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: zosyn attending: chief complaint: pancytopenia major surgical or invasive procedure: intrathecal chemotherapy bone marrow biopsy picc line history of present illness: 26m w/ no pmhx presents with fatigue. started a month ago, progressively worsened. occasionally has had fever at night of up to 100.4. reports that he has profound exertional dyspnea and fatigue, with very decreased exercise tolerance. scraped left leg two weeks ago, developed cellulitis, has been on bactrim and augmentin x 8 days. yesterday developed lines in his left eye vision, pcp found retinal hemorrhages and pancytopenia. sent to , received 2u prbcs, transferred here for platelets. no nausea/vomiting, cp, abd pain, epistaxis, hematuria, blood in stool, rashes. initial vs in the ed: 99.2 92 126/76 16 100%. exam notable for bilateral retinal hemorrhages. labs notable for leukopenia to 2.2 with only 7% pmns, hct 15, and platelets 6. patient was given 2 units prbcs and 1 unit of platelets. hct went down, cr went up. review of systems: (+) per hpi (-) denies night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: none social history: social history: lives with his girlfriend in the basement of his parents' house. works as a fry cook. no sick contacts. kids or pets. clean living situation. no travelling although went camping x 1 in / and did remove one tick but it was not engorged and never developed rash. never smoker, drinks 3 beers a couple times a week, denies illicits. sexually active with girlfriend only. family history: no history of autoimmune disorders. grandfather has leukemia. physical exam: admission exam: vitals: t: 98.0, bp: 123/70, p: 84, r: 16, o2: 100% 2l nc general: alert, oriented, anxious, pale heent: sclera anicteric, dry mucus membranes, oropharynx clear without ulcers, scattered petechiae on bilateral periorbital skin neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cn 2-12 intact, gait normal, strength 5/5 bilateral upper and lower extremities discharge exam: vs: 98.1 118/76 16 100 ra admission wt 192.79 lbs gen: nad heent: ulcers much improved. cv: rrr, s1 s2, no m/r/g chest: lctab abd: soft, nt, nd, no hsm, bowel sounds present ext: no c/c/e. picc site non-tender with mild erythema around insertion and around tape. skin: fine, erythematous, maculopapular rash on scalp is improving but with worsening confluent rash on trunk and now on distal arms and legs. r knee lesion, l anterior leg lesion - both stably erythematous. warts on toes. neuro: a+o x 3 pertinent results: =================================== admission labs =================================== 09:35pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 09:35pm urine color-straw appear-clear sp -1.010 09:35pm fibrinoge-155* 09:35pm pt-13.4* ptt-30.8 inr(pt)-1.2* 09:35pm wbc-2.2* rbc-1.73* hgb-5.4* hct-15.5* mcv-90 mch-31.1 mchc-34.7 rdw-13.3 plt 6 09:35pm albumin-4.1 09:35pm lipase-22 09:35pm alt(sgpt)-24 ast(sgot)-20 ld(ldh)-184 alk phos-44 tot bili-1.5 09:35pm glucose-90 urea n-14 creat-1.1 sodium-136 potassium-4.1 chloride-104 total co2-22 anion gap-14 10:40pm hiv ab-negative =================================== pathology =================================== bone marrow cytogenetics: cell culture of this specimen did not yield dividing cells for metaphase chromosome analysis. interphase fish assays were most consistent with the presence of a tetraploid or near-tetraploid clone. interphase fish did not detect a bcr-abl1 rearrangement or an mll rearrangement. bone marrow aspirate and core biopsy: bone marrow extensively involved by precursor b cell acute lymphoblastic leukemia/lymphoma (pre-b all). csf cytology negative for malignant cells. cytogenetics karyotype: nuc ish(bcr,abl1)x2. interphase fish with the bcr-abl1 probe set did not detect evidence of the presumed tetrploid clone seen by fish in the diagnostic specimen. fish details: fish evaluation for a bcr-abl (bcr-abl1) rearrangement was performed on nuclei with the lsi bcr/abl dual color, dual fusion translocation probe ( molecular) for bcr at 22q.11.2 and abl at 9q34, and is interpreted as normal. no nuclei with the prior abnormal pattern were observed in 100 nuclei studied. =================================== microbiology =================================== blood culture- negative urine urine- negative blood culture- negative blood culture- negative blood culture- {capnocytophaga species}; aerobic bottle urine culture- negative throat culture viral culture: r/o hsv- negative tissue gram stain-final; tissue-final; anaerobic culture-final; fungal culture- negative stool c. difficile- negative; fecal culture- negative; campylobacter culture- negative; ova + parasites- negative csf;spinal fluid gram stain- negative serology/blood lyme serology- negative mrsa screen mrsa screen-negtive blood (ebv) - virus vca-igg ab-final; - virus ebna igg ab-final; - virus vca-igm ab-final inpatient blood (cmv ab) cmv igg antibody-final; cmv igm antibody-final ================================== pertinent imaging ================================== ct chest/abd/pel w contrast 1. the spleen is markedly enlarged, measuring 20 cm in craniocaudal dimension, without focal lesion. 