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: amoxicillin attending: chief complaint: left sided weakness major surgical or invasive procedure: stereotactic brain biopsy history of present illness: this is a 42 year old woman with a history of ms diagnosed in of this year when she had recurrent vertigo. she began to have left sided weakness 3 days ago. she was treated with solu-medrol for ms flair up. when she did not improve, she went to hospital and her neurologist recommended an mri brain. this showed a large ring enhancing lesion on the right. she was given solu-medrol, decadron and 1g fosphenytoin. she was transferred to for further management. she is usually ambulatory. she had a colonoscopy and mammogram last year without abnormal finding. she reports headache,posterior rle numbness to the ankle. she denies fever chills,pain, nausea. past medical history: ms, ulcerative colitis, asthma, bony tumor removed for her right ear with a mastoidectomy > 10 years ago. pathology unknown. social history: she is right handed. she lives with her husband, she works cleaning houses. she does not smoke and she rarely uses etoh. family history: family hx:her maternal grandmother had lung ca. physical exam: on admission: gen: wd/wn, nad heent: pupils: 2-1.5 eoms intact extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam orientation: oriented to person, place. language: speech slurred. naming intact. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 2 to 1.5 mm bilaterally. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii:left facial droop. viii: hearing intact to voice. xii: tongue midline without fasciculations. motor: tri grip ip at l 0 0 0 0 2 3 3 3 r 4+ 4+ 4+ 4+ 4+ 5 5 5 sensation: intact to light touch toes downgoing right, upgoing on left coordination: normal on finger-nose-finger on the right at discharge: vs: tmax-98.6 tcurrent-98 bp-112/17 hr-80 rr-18 o2sat-97% on ra gen: no acute distress. pleasant demeanor. heent: perrl, eomi, moist mucous membranes, clear oropharynx neck: no jvd, no lymphadenopathy cardio: rrr, no murmurs, rubs, gallops lungs:decreased breath sounds at bilateral lung bases. dry crackles at right lung base. no wheezing. abdomen: soft, nontender, nondistended, normoactive bowel sounds extremities: no edema or cyanosis. neuro: cranial nerves ii-xii grossly intact with exception of left facial droop. 4/5 strength in left upper and lower extremities. 5/5 strength in right upper and lower extremities. pertinent results: admission labs: 12:38am blood wbc-12.2* rbc-3.68* hgb-11.9* hct-35.4* mcv-96 mch-32.4* mchc-33.7 rdw-13.2 plt ct-334 05:55am blood neuts-83.3* lymphs-9.4* monos-6.8 eos-0.1 baso-0.3 12:38am blood pt-12.2 ptt-26.0 inr(pt)-1.1 12:38am blood glucose-163* urean-11 creat-0.6 na-142 k-3.5 cl-107 hco3-26 angap-13 12:38am blood calcium-9.0 phos-4.7* mg-2.0 discharge labs: 06:00am blood wbc-5.1 rbc-3.02* hgb-9.8* hct-28.9* mcv-96 mch-32.3* mchc-33.7 rdw-14.1 plt ct-193 06:00am blood pt-12.6* ptt-29.9 inr(pt)-1.2* 06:00am blood glucose-85 urean-7 creat-0.4 na-134 k-4.7 cl-97 hco3-28 angap-14 06:00am blood calcium-9.0 phos-4.3 mg-2.0 microbiology: blood cultures : pending at time of discharge, ngtd mri brain-wand study 1. unchanged heterogeneously enhancing lesion in the right frontal region with significant edema in the basal ganglia and mass effect as described above. fiducial markers are in place. 2. unchanged right cerebellar enhancing lesion with mild vascular enhancement, adjacent to the cerebellar nodule on the right, possibly consistent with a developmental venous anomaly, a second lesion in this region cannot be completely ruled out. ct head a large right frontotemporal mass with extensive surrounding vasogenic edema and mass effect and leftward shift of midline structures to approximately 8 mm. subfalcine and uncal herniation. the above findings in conjunction with the prior mri are concerning for a tumefactive multiple sclerosis or a primary malignant tumor (including primary versus secondary). the above findings were discussed with , at approximately 1:30 a.m. and immediately after the ct study. mri brain: 1. limited study for surgigal planning showing mild interval improvement in the ring-enhancing mass in the left frontal lobe with reduction in degree of mass effect. 2. relatively stable appearance of right cerebellar enhancing focus, suggesting multifocal disease. ct head postop: impression: 1. pneumocephalus and small amount of acute blood products in the right frontal region after biopsy. 2. right frontotemporal edema due to large mass with subfalcine herniation, better-delineated on mri of earlier today. mild effacement of the right perimesencephalic cisterns is improved from . chest x-ray (pa and lat) conclusion: new airspace consolidation at the base of both lungs, but more prominent in the right lower lobe, suggestive of multifocal pneumonia or aspiration. leni's: impression: deep venous thrombosis within the left gastrocnemius and soleus veins. ct abd & pelvis w/o con impression: 1. no acute intra-abdominal or intra-pelvic process. 