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: no known allergies / adverse drug reactions attending: chief complaint: malaise, fevers, weight loss and weakness major surgical or invasive procedure: picc line insertion history of present illness: 64 yo m w/ no significant pmh presenting with 3 weeks of generalized weakness and found to have elevated lfts. he has been generally healthy, approx 3 wks ago he experienced the gradual onset of fatigued, decreased appetite, "bad" taste in mouth, and some fever/chills. he finally went to ed 2 days prior, cxr neg, was diagnosed with uti, discharged on levoquin at . symptoms persisted until today, so he returned to the ed at . ua was neg but he was found to have elevated lfts. us showed hypoechoic lesions in liver and spleen and he was transferred here for inpatient workup and mrcp/ercp. . this has never happened before and he denies any past hx. of jaundice, blood transfusions, iv drug abuse, or new sexual partners. has not been sexually active with his wife for at least 6 months. he drinks alcohol x per week at dinner with his wife. has been taking tylenol x per day since this past wed as instructed over the counter. he did travel to his summer home at 3 weeks ago, but denies any tick bites. he does have pet dogs and lives in semi wooded area outside . . in the ed initial vitals were:97 102 97/65 18 100% ns x 1 liter in ed and was transferred to the floor. heme/onc on board, he was ruled out for ttp and dic. id recommended started zosyn and doxy for tick borne or hepatobiliary causes. pt found to be tacycardic to the 160s while going to bathroom which resolves to the 100s. ekg with sinus tachycardia and rate related v3 st depressions. he was bolused 4l and hemodynamics improved to hr 110s, 115/67, but continued to be more work for nursing. on arrival to the micu,:103 bp:121/70 p:114 r:42 o2:87% on ra, returned to 98% on 4l nc. pt alert, confused, shaking with chills. no acute distress. review of systems: (+) per hpi the patient major complaints are fevers, chills, decreased appetite, and weight loss of 6-7lbs in last 3 wks. (-) he denies any abdominal pain, nausea,rashes,confusion, athralgias, myalgias, muscle weakness, sore throat,stiff neck, headache, vision changes, vomiting, gerd, nocturnal cough, cough, chest pain, dyspnea, melena. he usually passes one brown bm per day, over the past 3 weeks he has been passing yellow semi loose stools per day but denies frank watery diarrhea. he denies any recent travel outside the country or sick contacts. denies any dysuria,low back pain,nocturia, hematuria, penile lesions or penile discharge, flank pain. he denies dyspepsia, early satiety, or dysphagia. . past medical history: left hip replacement. depression social history: denies blood transfusion hx, no illicit drugs. drinks alcohol socially x per week with wife. use for "few years" last as teenager. last sexually active with wife at least 6 months ago. family history: no hx of liver or autoimmune disease physical exam: admission exam: vitals: t:103 bp:121/70 p:114 r:42 o2:87% on ra, returned to 98% on 4l nc. pt confused, mumbling, oriented x1. denied any pain. general: alert, oriented x1, stuttering, unable to construct coherent sentences. heent: sclera icteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 4+/5 strength symmetric upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge exam: vitals: t:98.2 bp:130/82 p:70 r:18 o2:98% on ra, general: alert, oriented x3, nad lying comfortably in bed heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, 1+ edema le, no clubbing, cyanosis neuro: anisocoria l>r, cnii-xii intact, no focal neurologic deficits, 5/5 strength symmetric upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally. pertinent results: 07:04pm urine hours-random creat-200 sodium-less than potassium-41 chloride-11 07:04pm urine osmolal-680 06:59pm urine hours-random 06:59pm urine gr hold-hold 06:59pm urine color-dkamb appear-hazy sp -1.021 06:59pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-mod urobilngn-4* ph-6.0 leuk-neg 06:59pm urine rbc-1 wbc-10* bacteria-few yeast-none epi-0 06:59pm urine hyaline-31* 06:59pm urine mucous-few 05:54pm pt-14.4* ptt-32.2 inr(pt)-1.3* 04:20pm glucose-117* urea n-32* creat-1.1 sodium-130* potassium-4.2 chloride-97 total co2-24 anion gap-13 04:20pm estgfr-using this 04:20pm alt(sgpt)-223* ast(sgot)-402* ld(ldh)-452* ck(cpk)-83 alk phos-284* tot bili-4.3* dir