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: penicillins / aztreonam attending: chief complaint: hemoptysis major surgical or invasive procedure: none history of present illness: 65m h/o multiple myeloma, amyloid, s/p autologous stem cell transplant , on hd for renal failure myeloma, recently admitted for w/u of hemoptysis presenting with recurrent hemoptysis. patient was admitted from /11 for evaluation of hemoptysis. he underwent bronchoscopy and was found to have diffuse alveolar hemorrhage. etiology was unclear- ddx included cytotoxic and non cytotoxic drugs, infection, or connective tissue disorder. ultimately was discharged home to complete a course of levofloxacin and follow up with dr. (primary oncologist), with dah attributed to being give heparin (for presumed pe in ed) in setting of hemoptysis. . patient was doing well, though by had already started to experience slightly labored breathing. continued to carry out daily activities with minimal residual cough (dried blood) until monday when symptoms acutely worsened with acute onset sob with associated chest tightness. coughed up frank blood for the first time since discharge and given increased respiratory distress came to ed for further evaluation. . in the ed, initial vital signs were 97.8 91 171/70 24 89% on ra. patient was visibly tachypnic and hypoxic. he was sat-ing 93% on non-rebreather. suctioning revealed blood. given his respiratory distress, patient opted for intubation; was intubated with rocuronium and etomidate. was then given propofol and fentanyl. also received labetalol 10 mg for hypertension 213/102 with heart rates in the 120s. ekg showed new left bundle branch block. . on the floor, the patient is intubated, and somewhat distressed, coughing up bright red blood via his endotracheal tube. past medical history: oncology history: - multiple myeloma, s/p autologous stem cell transplant in - amyloidosis other medical history: - esrd amyloidosis - hyperlipidemia - restless leg syndrome - h/o genital herpes - depression - anxiety - s/p lens implantation (left) for cataracts - s/p discectomy - history of shoulder injury social history: - he works as a sales executive for luggage store, has been married for about 40 years. he has two children aged 39 and 37, one of whom lives in . - drinks occasionally. - ex-smoker, quit in . family history: he has a significant family history notable for one brother with cll and two first cousins with aml. his son had a recent pe. father died at age 89 of prostate cancer and mother of pe and an mi. physical exam: vitals: t 96.7 bp 78/46 hr 67 rr 22 100% intubated general: intubated, sedated, no acute distress heent: intubated, jvp not elevated, no lad lungs: coarse bs b/l, no rales or wheezes appreciated cv: regular rate and rhythm, normal s1 + s2, prominent holosystolic murmur radiating from l avf abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: warm, well perfused, no clubbing, cyanosis or edema, excellent thrill in the l av fistula pertinent results: tt echo: the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the right atrial pressure is indeterminate. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. there is mild to moderate global left ventricular hypokinesis (lvef = 40 %). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. right ventricular chamber size is normal. with borderline normal free wall function. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. severe (4+) central, mitral regurgitation is seen. no apparent chordal rupture or partial flail leaflet is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. te echo : regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. no aortic regurgitation is seen. there is borderline/mild posterior leaflet mitral valve prolapse. moderate to severe (3+) mitral regurgitation is seen. there is no evidence of mitral valve leaflet flair due to tendinae or papillary muscle rupture. the anteromedial and posterolateral papillary muscle are hypocontractile. there is no pericardial effusion. impression: moderate-to-severe mitral regurgitation secondary to isolated papillary muscle dysfunction; no flail seen . tt echo : there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild to moderate (+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a very small pericardial effusion. compared with the prior study (images reviewed) of , the severity of mitral regurgitation and the estimated pulmonary artery systolic pressure are now lower. . c. cath estimated blood loss: <100 cc hemodynamics (see above): coronary angiography: right dominant lmca: no angiographically-apparent cad. lad: ectatic vessel with mild luminal irregularities lcx: 50% diffuse mid vessel disease in om rca: mild luminal irregularities with ectatic vessel assessment & recommendations 1. mild cad 2. continued medical management 3. euvolemia brief hospital course: 65 year-old male with multiple myeloma s/p autologous stem cell transplant () and amyloidosis, esrd on hd with recent admission for dah of unknown etiology admitted to micu with hemoptysis. in the micu (), patient was intubated for airway protection (extubated ). bronchoscopy revealed diffuse hemorrhage without