2. scattered subcentimeter axillary, mediastinal, retroperitoneal, and superficial inguinal lymph nodes with normal morphology. 3. three tiny ground glass nodules in the lungs of indeterminate ignifiance. 4. right iliac lucent lesion with non-aggressive appearance. echo impression: normal regional and global biventricular systolic function. normal diastolic function. no pathologic valvular abnormalities. ================================== discharge labs ================================== 12:00am blood wbc-3.7* rbc-3.14* hgb-9.4* hct-27.4* mcv-87 mch-30.0 mchc-34.4 rdw-15.9* plt ct-354 12:00am blood neuts-65 bands-2 lymphs-18 monos-3 eos-0 baso-0 atyps-1* metas-3* myelos-8* nrbc-6* 12:00am blood hypochr-1+ anisocy-2+ poiklo-1+ macrocy-1+ microcy-1+ polychr-1+ ovalocy-1+ schisto-occasional stipple-occasional 12:00am blood plt smr-normal plt ct-354 12:00am blood fibrino-169* 05:09am blood gran ct-44* 09:35pm blood ret aut-0.5* 02:31pm blood at-122 12:00am blood glucose-226* urean-13 creat-0.8 na-138 k-4.3 cl-101 hco3-30 angap-11 12:00am blood alt-132* ast-22 ld(ldh)-371* alkphos-73 totbili-0.6 dirbili-0.2 indbili-0.4 12:00am blood calcium-8.4 phos-3.6 mg-2.3 brief hospital course: mr. is a 26-year-old gentleman with no significant pmh who preseted to an hospital with fatigue and retinal heomorrhage. hew as found to be pancytopenic and ultimately diagnosed with -chromosome-negative all. he was admitted to the bmt service for induction chemotherapy with #06-254 protocol. ------------------- active issues ------------------- 1. -chromosome-negative all: patient presented with pancytopenia. prior to the bone marrow biopsy, a broad differential diagnosis was considered including bone marrow suppression secondary to viral infection vs. malignancy (given the 90% lymphocytes). patient's anemia and pancytopenia were profound, and while in the icu, he received prbc to maintain a hct > 21 and platelets to maintain platelets >50 given recent retinal hemorrhages. sperm banking was discussed and completed. an echocardiogram was normal. he was transferred to the bmt service, where he was enrolled in the adult all consortium trial (protocol #06-254) and started on induction chemotherapy. his induction regimen included vincristine on days 1,8,15, and 22; doxorubicin on days 1, and 2; mtx on day 3; e. coli asparaginase on day 4; it cytarabine on day 1; it cytarabine, mtx and hydrocortisone on day 15; and prednisone daily. patient was anticoagulated with lovenox given risk of clotting with asparaginase. platelets were maintained > 30,000, fibrinogen > 100,000, and hct > 21 with transfusions. atiii levels were checked weekly to ensure activity > 30%. patient's course was complicated by neurtopenic fever, hyponatremia, and mucousitis (please see below) but otherwise chemo was tolerated well. at the end of the induction cycle, patient had a repeat bone marrow biopsy to determine whether he is in complete remission. 2. visual changes/retinal hemorrhage: ophthalmology was consulted early in patient's admission and determined that his retinal hemorrhages were secondary to thrombocytopenia/newly diagnosed all. there was no evidence of leukemic infiltrates. patient had no pain and visual changes resolved without further intervention. 3. neutropenic fever: patient developed a fever and was initially started on cefepime and clindamycin (clindamycin for oral anaerobe coverage given mouth sores and possible dental cavity). a blood culture from his picc line (one bottle) grew gnr's at 83 hours. the gnr's speciated as capnocytophaga species, which has been described in neutropenic patients with mouth ulcers. given capnocytophaga's sensitivities (and desire to decrease risk for c. dif), cefepime and clindamycin were discontinued and zosyn was started. on , patient developed a drug rash that was most likely secondary to pcn component of zosyn, and he was switched to meropenem. prior to discharge, patient was transitioned to ertapenem for qd dosing as an outpatient. 4. mucousitis: patient developed several very painful oral ulcers. he also reported pain at the site of a dental cavity. his ulcers were swabbed and were negative for hsv. he received mouth care, acyclovir, fluconazole, and ultimately required a dilaudid pca for pain control. by the end of admission, ulcers had markedly improved and patient no longer required pain control. 