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: heparin agents / amoxicillin attending: chief complaint: left-sided weakness major surgical or invasive procedure: tee history of present illness: 59yo f h/o allergic rhinitis (without h/o asthma), hypothyroidism, h/o cholestasis, s/p bioprosthetic mitral valve thought to be needed after mi and papillary muscle infarction in , who presented here on with fatigue, lethargy and weakness. her current admission was preceeded by 5 days of diarrhea and abdominal pain, with no brbpr or melena. she presented here on and was discharged after abdominal ct and cbc showed no leukocytosis (eo's of 15). on , she had less of an appetite and complained to her husband of feeling generalized fatigue, with no other complaints. on the day of presentation, she could not stand or walk and could not figure out how to put on her gloves and she was brought here. even at the time of my history, the patient cannot relate much of what happened that day. but she confirms her husband's report that she noticed the sudden inability to stand or walk (she feels due to weakness) and she says that she was "disoriented," although she cannot relate to me what she means by that. at present, she denies changes in her vision that day. she denies that she had chest pain or shortness of breath. past medical history: pmh: - erythroderma - hypothyroidism ( grave's disease s/p rai ablation) - history of cholestasis - overactive bladder - deep venous thrombosis (arm; when line in place); coumadin discontinued end of - s/p mvr (bio) ; rupture of papillary muscle and mi (course included chest ct, which showed infiltrates atypical in distribution for aspiration pneumonia) - cardiac cath : normal coronary arteries. - h/o allergic rhinitis in the spring - h/o eosinophilia social history: sh: small-business owner, heavy machinery. married with no kids. no etoh/smoking or drugs family history: fh: - dm in her grandfather. - bullous pemphigoid - skin cancer, cad, multiple strokes in her father physical exam: 98.2 60s 110-140/68-70 18 98% ra general. pleasant. slightly blunted affect. difficulty giving a complete history secondary to long term memory impairments. heent. no icterus. mmm. no ulcers. chest ctab cv s1 s2 no m/r/g soft nt nd +bs ext. wwp. normal pulses neuro. eomi. tongue midline, palate elevates. hearing intact. hyper-reflexive on the left side. she has weakness in the left deltoid, but only minimal weakness in the right deltoid. she has good prox lower extremity and ankle strenght. she has a strong symmetric grip bilaterally. msk. she has no synovitis in her hands, with no pip, mcp, or wrist swelling. she has normal range of motion in her elbows and shoulders. she has normal internal and external rotation of her hips, and flextion of her knees without effusions. no mtp squeeze, and no ankle effusion. r sided hemiparesis - improving, unable to integrate details into complex picture pertinent results: cxr - ap upright chest radiograph: median sternotomy wires are intact. the cardiomediastinal silhouette is within normal limits. the pulmonary vasculature is normal. lungs are clear without focal consolidation, pneumothorax or pleural effusion. contrast is seen within the left upper quadrant, likely secondary to recent ct examination. impression: 1. no acute cardiopulmonary process. . ct - there is no evidence of intracranial hemorrhage. there is a hypodensity in superior aspect of the left frontal , represent an area of infarction. there are calcifications in the basal ganglia bilaterally. surrounding osseous structures and soft tissues are unremarkable. imaged paranasal sinuses are well aerated. impression: area of hypodensity in the left frontal may represent an acute infarction or partial volume averaging, correlation with mr sequences is recommended to further evaluate this finding. . mr - clinical information: patient with left-sided weakness, question of infarct or venous sinus thrombosis. technique: t1 sagittal and axial and flair t2 susceptibility and diffusion axial images of the brain were acquired. following gadolinium, t1 axial and coronal images were obtained. 