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: morphine / demerol attending: chief complaint: heart palpitations and dyspnea major surgical or invasive procedure: pulmonary intubation right picc line placement arterial line history of present illness: the patient is a 30yo male with a known history of hodgkins lymphoma and recent diagnosis of mesothelioma now undergoing chemotherapy with cisplatin and alimta, last dosed 2 weeks ago. since that session has been experiencing general malaise, poor appetite, weight loss. now 103lbs down from 135 lbs prior to chemotherapy. had been tolerating chemo reasonably well until day prior to admission when he began having anxiety attacks most of the night. heart rate had been fast and pounding. later on night prior to admission felt acutely dizzy around 1am in the setting of acute anxiety. was unable to get up from bathroom floor. took his pulse and noted it to be rapid and so activated ems. on arrival, was reportedly a narrow complex tachycardia at 200bpm. resolved with valsalva maneuvers in ambulance. second episode of svt at hospital at 3am and again at 4:30am. second and third episode required iv adenosine for termination. . at patient had svt that was terminated with adenosine 6mg iv x2 and metoprolol 5mg iv x1. the patient was then transferred to for further evaluation. . in the ed, initial vitals were bp 118/92, rr 16, o2 99% on 2l nc. the patient's exam was notable for bilateral wheezing and the patient was pale and ill-appearing. mr. initial ekg was sinus tachycardia with a shortened pr interval and a rate of 104 with no ischemic st changes noted. the patient had an episode of svt in the ed which abated after vagal maneuvers/carotid massage and adenosine 6mg iv x1. the patient was also given a dose of levaquin for suspected infection. tte echo was performed which showed no evidence of pericardial tamponade, pulsus measured between 6-8mmhg on 2 occasions. cardiology was consulted who felt dyspnea was likely non-cardiac but that patient would benefit from admission to ccu for management of svt. . on review of systems, he denied any prior history of stroke, tias, deep venous thrombosis, pulmonary embolism, abnormal bleeding with prior surgeries, myalgias, joint pains, cough, hemoptysis, black or bloody stools. he mentioned occasional constipation but denied diarrhea. he denied recent fevers, chills or rigors. no new or changing lymphadenopathy. all other review of systems negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, or syncope although patient stated he had some sensations of dizziness while enduring his above mentioned svt episodes. past medical history: past medical history: 1. cardiac risk factors: none, no diabetes, dyslipidemia or hypertension 2. cardiac history: none . 3. other past medical history: -hodgkin's lymphoma in , s/p chemotherapy and radiation -mesothelioma diagnosed w/biopsy , now s/p 5 cycles of cisplatin and allimta chemotherapy. -hypothyroidism -asthma in childhood -eczema social history: the patient has been living with his parents in and had previously been living independently. he is currently on disability but had been working full time as an engineer prior to his diagnosis and illness with mesothelioma. no history of prior tobacco use. etoh in distant past socially, no recent use. no history of any illicit drug use. . family history: history of heart palpitations in mother who also has a diagnosis of syndrome. maternal grandfather with palpitations as well but uncertain etiology, died in late 80's. otherwise, no family history of premature death. maternal grandmother with cva history. father with hypothyroidism. physical exam: vs: t= 96.9, bp=133/87, hr=110 rr=24-30 o2 sat= 100% 4l nc general: chronically ill appearing man, cachectic, markedly tachypneic heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 10 cm. cardiac: tachycardic, hyperdynamic, no murmurs, rubs or gallops, s1 and s2 regular. lungs: rapid but shallow breath sounds, bilateral basilar rales, occasional wheezes with expiration at mid to lower lung fields abdomen: soft, nt/nd. no hsm or tenderness. abdominal aorta not enlarged by palpation. no abdominal bruits. extremities: no cyanosis or edema. no femoral bruits. no palpable cords. skin: pallid complexion but no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ and left carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission labs : glucose-79 urea n-7 creat-0.5 sodium-137 potassium-5.0 chloride-100 total co2-29 anion gap-13 and cbc: wbc-13.9* rbc-3.65* hgb-9.9* hct-29.5* plt 358 mcv-81* mch-27.1 mchc-33.6 rdw-18.0* admission ekg: ekg showed sinus tachycardia with normal axis, normal intervals, no hypertrophy, no delta wave, small q-wave in iii, pr depression in i, ii and j-point elevation in v1, v2. no twi's or st elevations. . telemetry: sinus tachycardia on arrival to ccu . tte 2d-: ef 50-55%, trivial pericardial