bili-3.5* indir bil-0.8 04:20pm lipase-13 04:20pm albumin-2.6* calcium-9.6 phosphate-3.1 magnesium-1.6 04:20pm hav ab-negative 04:20pm asa-neg ethanol-neg acetmnphn-8* bnzodzpn-neg barbitrt-neg tricyclic-neg 04:20pm wbc-4.1# rbc-4.34* hgb-12.2* hct-37.5* mcv-86 mch-28.1 mchc-32.5 rdw-12.9 04:20pm neuts-89.4* lymphs-7.1* monos-3.0 eos-0.4 basos-0.1 04:20pm plt count-120*# 04:20pm ret aut-0.5* abdomen ct: there is minimal bibasilar dependent atelectasis. the visualized portions of the lungs are otherwise clear. innumerable small hypodensities are seen throughout the liver, measuring up to 14 mm in the right hepatic lobe (2:28). there are also innumerable, similar-appearing hypodensities throughout the spleen. the spleen is moderately enlarged, measuring up to 15.8 cm in its craniocaudal dimension. the portal vein is patent. the gallbladder is unremarkable. there is a 7-mm hypodense lesion in the pancreatic body (2:22), possibly a cyst versus side-branch ipmn. the pancreas is otherwise normal. there is no dilation of the main pancreatic duct or common duct. there is no intrahepatic biliary duct dilatation. the adrenal glands are grossly normal. the kidneys excrete contrast symmetrically. no focal renal lesions are identified. there is no hydronephrosis. the stomach and small bowel are grossly unremarkable. there is extensive diverticulosis, predominantly involving the sigmoid colon, without definite evidence for diverticulitis. the appendix is not definitely identified. there is a small quantity of free fluid within the mesentery and dependent portion of the pelvis. there is no free air in the abdomen. multiple enlarged lymph nodes are seen along the retroperitoneum, specifically in the aortocaval region. the largest nodal conglomerate is in the left paraaortic region at the level of the left renal hilum, measuring 4.1 x 2.0 x 4.2 (ap x tv x cc). this lesion demonstrates central hypodensity, consistent with necrosis (2:31, 601b:26). an additional representative node within the aortocaval region measures 2.6 x 1.6 cm (2:34). an enlarged portacaval node measures 1.8 x 1.3 cm (2:26). pelvis ct: the bladder is unremarkable. the prostate is normal in size. there are no pathologically enlarged pelvic lymph nodes. bone window: no suspicious lytic or blastic lesions are identified. multilevel degenerative changes of the thoracolumbar spine are seen. note is made of a left total hip arthroplasty. impression: 1. innumerable hepatic and splenic small hypodensities, concerning for lymphoma versus metastases, although an infectious process cannot be entirely excluded. the presence of bulkly retroperitoneal lymphadenopathy would favor a neoplastic process. further evaluation with mri may provide additional information. 2. small volume ascites, predominantly within the dependent portion of the pelvis. 3. 7-mm hypodense lesion in the pancreatic body, possibly a cyst versus side-branch ipmn. further evaluation with mri is recommended. 4. extensive colonic diverticulosis, particularly involving the sigmoid colon, without evidence of diverticulitis. liver biopsy(): extensive necrosis(approximately 80%). viable areas demonstrate mild steatosis and a polymorphous lymphoid infiltrate, which focally effaces the liver parenchyma. cells are positive for cd30 with co-expression of cd45, cd20, cd79, pax5, -1 and -2 but are negative for cd5, cd15, and alk-1. cd30 positive cells far outnumber cd20 positive cells. liver biopsy results indicate a lymphoma with features intermediate between diffuse large b-cell lymphoma and classical hodgkin lymphoma (grey zone lymphoma). in this case, a hodgkin lymphoma is favored for the following reasons: 1) co-expression of cd30, .2, and pax5 with evidence of ebv-infection (lmp+) is more likely to be associated with hodgkin lymphoma. 2) cd30+ cells far outnumber cd20 positive cells, indicating loss of cd20 in the majority of cd30 positive cells. 