3. bilateral lower lobe consolidative opacities, right greater than left, possibly secondary to compressive atelectasis given the adjacent pleural effusions, although infection or aspiration could have a similar appearance. 3. small quantity of sludge within the gallbladder. no associated gallbladder wall thickening to suggest acute cholecystitis. brief hospital course: ms. is a 42 yo female with a history of multiple sclerosis, ulcerative colitis, and asthma who presented with a rapid decline in strength and level of consciousness and found to have primary cns b cell lymphoma after stereotactic brain biopsy. her course was complicated by dvt, probable pe, and pneumonia. active diagnoses: # primary cns b cell lymphoma: ms. was transfered from hospital to the nsicu. her mri was entered into our system. she was on decadron for cerebral edema. her speech became more slurred during the night and decadron was increased to 10mg q6 hours. mannitol was started. ct head was done to rule out hemorrhage as her exam was dramatically worse then what was portrayed in the transfer notes. it was negative for hemorrhage but showed a frontotemporal mass. she was started on dilantin on the neurology service given seizure at osh. with medical management her exam improved with less weakness on her left. neuromedicine requested a biopsy due to the fact that review of osh records revealed an lp that did not suggest ms. they were concerned for tumor. on the night of , she was taken to the or on for a stereotactic brain biopsy. preliminary pathology was reviewed with heme-path and thought to be primary cns b-cell lymphoma. postoperative ct head demonstrated mild pneumocephalus and small amount of acute blood products in the area of the biopsy. patient was transferred to the neuro-sdu. her exam remained stable. on , patient was transferred to the floor. she continued on high dose steroids. over the next several days her exam improved with improvement of her left facial droop and left-sided weakness. she was transitioned from dilantin to keppra for seizure prophylaxis. her dexamethasone was tapered to dexamethasone 4 mg twice daily without further taper for the next week. she will be readmitted to the service next week on for chemotherapy and second dose of methotrexate. # dvt/pe: patient developed pleuritic right sided chest/abdominal pain and tachycardia. it was suspected that she had a pe, so lower extremity ultrasound was obtained which confirmed left lower extremity dvts. unable to perform cta chest given concern for contrast affecting renal function while dosing mtx. patient was treated with heparin drip then transitioned to lovenox for discharge. she was given dilaudid as needed for pain control. # health care associated pneumonia: patient developed fever and hypoxia during her hospital course and was found to have right pleural effusion and bilateral opacities worrisome for pneumonia. patient was treated for hcap with cefepime and vancomycin. she is discharged with a picc line and will continue cefepime and vancomycin for 4 more days with last dose to be completed on to complete an eight day course. she remained afebrile for >48 hours prior to discharge. # constipation: most likely secondary narcotics and inactivity. pt was given senna, colace, miralax, in addition to prn lactulose. # abdominal pain: likely referred from right-sided pleuritic pain as discussed above. ct abdomen showed no acute process. pt's pain improved when treated for thrombosis and pneumonia. # anemia: no active s/s of bleeding. most likely related to phlebotomy, acute illness and mtx treatment. inactive diagnoses: # ulcerative colitis: held mesalamine and discharged with plan to continue to hold for now given as it can interfere with methotrexate. # asthma: no signs of exacerbation. continue singulair, advair, albuterol prn. transitional issues: 1. code status: full 2. contact: 3. med changes: - start vancomycin 1 gram every 12 hours for 4 more days (last day = ) - start cefepime for 2 gram every 8 hours for 4 more days (last day = ) - start lovenox 60mg sc injections twice daily - start levetiracetam 500mg by mouth twice daily - start dexamethasone 4mg by mouth twice daily - start omeprazole 40mg by mouth daily - start calcium + vit d twice daily - start dilaudid 4mg by mouth every 4 hours as needed for pain **this medication can cause sedation and should not be taken when doing heavy activity. - start docusate sodium 100mg tablet three times per day (for constipation) - start senna 2 tablets daily as needed for constipation - start miralax packet once daily as needed for constipation - start ondansetron 4mg by mouth every 8 hours as needed for nausea - stop mesalamine please continue the other medications you were taking prior to this admission. 