effusion, moderate tr, mild pulm htn, no tamponade. cta chest w&w/o c&recons: no evidence of pulmonary embolism, left lower lobe airspace disease with air bronchograms consistent with pneumonia, bilateral loculated pleural effusions, marked left-sided pleural thickening and a large loculated left subpulmonic effusion. this could represent the patient's mesothelioma. increased bronchovascular soft tissue density, particularly in the left hilum, is most likely related to the patient's previous radiation. no gross evidence of airway obstruction. a separate hilar mass is felt to be less likely, but correlation with previous outside studies would be useful. given the patient's history, follow-up evaluation in months to document stability is advised. 1.8 x 1.5 cm enhancing lesion in the left lower lobe of the liver. differential diagnosis includes focal nodular hyperplasia, adenoma, or a flash filling hemangioma. additional labs : 04:10pm alt(sgpt)-28 ast(sgot)-30 ld(ldh)-209 alk phos-168* tot bili-0.2, albumin-2.9* calcium-8.7 phosphate-4.6* magnesium-1.4*, tsh-6.0*, urine color-straw appear-clear sp -1.009 04:10pm urine blood-mod nitrite-neg protein-neg glucose-neg ketone-15 bilirubin-neg urobilngn-neg ph-5.0 leuk-tr 04:10pm urine rbc-* wbc-* bacteria-mod yeast-none epi-0-2 abg: po2-109* pco2-52* ph-7.34* total co2-29 base xs-1 lactate-0.8 07:15am glucose-106* urea n-9 creat-0.5 sodium-136 potassium-4.6 chloride-97 total co2-28 anion gap-16 07:15am estgfr-using this 07:15am probnp-1149* 07:15am calcium-8.6 phosphate-4.8* magnesium-1.5* 07:15am wbc-14.5* rbc-4.18* hgb-10.9* hct-34.0* mcv-82 mch-26.0* mchc-32.0 rdw-16.5* 07:15am neuts-90.0* lymphs-5.9* monos-4.0 eos-0.1 basos-0.1 07:15am pt-13.3 ptt-32.7 inr(pt)-1.1 05:36am blood wbc-17.1* rbc-3.70* hgb-10.1* hct-30.0* mcv-81* mch-27.2 mchc-33.5 rdw-17.7* plt ct-405 12:32pm blood alt-16 ast-23 ld(ldh)-200 alkphos-144* amylase-32 totbili-0.2 12:32pm blood lipase-24 05:32pm blood type-art po2-122* pco2-54* ph-7.44 caltco2-38* base xs-11 intubat-intubated 05:49am blood wbc-11.1* rbc-3.51* hgb-9.3* hct-27.9* mcv-80* mch-26.5* mchc-33.3 rdw-18.0* plt ct-402 06:37am blood wbc-11.4* rbc-3.67* hgb-9.7* hct-30.2* mcv-82 mch-26.5* mchc-32.2 rdw-16.8* plt ct-512* 06:37am blood glucose-103 urean-6 creat-0.8 na-144 k-3.8 cl-97 hco3-40* angap-11 06:37am blood calcium-9.1 phos-4.3 mg-1.9 11:05am blood type-art po2-107* pco2-58* ph-7.44 caltco2-41* base xs-13 11:05am blood type-art po2-107* pco2-58* ph-7.44 caltco2-41* base xs-13 labs : 6:00am wbc-12.4* rbc-3.76* hgb-9.8* hct-31.0* mcv-82 mch-26.1* mchc-31.7 rdw-17.0* plt ct-693* and calcium-9.5 phos-3.4 mg-1.8 glucose-97 urean-9 creat-0.8 na-142 k-3.6 cl-95* hco3-40* 05:00am blood wbc-10.9 rbc-3.40* hgb-9.2* hct-28.0* mcv-82 mch-27.2 mchc-33.0 rdw-18.3* plt ct-648* 05:00am blood glucose-88 urean-15 creat-1.2 na-141 k-4.6 cl-97 hco3-35* angap-14 additional imaging and cardiac reports : repeat tte: the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is a moderate sized pericardial effusion primarily anterior to the right ventricular free wall and minimal lateral and inferolateral to the left ventricle. there is no right atrial or right ventricular diastolic collapse. compared with the prior study (images reviewed) of , the effusion may be slightly larger. serial evaluation is suggested. portable cxr: in comparison with study of , the endotracheal tube tip now lies approximately 4.4 cm above the carina. mild prominence of interstitial markings persists consistent with mild interstitial edema. little change in the partly organized left pleural effusion. left apical pleural thickening or fluid cap persists. portable cxr:the et tube tip is 4.3 cm above the carina. the ng tube tip is in the stomach. the cardiomediastinal contours are unchanged as well as diffuse pleural thickening of the left hemithorax and small right pleural effusion. repeat tte : overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the mitral valve leaflets are mildly thickened. there is a moderate sized pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade.compared with the prior study (images reviewed) of , the pericardial effusion is more circumferential, but still primarily anterior to the rv. no ra or rv diastolic collapse. ekg: rate 111, artifact is present. sinus tachycardia. the p-r interval is short at 100 without evidence of pre-excitation. qt/qtc of 340/429. left atrial abnormality. non-specific st-t wave changes. compared to the previous tracing left atrial abnormality is new. portable cxr: left-sided pleural opacification appears similar. cardiomediastinal contours remain slightly widened, and a worsening diffuse interstitial process is present, likely reflecting pulmonary edema. additional dependent airspace opacities in the retrocardiac regions are unchanged and could reflect dependent edema or infection. repeat tte: due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. trivial