3) the subsequent biopsy of the patient's bone marrow (s12-31075h) revealed patchy infiltration by a lymphoma containing classic -sternberg cells and an appropriate immunoreactive background. mr head w & w/o contrast (): impression: no evidence of intracranial lymphoma. no evidence of acute intracranial abnormalities. unilat up ext veins us left (): impression: no left upper extremity deep venous thrombosis. fdg tumor imaging (pet) (): report pending discharge labs: 12:10am blood wbc-2.4* rbc-2.97* hgb-8.5* hct-25.5* mcv-86 mch-28.5 mchc-33.3 rdw-15.7* plt ct-171 12:10am blood neuts-78.6* lymphs-19.2 monos-2.2 eos-0 baso-0 12:10am blood pt-11.4 ptt-23.4* inr(pt)-1.1 12:10am blood glucose-130* urean-22* creat-0.6 na-136 k-4.5 cl-105 hco3-27 angap-9 12:10am blood alt-109* ast-52* ld(ldh)-197 alkphos-418* totbili-2.3* 12:10am blood albumin-2.3* calcium-7.6* phos-2.4* mg-2.0 uricacd-2.0* brief hospital course: 64 y.o male w/ no significant pmhx presenting with 3 weeks of generalized weakness, fevers/chills decreased appetite found to have elevated lfts,anemia/thrombocytopenia and hepatic/splenic hypodensities on ct which was found to be stage iv hodgkins lymphoma with involvement of the liver, spleen, and bone marrow. micu course: #fever: he had a high fever in the setting of vague weakness, slight jaundice, and hepatic lesions. possible diagnoses included acute viral hepatitis vs. tick- illness (human ehrlichiosis and anaplasmosis and babesia) vs malignancy. less likely on the differential included autoimmune hepatitis, alcoholic hepatitis, and lower biliary process. acute hiv was also considered. he was started on vanc/zosyn/doxycycline for empiric coverage. hepatitis b/c serologies and pcr revealed him to be hcv negative. blood smear was unremarkable for parasites. anaplasma/ehrlichiosis/babesia serologies revealed: lyme was negative. ebv serologies revealed past infection. ct abdomen revealed innumerable hepatic and splenic small hypodensities, concerning for lymphoma versus metastases, w/ infection also possible. a 7-mm hypodense lesion in the pancreatic body, possibly a cyst versus side-branch ipmn, was also found. mri abdomen revealed an enlarged edematous liver with hepatomegaly and gallbladder wall edema, multiple focal hepatic lesions and innumerable focal lesions in the spleen. and retroperitoneal lymphadenopathy, suggestive of a lymphoproliferative disorder. sarcoidosis was also considered possible. two subcentimeter pancreatic cysts w/ 12-month mri f/u recommended were also seen. an us-guided biopsy of the liver was performed, with preliminary results concerning for lymphoma vs. hemophagocytic lymphohistiocytosis. cytology revealed atypical cells of undetermined significance. am cortisol was elevated to 35. ldh was elevated to the 500s-600s during throughout his micu stay. blood, fungal, and urine cultures were unremarkable. c. difficile was negative. id and heme/onc were consulted, and they recommended that empiric antibiotic therapy be discontinued given that liver biopsy was consistent with malignant process. heme/onc began allopurinol for uric acid production prophylaxis and dexamethasone was started with daily surveillance of tumor lysis labs. potassium increased significantly after initiation of steroids, without any ekg findings (no prolonged pr interval, peaked t waves, or widened qrs) at k of 5.6 and 7.3. #liver/splenic hypodensities: while in the micu, the liver and splenic hypodensities were most suspicious for malignancy of lymphoma or mets (likely primary would be from prostate/pancreas). also possible were small abscesses given fever and acute sx. ir-guided percutaneous biopsy revealed grey zone lymphoma of the liver. #altered mental status: pt exhibited acute confusion which seems to be far from his baseline. be due delerium febrile state. also question of acute intracranial process as he did have transient difficulty with language. no other localizing neurological symptoms. also possible ams is secondary to hyponatremia, however this level is not extremely low. tsh was within normal limits. #thrombocytopenia/anemia: no signs of bleeding or melena. in the setting of acute illness. no clinical splenomegaly. coags not concerning .likely related to infectious/malignancy process above. #hypotension and tachycardia: pt was febrile at the time and had gotten up to go to the bathroom and was syncopal. likely he was hypovolemic and also vasodilated in the setting of fever. improved when fever was treated and volume was repleted. on the floors medicine/bmt: # hodgkins lymphoma: pt was found to have stage iv hodgkins lymphoma with involvement of the liver, spleen, bone marrow, and likely subcarinal lymph nodes. both percutaneous biopsy of the liver and bm biopsies were obtained, which revealed lymphoma with characteristics intermediate between large b cell lymphoma and classical hodgkin lymphoma. given the prescence of -sternberg cells in the bone marrow