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: history of present illness: the patient is a 47-year-old gentleman with a history of multiple myeloma who was - on the day of admission - day 41 status post a matched unrelated nonmyeloablative allogenic transplant. his initial presenting complaint was shortness of breath and cough. the patient was diagnosed with multiple myeloma in the fall of when a bone marrow biopsy revealed myeloma with hypercellular marrow with 66 percent plasma cells. iga level was at 4910 at that time. he was treated with vad, followed by stem cell mobilization with cytoxan, with high- dose chemotherapy stem cell rescue. he did well for approximately for one year until decrease of when his igg levels rose. he was treated with thalidomide alone but developed neuropathy. decadron was added, but he still had resistance of disease. in , he was treated with four cycles of velcade, still with a dropping platelet count, increasing neuropathy, and only a modest decrease in his igg level; which subsequently then began to increase. on , he was admitted for a nonmyeloablative allogenic transplant on the mini-mud protocol. post transplant course was complicated by acute graft-versus-host disease of the gastrointestinal tract, congestive heart failure with cardiomegaly, and renal insufficiency. a bone marrow biopsy and aspirate on day plus 30 showed extensive involvement by plasma cell myeloma. he was subsequently tapered rapidly off his neoral, which he tolerated without any acute exacerbation of graft-versus-host disease. on , he presented to clinic with increasing shortness of breath and an increased nonproductive cough. a repeat computer tomography of the chest was obtained which revealed a linear opacity in the right middle lobe that was felt to be either focal atelectasis versus focal pneumonia as well as an increased size of pleural-based soft tissue lesions. past medical history: multiple myeloma. tonsillectomy. appendectomy. vasectomy. hemorrhoids. past surgical history: tonsillectomy as a child. appendectomy in the early . medications on admission: 1. multivitamin every day. 2. folic acid 1 mg once per day. 3. protonix 40 mg once per day. 4. lopressor 2.5 mg twice per day. 5. ursodiol 300 mg twice per day. 6. allopurinol 200 mg once per day. 7. fluconazole 200 mg once per day. 8. neurontin 300 mg twice per day. 9. fentanyl 50-mcg patch q.72h. 10. oxycodone 5 mg to 10 mg q.4-6h. as needed (for breakthrough pain). 11. neoral 25 mg twice per day (stopped on ). 12. prednisone 5 mg once per day. 13. colace 100 mg twice per day. 14. senna one to two tablets by mouth twice per day as needed. 15. ativan 0.5 mg to 1 mg q.6h. as needed. 16. compazine 10 mg q.6h. as needed. 17. aerosolized pentamidine every month (his last treatment being ). allergies: keflex (which caused nausea and dizziness). physical examination on presentation: in general, the patient was a pale and ill-appearing gentleman in no acute distress. head, eyes, ears, nose, and throat examination revealed the oropharynx was red. the mucous membranes were dry. skin revealed there were no rashes. the lungs had crackles at the right base. poor air movement throughout. the heart was regular in rate and rhythm. there were no murmurs, rubs, or gallops. the chest revealed no tenderness to palpation over the sternum or the anterior ribs. the abdomen was soft, nontender, and nondistended. there were positive bowel sounds. there was no hepatosplenomegaly. the extremities revealed there was no clubbing, cyanosis, or edema. no calf tenderness. back revealed there was costovertebral angle tenderness. no vertebral tenderness. mild tenderness to palpation over the right posterior ribs. pertinent laboratory values on presentation: white blood cell count was 3.1, his hematocrit was 27.7, and his platelets were 88. his blood urea nitrogen was 18. his creatinine was 1.3. alanine-aminotransferase was 23, his aspartate aminotransferase was 24, his lactate dehydrogenase was 337, his alkaline phosphatase was 206, his total bilirubin was 1.2, with an indirect bilirubin was 0.9. cytomegalovirus viral load from not detected. pertinent radiology-imaging: a computed tomography of the chest from revealed stable cardiomegaly, increased size of the left anterior, left paravertebral, right paravertebral pleural-based soft tissue lesions. an increased opacity in the right middle lobe; called as focal atelectasis versus pneumonia. an echocardiogram from revealed left atrium and right atrium moderately dilated. left ventricular thickness was normal. left ventricular cavity was mildly dilated. left ventricular systolic function was low-normal. ejection fraction of 50 percent to 75 percent. mild-to- moderate 1 plus to 2 plus mitral regurgitation. borderline pulmonary artery systolic hypertension. summary of hospital course: pulmonary issues: his initial presenting complaint was cough, mild shortness of breath, and a concern of a right middle lobe process. on presentation, he was afebrile. he was treated with levaquin initially; however, early on became febrile and was changed to therapy with cefepime. a pulmonary consultation was called on hospital day three. as per their recommendations, a _____________ was sent which was negative as well as a aspergillus ____________ level which was also negative. he was continued on treatment with cefepime and levaquin with minimal change in fever curve or symptoms. there was a discussion over the patient undergoing a bronchoscopy; however, prior to that happening, the