mitral regurgitation is seen. there is a moderate sized pericardial effusion. there are no echocardiographic signs of tamponade. impression: moderate circumferential pericardial effusion without signs of tamponade. compared with the prior study (images reviewed) of , the findings are similar. : upper extremity us: no right upper extremity dvt. ekg: rate 105, sinus tachycardia. diffuse j point elevation suggestive of early repolarization. cxr (ap) : as compared to the previous radiograph, there is minimally better transparency in both lung bases. the size of the cardiac silhouette and the remaining radiographic findings are unchanged. microbiology : : negative blood cultures : negative blood cultures : negative urine culture : negative urine legionella ag test sputum culture : negative clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. blood cultures x2 : negative 10:07am urine color-straw appear-clear sp -1.016 10:07am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg urine culture : no growth. brief hospital course: in summary, the patient is a 30-year-old male with a history of hodgkins lymphoma diagnosed in who was recently diagnosed with mesothelioma in after confirmatory biopsy at /. he presented to as a transfer from hospital where he presented shortly after 2am on with tachypnea and multiple episodes of svt terminating with vagal maneuvers and iv adenosine. abnormal rhythm: the patient's differential included avnrt, wpw given his short pr interval on ekg and family history. he continued to have bouts of svt with rates into the 270s. he was symptomatic with lightheadedess and hypotensive. he was sedated with propofol and intubated, and cardioverted x2 succesfully. he was then started on procainamide drip overnight. an ep procedure with possible ablation was discussed but it was felt that this was a high risk in the setting of his commorbidities. procainamide was discontinued and amiodorone po was started for better control of mr. svt with the understanding that it would not be used as a long term medicine in the setting of underlying pulmonary disease. metoprolol was discontinued given risks for bradycardia and hypotension while on amiodorone. initiallly, the main differential of his svt was felt to be a form of avnrt vs.avrt. he had a breakthrough episode of svt on and his hr rose into the 160s range for less than 5 minutes. he remained alert and oriented and had no associated chest pains, dizziness or desaturations during this episode. the tachycardia terminated after carotid massage and no additional anti-arrhythmics were needed. following this event the ep team was consulted for further review of the patient's ekgs and telemetry strips and felt that this svt was a 2:1 atrial tachycardia with aberrancy and was slightly slower than the more rapid svt the patient had experienced after admission. after this event the team decided to uptitrate amiodarone for better control and on the team decided to continue his dose at 200mg x 1 week and then he would decrease to 200mg daily dose. in general the patient's svt was well controlled on amiodarone at the time of discharge home and he was set up for an ep follow-up visit at for continued management of his arrhythmias. at the time of discharge he had no complaints of dizziness, palpitations, chest pain or shortness of breath at rest. the patient advised he will need to have follow-up lfts and pfts as part of his outpatient follow-up now that he is on amiodarone. of note - just prior to transfer on the morning of , he had another episode of asymptomatic svt. ekg was suggestive of 2:1 atrial flutter. he broke this rhythym on his own after approx 3 minutes. cardiac pump function: in regards to mr. cardiac pump function he had serial echocardiograms during his hospital stay which revealed a normal ef in the 55-60% range despite some evidence of pulmonary volume overload. these pulmonary findings were likely due to his underlying underlying mesothelioma versus cardiac in origin. he had no jvd elevations or lower extremity edema consistent with pump failure during his hospital course despite having an elevated bnp. repeat tte studies showed that his baseline pericardial effusion appeared more circumferential, but still remained primarily anterior to the rv. no ra or rv diastolic collapse or tamponade features were noted. the patient's pulsus was monitored and remained in the 6-8mmhg range during his hospital course. . respiratory distress: initially a pulmonary embolism was ruled out with cta after admission given the patient's baseline sinus tachycardia and tachypnea. during an acute episode of svt on , hospital day 2 in the ccu, the patient's hr reached 260-270 range and after failed vagal maneuvers and 2 rounds of adenosine iv the patient was cardioverted to attain nsr again. the patient started to get lightheaded, hypotensive and anxious. prior to cardioversion, anesthesia