this is most consistent with hodgkins lymphoma. due to his liver enzymes being elevated he was first started on dexamethasone for treatment of the lymphoma. after several days his lft's and bili began to trend down such that chemotherapy could be started. pt was informed about his options of chemo with dr. , dr. and dr. . beacopp was initated on , holding adriamycin and procarbazine due to persistently elevated lfts. pt received reduced dosage chemotherapy and on tbili was down to 2.6 so procarbazine and adriamycin were added at a reduced dosage. pt tolerated chemotherapy regimen well and will be discharged on procarbazine and prednisone to continue the beacopp regimen with the plan for him to get day 8 bleomycin and vincristine as an outpatient. he also had a staging pet scan on of which the is pending. # anisocoria: in addition on the floors pt experienced new onset anisocoria l pupil > r pupil which was concerning for cns lymphoma. pupils remain reactive to light and accommadation and eomi. pt remains alert and oriented. no change in mental status. a mri of the head with and without contrast did not reveal any intracranial lymphoma. in addition, pt does not have any other focal neurologic deficits. at this time it is unclear why the patient has anisocoria. per pt request an lp was deferred at this time. # liver/splenic hypodensities- pt presented to the hospital with fatigue and weakness. his labs revealed transaminitis and elevated bilirubin. follow-up ct scan of the abdomen revealed lesions on the liver and spleen along with retroperitoneal lad, which were concerning for either malignancy (lymphoma vs. mets) vs. infectious. he was started empirically on vancomycin, piperacillin-tazobactam, and doxycycline. once on the floor, he was sent for a biopsy of the livery lesion, the initial read of which revealed lymphocytic infiltration concerning for lymphoma vs. lymphophagocytic histiocytosis. it was later determined to be a grey zone lymphoma. hep b surface ag, surface ab, core ab negative. hav ab neg. bcv ab negative. cea 2.8 wnl. after liver and bm biopsy confirmed lymphoma, he was stopped on all antibiotics, and started on allopurinol for ppx against elevated uric acid, and 40mg iv dexamethasone qd with tumor lysis labs. his k trended upward to 5.6 and 7.3 s/p initiating steroids, with normal ekg. #pancytopenia-no signs of bleeding or melena. improving on steroids. anemia without thrombocytopenia. in the setting of acute illness. no clinical splenomegaly. coags are not concerning. likely related to malignancy process and secondary to chemotherapy. pt did not require transfusion suppport during in house chemotherapy. #fever: resolved. had high fever in the setting of vague weakness, slight jaundice, and hepatic lesions. this was likely secondary to malignancy as other etiologies on differential including autoimmune hepatitis, alcoholic hepatitis, and lower biliary process were ruled out. hepatitis labs were negative for hav, hbv, and hcv. also possible is acute hiv. however hiv ab was found to be negative. pt had received tylenol prn for fever, limit to 2g daily in light of liver dysfunction. on discharge pt is currently afebrile. #upper extremity swelling: on night of pt noticed swelling of left upper extremity where picc line is in place, not associated with pain or erythema. concern was for upper extremity dvt. duplex ultrasound showed no evidence of upper extremity dvt. currently no pain or erythema around picc line, and swelling decreased this am. picc site should be monitored for signs of infection, erythema, warmth. #transaminitis/hyperbilirubinemia: secondary to hepatocellular injury/cholestasis due to lymphoma involvement of the liver. ast/alt/alp decreased since admission, t bili is now down to 2.6. lft's should continue to be monitored as an outpatient. #hyperglycemia: blood glucose has been mildly elevated since starting steroids. -check bg before meals and bedtime. pt was on low dose iss for hyperglycemia (bg>150). pt did not require much insulin. pt will be discharged with 4 days of steroids and then tapered. no need for insulin at home given only mild elevation of glucose on steroids. chronic issues: # depression - on citalopram at home. he was initially started on paxil, but transitioned to citalopram, s/p confirmation of medications with pharmacy. mood improved until diagnosis of lymphoma was made. his low mood currently is appropriate given his