4. follow up: with oncology with readmission next week, dr. for additional mtx 5. pending studies: final pathology read for tumor biopsy medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr. 1. mesalamine 1200 mg po tid 2. fluticasone-salmeterol diskus (100/50) 1 inh ih 3. montelukast sodium 10 mg po daily 4. albuterol inhaler 1 puff ih q6h:prn wheeze 5. fluticasone propionate nasal 1 spry nu daily 6. meclizine dose is unknown po frequency is unknown - not taking, rarely 7. diphenhydramine dose is unknown po frequency is unknown - not taking 8. acetaminophen 650 mg po q6h:prn pain or fever > 101.4 discharge medications: 1. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 2. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) inhalation inhalation twice a day. 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation q6h (every 6 hours) as needed for sob/wheeze. 4. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal daily (daily). 5. docusate sodium 100 mg capsule sig: one (1) capsule po tid (3 times a day). 6. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. polyethylene glycol 3350 17 gram powder in packet sig: one (1) powder in packet po daily (daily). 8. dexamethasone 4 mg tablet sig: one (1) tablet po bid (2 times a day). 9. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 10. senna 8.6 mg tablet sig: two (2) tablet po daily (daily) as needed for constipation. 11. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 4 days: day 1 = , last day , to complete 8 day course. 12. cefepime 2 gram recon soln sig: two (2) recon soln injection q8h (every 8 hours) for 4 days: day 1 = , last day , to complete 8 day course. 13. calcium citrate + d 315-200 mg-unit tablet sig: one (1) tablet po twice a day. 14. enoxaparin 60 mg/0.6 ml syringe sig: sixty (60) mg subcutaneous q12h (every 12 hours). 15. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. 16. hydromorphone 2 mg tablet sig: two (2) tablet po every four (4) hours as needed for pain: do not take while driving or doing heavy activity . discharge disposition: extended care facility: discharge diagnosis: primary: 1. cns b-cell lymphoma 2. deep vein thrombosis 3. pneumonia secondary: 1. ulcerative colitis 2. asthma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mrs. , it was a pleasure taking care of you during your stay at . you came to the hospital for weakness in your legs and were found to have a brain lesion. a stereotactic brain biopsy was performed and found that you have cns b-cell lymphoma. you were started on steroids to reduce the swelling in your brain and your weakness gradually improved. chemotherapy was started with methotrexate. you also developed blood clots in your leg and most likely had a blood clot in your lungs causing you pain in your back. you developed a fever and a cxr showed that you probably have a pneumonia. you were started on antibiotics and improved. a picc line was placed so you can continue antibiotics as an outpatient. the following medications were changed during this admission: - start vancomycin 1 gram every 12 hours for 4 more days (last day = ) - start cefepime for 2gram every 8 hours for 4 more days (last day = ) - start lovenox 60mg injections twice daily - start levetiracetam 500mg by mouth twice daily - start dexamethasone 4mg by mouth twice daily - start omeprazole 40mg by mouth daily - start calcium + vit d twice daily - start dilaudid 4mg by mouth every 4 hours as needed for pain **this medication can cause sedation and should not be taken when doing heavy activity. - start docusate sodium 100mg tablet three times per day (for constipation) - start senna 2 tablets daily as needed for constipation - start miralax packet once daily as needed for constipation - start ondansetron 4mg by mouth every 8 hours as needed for nausea - stop mesalamine please continue the other medications you were taking prior to this admission. followup instructions: please follow-up with the following appointment: department: neurology when: friday at 1 pm with: , md building: sc clinical ctr campus: east best parking: garage you will return to the hospital next week on prior to your next dose of methotrexate. after that hospitalization, we will help to arrange further follow-up appointments. procedure: enteral infusion of concentrated nutritional substances closed [percutaneous] [needle] biopsy of brain injection or infusion of cancer chemotherapeutic substance other immobilization, pressure, and attention to wound central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified anemia, unspecified unspecified pleural effusion hyposmolality and/or hyponatremia asthma, unspecified type, unspecified other convulsions compression of brain constipation, unspecified cerebral edema dysarthria acute venous embolism and thrombosis of deep vessels of proximal lower extremity unspecified sedatives and hypnotics causing adverse effects in therapeutic use other conditions of brain personal history of other diseases of digestive system hemiplegia, unspecified, affecting nondominant side primary central nervous system lymphoma, unspecified site, extranodal and solid organ sites 

Answer: The patient is high likely exposed to