5. hyponatremia: patient's labs were consistent with siadh, which was most likely secondary to vincristine or mtx. he received salt tabs and furosemide and sodium improved. 6. skin findings: patient had a violaceous patch on r knee after falling in a softball game prior to diagnosis but was very slow to resolve. he was seen by dermatology who biopsied the lesion and determined there were signs of retained foreign body but no signs of fungal infection. 7. constipation: most likely secondary to vincristine and narcotics. patient received bowel regimen. transitional issues - complete ertapenem (through ) - follow-up final bone marrow results to assess for complete remission - new pcn allergy (rash while on zosyn) medications on admission: preadmission medications listed are correct and complete. information was obtained from patientfamily/caregiver. 1. ibuprofen 400 mg po q8h:prn pain 2. sulfameth/trimethoprim ds 1 tab po bid had one day left in 10 day cycle 3. amoxicillin-clavulanic acid 500 mg po q8h had one day left in 10 day course discharge medications: 1. sulfameth/trimethoprim ds 1 tab po 3x/week (tu,we,th) this week, take bactrim on , and . after that, take bactrim monday, wednesday, and friday. rx *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth three times a week disp #*30 tablet refills:*0 2. acyclovir 400 mg po q8h rx *acyclovir 400 mg 1 tablet(s) by mouth every 8 hours disp #*30 tablet refills:*3 3. docusate sodium 100 mg po bid rx *docusate sodium 100 mg 1 capsule(s) by mouth twice a day disp #*30 capsule refills:*3 4. enoxaparin sodium 40 mg sc daily start: in am rx *enoxaparin 40 mg/0.4 ml inject 40 mg under the skin daily disp #*2 syringe refills:*0 5. ertapenem *nf* 1 gram injection daily reason for ordering: discharging on ertapenem. want to give today's dose prior to discharge. 6. fluconazole 400 mg po q24h rx *fluconazole 200 mg 2 tablet(s) by mouth daily disp #*30 tablet refills:*0 7. lorazepam 1 mg po q8h:prn nausea, anxiety do not drive or operate machinery while taking lorazepam. do not take with alcohol. rx *lorazepam 1 mg 1 tablet by mouth as needed (no more often than every 8 hours) disp #*10 tablet refills:*0 8. oxycodone (immediate release) 5 mg po q4h:prn mouth pain rx *oxycodone 5 mg 1 tablet(s) by mouth every 4 hours disp #*15 tablet refills:*0 9. polyethylene glycol 17 g po daily:prn constipation rx *polyethylene glycol 3350 17 gram 1 packet by mouth daily disp #*60 unit refills:*5 10. ranitidine 150 mg po bid rx *ranitidine hcl 150 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*0 discharge disposition: home with service facility: discharge diagnosis: chromosome negative all 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 being a part of your care during your admission to . as you know, you were admitted for treatment of your all. you received chemotherapy and a medication called lovenox to prevent clotting. you experienced mouth ulcers and a bacterial infection in your blood, both of which have improved. your blood counts have also gotten better. on , you had a bone marrow biopsy which will help us know if you are in a complete remission. we are discharing you with 2 days of iv antibiotics, which you will use through your picc line. we are also discharging you with a prescription for lovenox. if you have any fevers (even low fevers), worsening rash, worsening redness or pain at your picc insertion site, chills, nausea, vomiting, diarrhea, or any other new symptosm that concern you, please call our office immediately. followup instructions: readmission to bmt unit on friday, md procedure: spinal tap incision of lung biopsy of bone marrow closed biopsy of skin and subcutaneous tissue injection or infusion of cancer chemotherapeutic substance injection or infusion of cancer chemotherapeutic substance injection of other agent into spinal canal central venous catheter placement with guidance diagnoses: cellulitis and abscess of leg, except foot bacteremia disorders of phosphorus metabolism antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use other constipation dermatitis due to drugs and medicines taken internally diarrhea other disorders of neurohypophysis drug induced neutropenia examination of participant in clinical trial acute lymphoid leukemia, without mention of having achieved remission retinal hemorrhage other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms penicillins causing adverse effects in therapeutic use viral warts, unspecified mucositis (ulcerative) due to antineoplastic therapy other pancytopenia antineoplastic chemotherapy induced anemia pityriasis versicolor 

Answer: The patient is high likely exposed to