patient developed atrial fibrillation with a rapid ventricular rate with resulting hypotension and was transferred to the intensive care unit. the details of this will be dictated below. while in the intensive care unit, the patient continued to be febrile despite levaquin and cefepime. thus, voriconazole was initiated for concern over a possible fungal etiology. on , the patient had a repeat computed tomography scan of the chest which showed an interval decrease in the right middle lobe infiltrate with no new consolidations. due to this radiographic improvement, it was felt that holding off on bronchoscopy was advisable, and the patient was continued on levaquin and voriconazole alone. the patient subsequently became afebrile. thus, it was decided to complete a course of antibiotics as there was still no clear indication of the etiology of this right middle lobe process. the voriconazole was stopped first, and he then completed a 14-day course of levaquin without further fevers. throughout the remainder of the hospital course, he continued to have a nonproductive cough as well as to be tachypneic. however, he remained afebrile to the date of this summary. acid base issues: as the patient was tachypneic, and it was noted that his bicarbonate was low at 14 to 18, a blood gas was performed. this revealed a ph of 742, a po2 of 100, and a pco2 of 21. the renal team was consulted to help with interpreting this, and they felt that this represented a chronic respiratory alkalosis, and that the low bicarbonate was compensation for that and did not represent a primary metabolic acidosis. the renal and pulmonary teams worked together to develop a differential diagnosis which included hypoxia; such as secondary to a pulmonary embolism, a central process such as a cerebrovascular accident, or meningitis/encephalitis, and medication. the suspicion for a pulmonary embolism was low given his po2 of 100 on room air, and a computed tomography angiogram of the chest was undesirable given the patient's increased creatinine, and a v/q scan would not be a good study given the soft lesions. lower extremity noninvasives were performed, and they were negative. a magnetic resonance imaging of the head revealed no cerebrovascular accident or evidence of basilar meningitis. a lumbar puncture was performed to explore the potential of a central nervous system infection or an infiltration by his myeloma given this respiratory alkalosis as well as due to new onset somnolence (as will be described below). the lumbar puncture did reveal 150 white blood cells in the cerebrospinal fluid with a normal glucose and protein. the cytology revealed plasma cytoid cells, but it was felt to not be diagnostic of multiple myeloma. throughout his course, the patient's tachypneic did improve somewhat and his bicarbonate did improve; although it remained low at approximately 17 to 19. atrial fibrillation issues: the patient did have a history of atrial fibrillation. during his course he had two episodes of atrial fibrillation with a rapid ventricular rate with resultant hypotension requiring overnight stays in the medical intensive care unit. one event occurred early on in his course (on ). a second then occurred on . after the medical intensive care unit stay on , the patient was seen by cardiology and loaded on amiodarone and was put into a normal sinus rhythm. following that, the patient became somnolent, and one of the possibilities included high doses of amiodarone. for this reason, the patient's dose was titrated quickly down to a maintenance of 200 mg per day. eventually, the amiodarone was stopped due to the patient's dysphagia and inability to swallow pills. eventually, a nasogastric tube was placed and the medications were being given down the nasogastric tube at 400 mg a day, but subsequently - on - the patient developed atrial fibrillation again with a rapid ventricular rate; again causing hypotension. he was quickly converted chemically back to a normal sinus rhythm and reloaded on amiodarone through the nasogastric tube. at the time of this dictation, he remains in a normal sinus rhythm with a stable blood pressure. we plan to continue the amiodarone taper at 400 mg twice per day times seven days, followed by twice per day times seven days, followed by once per day times two weeks, followed by 200 mg once per day as maintenance. somnolence issues: as mentioned above, following the patient's amiodarone load on he became somnolent. it was unclear if this was related to an infection, or a medication such as amiodarone, or being over liberal with ativan for nausea. as discussed above, a lumbar puncture was performed due to the concern of a central process causing tachypnea as well as somnolence. again, as discussed above, the results demonstrated white cells of unclear significance. it was felt it could be an aseptic meningitis due to medication versus due to multiple myeloma, and it was never clear if the cerebrospinal fluid findings corresponding to the patient's somnolence; as over a number of days, with the titration of his amiodarone and the holding of his ativan dosing, the patient's mental status returned to baseline. dysphagia issues: it was noted that the patient was choking when he attempted to eat or drink. a swallow study was performed which revealed major deficits in swallowing, putting the patient at very high risk for aspiration of even his own secretions. it was recommended that he be completely nothing by mouth including medications, and that a neurology consultation be