new diagnosis of lymphoma. pt was instructed to not take citalopram while undergoing chemotherapy. transition issues: #pt will need to get day #8 chemo (vincristine and bleomycin on ). an appointment with dr. has been scheduled #pt will need to take neupogen after day #8 chemo. a prescription was called in his pharmacy. pt was instructed not to take neupogen until instructed by his oncologist. medications on admission: home medications: levofloxacin x 2 days citalopram 20mg qd discharge medications: 1. allopurinol 300 mg po daily rx *allopurinol 300 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 2. docusate sodium 100 mg po bid:prn constipation rx *docusate sodium 100 mg 1 capsule(s) by mouth :prn disp #*60 capsule refills:*0 3. omeprazole 20 mg po daily rx *omeprazole 20 mg 1 capsule(s) by mouth daily disp #*30 capsule refills:*0 4. procarbazine hcl 150 mg po days 1, 2, 3, 4, 5, 6 and 7. (, , , , , and ) (100 mg/m2 - dose reduced by 25% to 75 mg/m2) reason for dose reduction: lft abnormalities 5. prednisone 100 mg po daily days rx *prednisone 10 mg 10 tablet(s) by mouth daily disp #*40 tablet refills:*0 6. senna 1 tab po bid:prn constipation rx *senna 8.6 mg 1 capsule by mouth : prn disp #*30 capsule refills:*0 7. ondansetron 8 mg po q8h:prn nausea rx *ondansetron hcl 4 mg tablet(s) by mouth q8h: prn disp #*60 tablet refills:*0 8. filgrastim 300 mcg sc q24h duration: 10 doses please do not start until instructed to by oncologist. rx *neupogen 300 mcg/0.5 ml 1 subcutaneous injection daily once instructed to start by oncologist daily disp #*10 syringe refills:*2 9. nystatin oral suspension 10 ml po qid rx *nystatin 100,000 unit/ml 10 ml by mouth four times a day disp #*1 bottle refills:*2 10. sulfameth/trimethoprim ss 1 tab po daily rx *sulfamethoxazole-trimethoprim 400 mg-80 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*2 11. acyclovir 400 mg po q8h rx *acyclovir 400 mg 1 tablet(s) by mouth qh8 disp #*90 tablet refills:*0 discharge disposition: home with service facility: critical care systems discharge diagnosis: hodgkins lymphoma hepatitis/biliary obstruction secondary to lymphoma anisocoria left upper extremity swelling discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure caring for you on your recent hospitalization at . you came to the hospital because you were having fevers, weight loss, fatique, and jaundice. you were found to have liver dysfunction which was due to having a tumor in your liver. we then found that you had hodgkins lymphoma with involvement of your liver and spleen. you were given steroids after which your liver function improved. you were then started on chemotherapy for the hodgkins lymphoma which you tolerated very well. the chemotherapy you received was reduced dosage since your liver function was still decreased. we also found that your pupils were unequal in size and so we preformed a mri scan of your head which was normal. you also had a pet scan to determine the extent of the lymphoma. you also experienced swelling of your left arm around the site of your iv line. an ultrasound showed that you did not have any blood clot in or around the iv catheter. please follow up with the following appointments as listed below. please take the following medications: acyclovir 400mg po q8h bactrim ss 1 tab daily prednisone 100mg by mouth x 4 days procarbazine hcl 150 mg by mouth x 4 days allopurinol 300 mg by mouth daily docusate sodium 100 mg by mouth twice per day as needed for constipation omeprazole 20 mg by mouth daily ondansetron 8 mg by mouth every 8 hours as needed for nausea filgrastim 300 mcg subcutaneous injection once daily: please do not start taking filgrastim until instructed to by oncologist. followup instructions: department: bmt chairs & rooms when: friday at 9:00 am department: hematology/oncology when: friday at 9:00 am with: , bsn building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: friday at 9:30 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: closed (percutaneous) [needle] biopsy of liver biopsy of bone marrow injection or infusion of cancer chemotherapeutic substance central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified anemia, unspecified depressive disorder, not elsewhere classified candidiasis of mouth obstruction of bile duct anisocoria hodgkin's disease, unspecified type, lymph nodes of multiple sites other pancytopenia 

Answer: The patient is high likely exposed to