was called and the patient was sedated and given propofol and midazolam prior to intubation for airway protection and comfort as the patient was extremely anxious and respirations were in the 30s. the patient became very sedated with low rr and repeat abg showed a respiratory acidosis with ph 7.17 and pco2 101. given patient's known sensitivity to benzodiazepines and in light of abg he was given flumazenil 0.2 mg iv for over-sedation concerns. the patient responded well and abg trends improved and respiration rate climbed to appropriate range with ventilation assistance. he remained intubated for several days on assist control mode and then pressure support with very low doses of propofol for comfort and light sedation. the patient's cyclobenzaprine and ativan doses were held and tubefeeds were supplemented for nutrition. he was successfully extubated on . the patient had excellent urine output and self-diuresis s/p extubation and did not require any additional lasix. he complained of a mild sore throat after extubation which abated in 2 days and he was given additional cepacol throat lozenges for added relief. on the day of his planned discharge, he was found to be somnolent and difficult to arouse. an abg showed hypercarbia. he was transfered to the ccu for bipap. it was felt that a bipap titration could be performed, allowing him to be discharged to home with bipap at night and during the day while at rest. he did not tolerate the bipap, however, and he became more hypercarbic. abg on showed a ph of 7.16 and co2 100. he was intubated. pneumonia: the patient's above respiratory distress was felt to be multi-factorial with contributing underlying poor lung reserve at baseline given his mesothelioma alongside a newly recognized lll pneumonia on ct and cxr as well as his extreme anxiety and tendency toward tachypnea. the pulmonary team was called to comment on the patient's cta and cxr findings as compared with reports which were obtained for baseline comparison. the patient's bilateral basal pleural thickening and and bilateral effusions were prominent on prior imaging but he had a newer left lower lobar consolidation which was felt to be a new pneumonia. he also had an elevated white count which was 13 on admission and peaked at 17. he was therefore started on iv vancomycin, zosyn and azithromycin for extended atypical bacterial coverage. a right sided picc line was placed for iv antibiotic therapy. further workup included sputum gram stain and culture, pcp smear, fungal culture , urine legionella antigen,and blood cultures. all studies returned as unremarkable for any definitive infections. . mesothelioma: based on above outlined chest ct and cxr results it is unclear whether that patient has progression of his underlying mesothelioma process in light of overlying changes secondary to new pna and infiltrates which may account for soem of the effusions on imaging. the patient will plan to follow-up with his oncologist at to discuss additional pet / ct scans and to manage his ongoing chemotherapy. the heme-oncology fellows were consulted for any additional recommendations during the hospital stay. of note, the oncology team felt that the patient's lung ct changes and decompensated respiratory status requiring intubation and cardiac ectopy was unlikely secondary to any drug/chemotherapy regimen. . anxiety: the patient was initially managed with low dose ativan and his home celexa regimen but after he had benzodiazepine related somnolence and impaired respirations requiring extubation his ativan was held. he continued to receive his usual home dose of celexa throughout his hospital stay. trazadone was given twice for insomnia but was soon discontinued as the patient was extremely sensitive and became confused and lethargic as with other benzodiazepines that he had previously been taking. . superficial phlebitis: the patient had an erythematous inflammation on his right forearm at the site of a prior iv placement. the area had mild edema and was also tender. no open sores or ecchymoses. an ultrasound was done which showed no underlying abscesses to be drained. he was given warm compresses for some added relief. additional dvt was ruled out by ultrasound as well. he had no febrile episodes corresponding to this presentation. . uti: at admission the patient had a routine ua done which showed wbc with trace leukocytes and negative nitrates but moderate bacteria was noted. the patient's antibiotic regimen for his pna was deemed as adequate coverage for his uti as well. clinically, he denied suprapubic pain, urgency, dysuria or hematuria. follow-up urine culture was negative. . nutrition and electrolytes: in terms of nutrition, the patient continued a regular diet up until he was intubated. during intubation his nutrition was supplemented with tubefeeds via ogt. post-extubation he had a hearty appetite and continued to have good po intake with a