2d time-of-flight mrv of the head and 3d time- of-flight mra of the circle of were obtained. findings: brain mri: diffusion images demonstrate multiple foci of slow diffusion in both cerebral hemispheres distributed in the frontal and parietal and occipital lobes. small foci of slow diffusion are also seen in both cerebellar hemispheres. findings are indicative of multiple bilateral supra and infratentorial acute brain infarcts. given the disc augmentation of multiple vascular territories, embolic event is favored. there is no evidence of acute or chronic hemorrhage identified. there is no mass effect, midline shift or hydrocephalus seen. impression: multiple bilateral supra and infratentorial acute brain infarcts. mrv of the head: the head mrv demonstrates normal flow signal in the superior sagittal sinus and deep venous system. the left transverse sinus is small in size, which could be a normal variation. the right transverse sinus and jugular vein demonstrate normal flow signal. impression: normal mrv of the head. no evidence of sinus thrombosis. mra of the head: head mra demonstrates normal flow signal within the arteries of anterior and posterior circulation. no evidence of vascular occlusion or stenosis seen. impression: normal mra of the head. . echo - no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). right ventricular systolic function is normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. there is no aortic valve stenosis. trace aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the motion of the mitral valve prosthetic leaflets appears normal. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no evidence of endocarditis. normally-functioning bioprosthetic mitral valve with trace regurgitation. . left upper extremity ultrasound: normal compressibility, color flow, and doppler waveforms are seen in the left internal jugular vein, brachial, basilic veins. though the left axillary vein is not totally compressible, it shows normal color flow and doppler waveforms. normal color flow and doppler waveforms are also demonstrated in the left subclavian vein. impression: no evidence of dvt in the left upper extremity. . skin biopsy - note: no vasculitis is seen in the sections examined. no fungal organisms are seen on pas stain. there is no increase in dermal mucin on alcian blue stain. the findings are consistent with a hypersensitivity reaction, such as to a drug, in the appropriate clinical setting. although less likely, other considerations also include arthropod bites and an id reaction. clinical: 59 y/o white female with complex past medical history who is admitted with hypertension, fatigue and neuropathy. the patient also has diffuse morbilliform type rash on the chest, back, upper extremities, eosinophilia and increased lft's. however, eosinophilia, rash and lfts started prior to hospitalization, prior to receiving antibiotics. differential diagnosis is dress/hypersensitivity reaction (due to mvi, nsaid, or supplement) versus vasculitis churg- versus viral exanthem. location is anterior chest. . ruq u/s: the liver is normal in size and echotexture. no focal hepatic lesions are identified. no intra or extrahepatic biliary ductal dilatation. the common bile duct is not dilated, measuring 5 mm. the visualized portion of the pancreas is seen, however, the distal body and tail are not well seen. the gallbladder demonstrates a normal, relaxed, configuration. there is mild gallbladder wall edema that may be related to third spacing of fluid. there is a 3 mm echogenic focus in the dependent portion of the gallbladder, most likely representing a small polyp. no gallstones are identified. the hepatic veins are abnormally dilated. the portal vein is widely patent and demonstrates normal hepatopetal flow. there is a small amount of perihepatic fluid. there is a right pleural effusion. findings were discussed with neurology resident, dr. , at the time of initial interpretation. impression: 1. mild gallbladder wall edema without other specific son signs of cholecystitis. 2. new right pleural effusion. 3. minimal perihepatic fluid. . echo - the left atrium is normal in size. the estimated right atrial pressure is 0-5mmhg. left ventricular wall thickness, cavity size, and 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. trace aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the mitral prosthesis appears well seated, with normal leaflet motion and transvalvular gradients. