also started on a ca channel blocker. on transfer back to the floor he was unable to swallow so he was changed to iv medications only. he was on low dose metoprolol iv and remained in normal sinus rhythm without any hypertension. his metoprolol was discontinued in the end of . he remained in nsr with normal blood pressure. he has anticoagulation with lovenox for history of dvts. . # diffuse large b cell lymphoma: status post cycles of mr-chop. he completed hd-mtx one week prior to admission. he was on bactrim prophylaxis and acyclovir 400mg tid was started as the patient developed lesions on the shaft of his penis found to be hsv2. his wbcs, anc, and plts all began to fall. it was unclear if this was due to medications or due to cancer involvement of his bone marrow. his acyclovir was changed to valtrex (and ultimately discontinued), his pantoprazole was changed to zantac, and his bactrim was discontinued. his counts initially increased but then began to fall again. a bone marrow biopsy was done on and the results were unremarkable. he received neupogen on and his counts began to rise and he is no longer neutropenic. he will follow up with his primary oncologist after discharge. . #back pain: in early he began complaining of severe lower back pain. he required po dilaudid and then iv dilaudid for the pain. his iliac crests are prominent given his weight loss and his back pain was thought to be secondary to pressure on these bones as well as sleeping on the soft hospital beds. however, due to the severity of the back pain he received plain films of his back and a ct scan of his back both of which were overall negative. a bone scan was then done as there was concern for either osteomyelitis or recurrence of his cancer. the bone scan was negative. he is being discharged on ms contin and msir. we expect that his back pain will improve with change in mattress. he should be tapered down from his current doses of morphine as tolerated. . # hypogammaglobulinemia: patient had spep on and got ivig on . # dvt: his dvt was diagnosed in 11/. he was continued on lovenox which was held on occasion for procedures. on he was complaining of pain in his right leg after physical therapy. lenis were done and showed evidence of old dvt but no evidence of acute dvt. he is being discharged on lovenox 70mg sc bid. . # fen- he is currently on a regular diet. . # ppx ?????? he is being discharged on lovenox for dvt prophylaxis and zantac for reflux. medications on admission: bactrim ds 1 tab po 3x/week (mo,we,fr) fluconazole 400 mg daily lorazepam 0.5 mg po q4h:prn fluticasone propionate 110mcg 2 puff ih enoxaparin 70 mg sc q12h pantoprazole 40 mg po q24h colace 100 mg po bid:prn tylenol prn discharge medications: 1. enoxaparin 80 mg/0.8 ml syringe sig: one (1) subcutaneous q12h (every 12 hours). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day): hold for loose stool. 3. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day): hold for loose stool. 4. polyethylene glycol 3350 100 % powder sig: one (1) po daily (daily) as needed for constipation. 5. ondansetron 4 mg tablet, rapid dissolve sig: tablet, rapid dissolves po every eight (8) hours as needed for nausea. 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 7. camphor-menthol 0.5-0.5 % lotion sig: one (1) application topical four times a day as needed for itching. 8. morphine 15 mg tablet sustained release sig: three (3) tablet sustained release po twice a day: hold for sedation or rr<12. 9. morphine 15 mg tablet sig: two (2) tablet po every four (4) hours as needed for pain: hold for sedation or rr<12. discharge disposition: extended care discharge diagnosis: primary diagnosis: 1. pneumonia (cryptogenic organizing pneumonia) 2. horner's syndrome 3. deconditioning with upper and lower extremity weakness 4. dlbcl 5. dysphagia 6. cranial nerve six palsy 7. dropping wbc, anc, and plts 8. mac . secondary diagnosis: 1. dvt discharge condition: stable. discharge instructions: you were admitted with fevers and pneumonia. you were intubated and underwent a bronchoscopy and later underwent a procedure where they took a sample of tissue from your lung. you were initially treated with antibiotics but these were changed to steroids when no organism was isolated. you were slowly taken off your steroids. you also developed unequal pupils called horner's syndrome which has partially resolved. you developed weakness in your upper extremities and lower extremities. you have done a great job getting your strength back but still need to go to rehab to strengthen your lower extremities which have been slow to improve. a sample of lung tissue came back with question of tuberculosis vs mac. you waited a long time and the state lab was eventually able to determine it was mac. you do not need treatment for the mac which was determined by the infectious disease doctors. you had a fall while on pain medications plus a sleeping medication. the next morning you developed double vision. you had a cranial nerve six palsy of your left eye causing the double vision. many scans were done of your head and no new abnormalities were found. you should follow up with opthomology as an outpatient as they can make special glasses for you or discuss possible corrective surgery. we have given you an eye patch to wear in the meantime. you will also need to follow up with a neuro-opthomologist dr. in weeks. your back pain is likely secondary to your bones being more prominent in the setting of having lost weight. you would benefit from a firmer bed than the ones we can provide in the hospital. . the following new medications were started: morphine sulfate contin, morphine sulfate ir, zantac, ondansetron, miralax, sarna lotion . the following medications were discontinued: bactrim, fluconazole, lorazepam, pantoprazole . the following medicatons were continued: fluticasone propionate enoxaparin colace senna . please seek immediate medical attention if you develop fever, chills, difficult breathing, cough, chest pain, trouble swallowing, increased upper extremity or lower extremity weakness, new trouble with your vision, abnormal speech, diarrhea, blood in the stool, or any other new concerning symptom. followup instructions: dr. on thursday at 2:00. . neurology dr. on tuesday at 10am. . ophthalmology: please call for an appointment concerning your double vision. md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung parenteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus thoracoscopic excision of lesion or tissue of lung diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified anemia, unspecified acute kidney failure, unspecified atrial fibrillation atrial flutter sixth or abducens nerve palsy long-term (current) use of anticoagulants personal history of venous thrombosis and embolism unspecified disorder of autonomic nervous system large cell lymphoma, unspecified site, extranodal and solid organ sites 

Answer: The patient is high likely exposed to