purulence. he required 2 units prbc for hematocrit decrease from 31 to 23.5. etiology of hemoptysis was suspected to be new severe mitral regurgitation (not seen on tte just 10 days prior); autoimmune workup from prior admission was within normal limits. nicardipine drip was initiated for blood pressure control/afterload reduction; he was subsequently transitioned back to home blood pressure regimen. patient underwent evaluation by cardiology and cardiac surgery. rhc/lhc revealed normal wedge pressure, absence of occlusive coronary disease (50% om, otherwise normal), and increased cardiac output. for evaluation of hypokinetic lv papillary muscle (without rupture) with surrounding normal myocardium, he was initially planned for cardiac mri to assess for amyloidosis - given risk of nsf on esrd, this was not done. case was discussed with bmt service; repeat protein electrophresis revealed persistent monoclonal gammopathy. he was transferred to cardiology service on for further management with a plan for afterload reduction to reduce degree of mr and thereby negate the need for urgent surgery. . upon transfer to the floor a repeat tte deomonstrated markedly improved mitral regurgitation thanks to excellent afterload reduction. carvedilol 12.5 mg was added to his blood pressure regimen. he was continued on mwf hd. given the need for agressive afterload reduction, and his demonstrated htn while on hd despite significant volume reduction his bp meds should be given prior to hd each morning. he will also need a fistula-gram as an outpatient. medications on admission: acyclovir 400 mg daily citalopram 10 mg daily simvastatin 20 mg daily ranitidine 150 mg daily diovan 160 mg nifedical xl 90 mg doxazosin 2 mg daily pramipexole 0.25 mg qhs temazepam 30 mg qhs prn insomnia renegel 800 mg tid with emals calcium acetate 667 mg 1-2 tabs with meals multivitamin men's 50 1 tab daily levofloxacin 500 mg tablet po q48hr (one dose on to complete 7 day course) b complex-vitamin c-folic acid 1 mg daily discharge medications: 1. acyclovir 400 mg tablet sig: one (1) tablet po once a day. 2. citalopram 10 mg tablet sig: one (1) tablet po once a day. 3. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 4. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 5. valsartan 160 mg tablet sig: one (1) tablet po bid (2 times a day). 6. nifedipine 90 mg tablet extended release sig: one (1) tablet extended release po bid (2 times a day). 7. pramipexole 0.25 mg tablet sig: one (1) tablet po once a day. 8. sevelamer carbonate 800 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 9. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 10. temazepam 30 mg capsule sig: one (1) capsule po at bedtime as needed for insomnia. 11. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 12. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 13. nephrocaps 1 mg capsule sig: one (1) capsule po once a day. disp:*30 capsule(s)* refills:*2* discharge disposition: home discharge diagnosis: diffuse alveolar hemmhorage mitral regurgitation hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to for hemoptysis (coughing up blood. you were found to have severe mitral regurgitation and high blood pressures. it is likley that your high bp and faulty valve worked togather to cause pressures to build up in the blood vessels in your lungs which caused you to have shortness fo breath and hemoptysis. we controlled your bp agreessivly and your mitral regurgitation and shortness of breath improved. . controlling your blood pressure will be an important part of preventing this from happeneing again. you shoudl record your bp at the same time every day and bring this record with you when you see your cardiologist and pcp so that they can adjust yoru blood pressure medications as needed. . while you were here we made the following changes to your medications: we stopped your levofloxacin we started you on carvedilol 12.5mg twice a day we started you on nephrocaps once a day we increased the dose of yoru renagel . you should continue to take your other medications as prescribed. followup instructions: you will be seen in clinic next week on thursday. if you do not have an appointment set up by the time you leave today they will call you to set up the appointment. . department: cardiac services when: thursday at 4:00 pm with: , md building: sc clinical ctr campus: east best parking: garage name: , location: medical specialist of palm beach address: , #240, beach, phone: appointment: wednesday 9:45am md, procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart insertion of endotracheal tube hemodialysis other bronchoscopy arterial catheterization diagnoses: end stage renal disease renal dialysis status mitral valve disorders congestive heart failure, unspecified other pulmonary insufficiency, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease dysthymic disorder peripheral stem cells replaced by transplant multiple myeloma, without mention of having achieved remission acute combined systolic and diastolic heart failure precipitous drop in hematocrit restless legs syndrome (rls) other amyloidosis hemoptysis, unspecified 

Answer: The patient is high likely exposed to