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . 07:00pm pt-13.2* ptt-24.7 inr(pt)-1.2* 07:00pm plt smr-normal plt count-196 07:00pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 07:00pm neuts-59.5 bands-0 lymphs-6.1* monos-1.7* eos-32.4* basos-0.3 07:00pm wbc-10.1 rbc-3.61* hgb-10.9* hct-30.1* mcv-83 mch-30.2 mchc-36.1* rdw-14.6 07:00pm tsh-1.1 07:00pm calcium-8.7 phosphate-4.0 magnesium-2.0 07:00pm ck-mb-53* mb indx-14.1* ctropnt-2.02* 07:00pm lipase-19 07:00pm alt(sgpt)-24 ast(sgot)-78* ld(ldh)-544* ck(cpk)-377* alk phos-100 amylase-35 tot bili-0.5 07:00pm glucose-98 urea n-14 creat-1.0 sodium-135 potassium-4.0 chloride-100 total co2-24 anion gap-15 07:12pm glucose-99 k+-3.9 08:45pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-50 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:45pm urine color-yellow appear-clear sp -1.011 08:45pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 08:45pm urine hours-random 09:55pm d-dimer-4134* 10:05pm lactate-1.0 11:30pm cerebrospinal fluid (csf) wbc-1 rbc-392* polys-0 lymphs-100 monos-0 11:30pm cerebrospinal fluid (csf) wbc-0 rbc-13* polys-0 lymphs-0 monos-0 11:30pm cerebrospinal fluid (csf) protein-21 glucose-63 12:26pm pt-14.0* ptt-28.3 inr(pt)-1.2* 12:26pm plt count-204 12:26pm wbc-16.4*# rbc-3.40* hgb-10.3* hct-28.0* mcv-82 mch-30.3 mchc-36.8* rdw-14.7 12:26pm cortisol-28.6* 12:26pm t4-8.2 12:26pm tsh-1.1 12:26pm calcium-7.2* phosphate-3.9 magnesium-1.8 12:26pm ck-mb-96* mb indx-15.7* ctropnt-2.46* 12:26pm lipase-19 12:26pm alt(sgpt)-27 ast(sgot)-85* ck(cpk)-611* alk phos-85 amylase-29 12:26pm glucose-115* urea n-14 creat-0.9 sodium-137 potassium-3.8 chloride-108 total co2-18* anion gap-15 02:13pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-50 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 02:13pm urine color-yellow appear-clear sp -1.017 07:55pm sed rate-55* 07:55pm crp-78.1* 07:55pm anca-negative b 09:18pm urine rbc-0 wbc-0-2 bacteria-few yeast-none epi-0-2 09:18pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-150 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 11:09pm freeca-1.04* 11:09pm lactate-1.1 11:09pm type-art po2-62* pco2-24* ph-7.43 total co2-16* base xs--5 brief hospital course: this 59-year old woman was admitted for falls, found to have mutliple cerebral infarcts, evidence of myocarditis, and persisent eosinophilia. . 1. neurological - the patient was admitted to the neuro-icu and required initial support with pressors. she remained afebrile however, with no source of infection. mri disclosed bilateral cerebellar small infarcts inolving frontal and parietal and occipital lobes, with bilateral cerbral hemisphere infarct in watershed distributions. areas were deemed to represent multiple bilateral supra and infratentorial acute brain infarcts. initially on the ct scan she had area of suspicious involvement in the left frontal , bilateral basal ganglia. it was unsure of these were secondary to periods of hypotension or embolic phenomenon, although an echo was negative for source of emboli. due to concern for aspirin sensitivity, the aspirin was discontinued. patient may be rechallenged in the future with aggrenox/aspirin for secondary stroke prevention. . 2. cardiac - patient cardiac enzymes were initially elevated and remained plateued throughout her stay, thought to be secondary to myocarditis. her troponins were elevated but her ckmb was normal. patient denies chest pain prior to or during her stay. her ekg showed persistent lbbb. her echocardiogram was also unremarkable with normal lvef and no wall motion abnormalities. cardiology was curb-sided and recommended cardiac mri, which was scheduled but could not be completed for technical reasons. this issue will need to be addressed as an outpatient during her cardiology visit. depending on patient's symptoms and , echo or an mri could be entertained at that point. . 