obtained. neurology saw the patient. they felt there were cranial nerve abnormalities that accounted for the dysphagia and the speaking difficulties that the patient was having. their differential included soft tissue lesions at the base of the skull compressing the cranial nerves at they exit the skull versus cerebrospinal fluid involvement by multiple myeloma, and less likely a paraneoplastic syndrome. repeated magnetic resonance imaging and computed tomography scans of the base of the skull revealed no evidence for lesions compressing the cranial nerves. there were plans for a repeat lumbar puncture; however, this was held off due to the fact that the patient had a soft tissue lesion located at l3, and there was concern for seeding of the cerebrospinal fluid or for getting a false-positive result on the lumbar puncture. it was eventually decreased to use empiric radiation therapy to the base of the skull to treat possible basilar meningitis or any compressive lesions not able to be seen by imaging. otherwise, the patient was kept completely nothing by mouth. a nasogastric tube was placed, and medications were given through that. nausea, vomiting, and diarrhea issues: early in the patient's course, he had high-volume diarrhea as well as frequent nausea and vomiting. he underwent a flexible sigmoidoscopy which was normal. however, biopsies revealed evidence of graft-versus-host disease. he was on low-dose solu-medrol for a brief time. this was eventually tapered off, and the gastrointestinal symptoms resolved. back pain issues: the patient with baseline back pain on admission; however, it became more and more severe leading to a magnetic resonance imaging of the spine which revealed metastatic disease in all visualized bones with soft tissue masses at t10-t11 and c11 with collapse of t7, and soft tissue masses at l3, but no cord compression, as well as a questionable pathologic fracture of the coccyx and sacrum. the patient was started on decadron, and radiation/oncology was consulted. he was started on radiation therapy from t6 to l4 as well as to the base of the skull (as discussed above). on , the plan was for 10 sessions. the patient's pain was managed with a dilaudid patient-controlled analgesia. he fentanyl patch had been stopped due to a theoretical risk of asystole with amiodarone and fentanyl. multiple myeloma issues: despite a falling igg level and a relative stability in the patient's blood counts, there was evidence for extensive worsening of his myeloma including the metastatic bone disease and questionable central nervous system involvement (as discussed above). the patient was therefore started on further chemotherapy with velcade and decadron, and there was discussion as to the possibility of eventual donor liver site infusion. aspiration issues: the patient's pulmonary status remained relatively stable after the resolution of the issues described above; however, his lung examination started to sound worse around to . in the setting of the rapid ventricular rate and the high risk for aspiration, it was felt that an aspiration pneumonia could be contributing so he was started on a course of levaquin and flagyl. at the time of this dictation, he was day four of that therapy. hypercalcemia issues: the patient's calcium started trending up to as high as 7.5. he was due for his dose of pamidronate, and this was given on with good results. pancreatitis issues: due to abdominal pain, the patient's amylase and lipase were checked - which were found to be elevated. they subsequently trended down, but tube feedings were attempted with a resultant bump in amylase and lipase. there was no clear etiology found at the time of this dictation for the initial elevation. tube feedings are being held currently. congestive heart failure issues: the patient with mild diastolic and systolic dysfunction shown on the echocardiogram. he had evidence of fluid overload including crackles in s4 and elevated jugular venous pressure, but diuresis was difficult due to his tendency to go back into atrial fibrillation when he became dry as well as a tentative blood pressure. it was felt that it was possible that he had amyloid involvement of the heart, and that this accounted for his difficult to manage fluid status. renal issues: the patient's creatinine was 1.3 on admission. he received intravenous fluids over the first few days on admission with an improvement in creatinine down to his baseline of 0.7, which remained that way throughout the remainder of his course. adrenal insufficiency issues: after the hypotension following his first episode of atrial fibrillation with a rapid ventricular rate, a cortisol stimulation test was performed. the random cortisol was appropriate at greater than 20; however, he did not bump in accordance with the stimulation. the remainder of the hospital course, as well as his discharge diagnoses, discharge medications, and followup will be dictated as part of an addendum to this summary. , 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 insertion of endotracheal tube closed [endoscopic] biopsy of bronchus transfusion of packed cells other radiotherapeutic procedure diagnoses: acidosis thrombocytopenia, unspecified congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation methicillin susceptible staphylococcus aureus septicemia sepsis methicillin susceptible pneumonia due to staphylococcus aureus multiple myeloma, without mention of having achieved remission acute pancreatitis 

Answer: The patient is high likely exposed to