regular diet. the patient had persistent hypokalemia and hypomagnesemia during his stay which was repleted continuously. he was ultimately placed on a standing daily magnesium supplement. goal potassium was >4 to avoid any additional pro-arrhythmic effects. these electrolyte abnormalities were attributed to the patient's underlying malnutrition secondary to his advanced cancer and chemotherapy as well as some loose stool he experienced towards the end of his hospital stay. c. difficile studies were negative. transfer of care: it became clear that the initial plan of controlling his svt and discharging him to home for further outpatient management was not possible with his continued hypercarbia. he was thus transferred to / for further oncologic care. the patient's family and fiance were in agreement at time of transfer. his family is aware that his prognosis is guarded. all test results to date and paperwork sent to / upon transfer. medications on admission: metoprolol 37.5mg tid citalopram 20mg daily ativan 1mg folic acid 1mg daily magnesium 250mg daily mvi folic acid famotidine 20mg daily mvi cyclobenzaprine 10mg tid levothyroxine 25ucg daily prochlorperazine 10mg po q6 oxycodone 5mg q4 prn a-z high potency multivitamin fentanyl patch 12ucg q72 discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 3. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 4. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 5. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 6. lorazepam 1 mg tablet sig: one (1) tablet po every four (4) hours: nausea. 7. prochlorperazine 25 mg suppository sig: one (1) rectal four times a day as needed for nausea: use around chemo doses as directed. 8. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 10. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed. 11. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 12. amiodarone 200 mg tablet sig: one (1) tablet po tid (3 times a day). 13. bismuth subsalicylate 262 mg/15 ml suspension sig: fifteen (15) ml po tid (3 times a day) as needed for heartburn/indigestion. 14. magnesium oxide 400 mg tablet sig: one (1) tablet po bid (2 times a day). 15. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). 16. multivitamin tablet sig: one (1) tablet po daily (daily). 17. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours) as needed. 18. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 19. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheezing. 20. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 21. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 22. propofol 10 mg/ml emulsion sig: ten (10) mcg/kg/min intravenous infusion. 23. ondansetron 8 mg iv q8h:prn nausea 24. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 25. budesonide 0.25 mg/2 ml suspension for nebulization sig: one (1) neb inhalation (2 times a day). 26. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) application mucous membrane (2 times a day). discharge disposition: extended care discharge diagnosis: supraventricular tachycardia mesothelioma leukocytosis pneumonia depression discharge condition: intubated, calm but alert on 10mcg/kg/min propofol. discharge instructions: you had rapid heart rate called suprventricular tachycardia that was not controlled on the metoprolol dose you were on. you needed to be cardioverted electrically into a normal rhythm. during this procedure, you were sedated and needed to be intubated so you would get enough oxygen. we changed metoprolol to amiodarone which also slows your heart rate. this medicine will be managed by dr. and there are lung and blood tests that you will need in the next few weeks. you also had a left lower lobe pneumonia shown on chest x-ray and an elevated white blood cell count and you were treated with antibiotics. after discussion with your oncology doctor at the / as well as with your family, it was felt that transfer to this facility for ongoing oncologic care was the next best step. followup instructions: oncology: , md phone: ( date/time: . primary care: , phone: date/time: . cardiology: provider: phone: date/time: 11:00 gryzmysh building on the . please call for directions the day before the test. . provider: , m.d. phone: date/time: 3:20 clinical center . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube insertion of endotracheal tube other electric countershock of heart arterial catheterization diagnoses: pneumonia, organism unspecified acidosis atrial fibrillation depressive disorder, not elsewhere classified acute respiratory failure hodgkin's disease, unspecified type, unspecified site, extranodal and solid organ sites infection and inflammatory reaction due to other vascular device, implant, and graft phlebitis and thrombophlebitis of superficial veins of upper extremities paroxysmal supraventricular tachycardia malignant neoplasm of pleura, unspecified 

Answer: The patient is high likely exposed to