3. hematology - patient noted to have persistent eosinophilia, prompting multiple consults throughout here stay to investigate possibile hypereosinophilic syndromes. hematology considered a bone marrow biopsy, but deferred this as possible work-up in the outpatient setting. review of peripheral smear, makes malignant process highly unlikely, patient has a chic fish test pending upon discharge and the result will be followed up in rheumatology clinic. at that point further workup if necessary will be determined. coagulation needs to be addressed as an outpatient. . 4. infectious disease - cultures remained negative, or no growth to date at the time of discharge. steroids were initiated on on , solumedrol 1g q24, beginning on for 5 days, then begun on a steroid taper, to decrease by 5mg q week. patient is being discharged on 30 mg qd. . 5. dermatology - due to a new red rash on the upper torso, dermatology was consulted for skin biopsy, with biopsy results consistent with drug rash, possibly due to vancomycin or cepahlosporin. . 6. gastroenterology - due to patient's complaints of loose stools/diarrhea and to aid in a diagnosis via biopsy, a colonoscopy was considered but was deferred due to resolution of symptoms. . 7. patient had her r scl pulled on upon d/c. . 8. full code . 9. communication: husband , jd home: ; work medications on admission: asa 81 mg qd 60 mg qd levothyroxine 100 mcg qd mvi qd oxybutynin 5 mg qd -pt denies using estradiol (in contrast to omr info) discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for fever. 2. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po every eight (8) hours as needed for itching. 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 4. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 5. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed. 6. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 7. 60 mg tablet sig: one (1) tablet po once a day as needed for allergies. 8. prednisone 5 mg tablet sig: five (5) tablet po once a day for 7 days: 25mg qd for 7 days, to , then dose will decrease. 9. prednisone 10 mg tablet sig: two (2) tablet po once a day for 7 days: to begin on and to end on . 10. prednisone 5 mg tablet sig: three (3) tablet po once a day for 7 days: to begin on and to end on . 11. prednisone 10 mg tablet sig: one (1) tablet po once a day for 7 days: to begin on , to end on . 12. prednisone 5 mg tablet sig: one (1) tablet po once a day for 7 days: to begin on , to end on , to end taper. discharge disposition: extended care facility: - discharge diagnosis: left intracranial hemorrhage (basal ganglia/internal capsule) hypereosinophilia syndrome discharge condition: patient discharged to rehab, walking on her own with deficits in left shoulder and left leg, tolerating po feeds and fluids, vital signs stable, afebrile. discharge instructions: patient was admitted for falls, found to have multiple strokes. she was also found to have abnormal laboratory values and treated with steroids. patient should: 1. take all medications as prescribed. 2. keep all follow-up appointments. 3. seek medical attention if she acquires chest pain, shortness of breath, nausea, vomiting, fevers greater than 101, or any other concern that is out of the ordinary for him. followup instructions: suture removal from skin biopsy site on 1. cardiology: , md phone: date/time: . 2. neurology: , md 8 phone: date/time: 9:00 . 3. , - apg (sb) date/time: 9:50 . 4. rheumatology - dr. - - :00am. - , 4b, across the street from emergency room. . 5. allergy - dr. - , 9:00am. . 6. hematology-oncology - will be considered by rheumatology or allergy physicians. procedure: venous catheterization, not elsewhere classified spinal tap incision of lung diagnostic ultrasound of heart arterial catheterization closed biopsy of skin and subcutaneous tissue infusion of vasopressor agent diagnoses: old myocardial infarction dermatitis due to drugs and medicines taken internally personal history of venous thrombosis and embolism diarrhea heart valve replaced by transplant hypovolemia other specified antibiotics causing adverse effects in therapeutic use cerebral artery occlusion, unspecified with cerebral infarction other nonspecific abnormal serum enzyme levels cephalosporin group causing adverse effects in therapeutic use history of fall myocarditis, unspecified eosinophilia other postablative hypothyroidism 

Answer: The patient is high likely exposed to