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: levaquin attending: chief complaint: fever major surgical or invasive procedure: bone marrow biopsy removal of hickman picc placement lumbar puncture history of present illness: 70 year old male with history of diffuse large b cell lymphoma, s/p 4 cycles of r-chop, 4 cycles of eshap and one cycle of and zevalin, discharged recently (2 days pta) after elective admission for mini-muds. he is now day 27 status post a nonablative allogeneic transplant with campath conditioning. his recent admission was c/b febrile neutropenia (no source identified, treated empirically with vanc, cefepime, flagyl and caspo, then subsequently weaned off of these agents), anorexia requiring tpn, diarrhea (c. diff negative x6) and transiently elevated lfts of unknown etiology (negative ultrasounds). by the time of discharge he was tolerating po's well, had been afebrile for >1week, was constipated and was ambulating. today he presented to clinic and was noted to have shaking chills and temp to 100.6. he says yesteday he had loose stools (had been given stool softeners on day of admission due to constipation) and his wife feels his line "looks worse". peripheral and line cultures were drawn in clinic. he was given 1 gram of vancomycin iv and 2grams of cefipime and a liter of normal saline with 2 grams of magnesium sulfate while in clinic. he was admitted for evaluation of low grade fever. . the patient reports that his overall energy level and endurance has been improving. denies any drenching nightsweats. he denies any fevers. he is without any pain. he denies any new or worsening lymphadenopathy. notes that he feels as though his left submandibular node as well as left inguinal node has gotten smaller. also feels as though his splenomegaly may have improved somewhat. he denies any cough, shortness of breath, chest pain, palpitations, or any other cardiac or respiratory difficulties. denies any pain anywhere, denies any shortness of breath upon exertion. denies any vomiting, diarrhea, or constipation. does continue with a little bit of nausea. he says that he has had intermittent r and l lq abdominal pain with bloating that is relieved with bms. he is starting to feel some now and would like a stool softener. denies any numbness or tingling in the fingers or toes. past medical history: 1. diffuse large cell lymphoma - initially presented with splenomegaly , found to have bulky disease above and below diaphram - s/p 4 cycles of r-chop and then switched to eshap due to disease progression. had persistent pelvic nodes and new inguinal node after second cycle of eshap. autologous transplant planned so underwent stem cell mobilization but had poor cell collection. restaging pet scans revealed progressive disease both above and below diaphram. he was therefore treated with gemzar/navelbine/prednisone with only partial response. - s/p 3rd cycle of eshap discharged . - s/p 4th cycle of eshap () - s/p + zevalin () - s/p campath and mini-muds () 2. s/p cataract surgery 3. left inguinal hernia 4. right upj stone social history: he is married, russian (from ), was a music composer and played the saxophone, no tobacco (quit 40 years ago), no alcohol, no drugs. also practices yoga on a regular basis. was a professional soccer player in the past. family history: two siblings are healthy. no history of malignancy. physical exam: temp: 98.7 bp: 144/82 hr: 92 rr: 20 o2 sat: 98%ra 144.2lbs gen: no acute distress, alert, oriented, thin elderly man heent: extraocular movements intact, pupils equal at ~2mm, reactive to light. pharynx is non injected. neck: supple, palpable l submandibular node, small left-sided inguinal node palpable cv: regular rate, no murmurs, rubs or gallops. s1, s2 auscultated lungs: clear to auscultation bilaterally, no rales, rhonchi or wheezes. abd: soft, non tender, non distended, with palpable spleen at the left inferior costal margin, palpable hepatic edge. no rebound tenderness. extr: mild puffiness in feet, no pitting edema, 2+dps neuro: cranial nerves ii-xii grossly intact. strenght at biceps, triceps, quadriceps and ankle extensors. r port c/d/i mild erythema at entry but no pus/drainage pertinent results: microbiology 9:15 am immunology (cmv) **final report ** cmv viral load (final ): cmv dna not detected. performed by pcr. detection range: 600 - 100,000 copies/ml. 12:20 pm urine site: clean catch **final report ** urine culture (final ): no growth. aspergillus galactomannan antigen 0.082 (neg) < 0.5 index b-glucan <31 pg/ml negative less than 60 pg/ml imaging: portable cxr- in comparison with the study of , there is no interval change. minimal streak of atelectasis at the left base above the slightly elevated left hemidiaphragm. no evidence of acute pneumonia or vascular congestion. central catheter remains in place. . ct torso w/o contrast 2:27 pm ct chest without intravenous contrast: multiple mediastinal lymph nodes have slightly increased in size and number. bilateral axillary lymph nodes have also increased in size. largest left axillary lymph node measures 12 mm, compared to 8 mm in short axis diameter previously. central airways are patent to the segmental levels bilaterally. lung windows continue to demonstrate biapical scarring. numerous pulmonary nodules are again noted. right upper lobe pulmonary nodule, series 2, image 18, has slightly increased in size. left upper lobe pulmonary nodule, series 2, image 21, remains stable in size. peripheral right upper lobe pulmonary nodule, series 2, image 24, has slightly increased in size, measuring 3 mm compared to 1.5 mm previously. left upper lobe pulmonary nodule, series 2, image 33, measures 5 mm, compared to 3 mm previously. multiple other nodules are stable in size. ct abdomen without intravenous contrast: numerous hypodense splenic lesions have increased in size and number. multiple hypodense lesions in the hepatic parenchyma also appear more prominent on today's study. right adrenal nodule is stable. extensive mesenteric and retroperitoneal lymphadenopathy has significantly increased in extent when compared to the prior study. there is no free air and no free fluid in the abdomen. the pancreas, abdominal loops of large and small bowel are unremarkable. ct pelvis without contrast: the 7-mm calculus at the right ureterovesical junction is unchanged in size and appearance. marked lymphadenopathy is present in the pelvis along the internal and external iliac chains. bone windows: demonstrate no definite evidence of suspicious lytic or sclerotic lesions. impression: 1. interval significant worsening of mediastinal, axillary, retroperitoneal and mesenteric lymphadenopathy, as well as slight increase in size of pulmonary nodules and splenic lesions, concerning for disease progression. 2. more prominent appearance of the hepatic lesions. specimen: bone marrow aspirate and core biopsy: diagnosis: hypocellular bone marrow with erythroid and megakaryocytic dysplasia. see note. histiocytes with ingested hematopoietic cells. see note. no diagnostic morphologic features of involvement by lymphoma seen. note 1: the dyspoiesis may be related to recent chemotherapy. note 2: several histiocytes with ingested hematopoietic precursors were noted. findings discussed with dr. and dr . correlation with clinical findings as well as other laboratory findings is needed to exclude the possibility of an evolving hemophagocytic process. flow cytometry report flow cytometry immunophenotyping the following tests (antibodies) were performed: kappa, lambda, and cd antigens: 2, 19, 45. results: three color gating is performed (light scatter vs. cd45) to optimize lymphocyte yield. cd45-bright mature lymphoid cells comprise 1% of total analyzed events. of these, b cells are extremely scant in number precluding evaluation of clonality. interpretation cell marker analysis demonstrates an extremely scant population of b-cells. clonality could not be assessed in this case due to insufficient numbers of b cells. correlation with clinical findings and morphology (see s08-) is recommended. flow cytometry immunophenotyping may not detect all lymphomas due to topography, sampling or artifacts of sample preparation. ct cap: impression: 1. slight increase in mesenteric and pelvic lymphadenopathy as well as size of hepatic lesions. stable appearance of axillary, retroperitoneal lymphadenopathy, pulmonary nodules and splenic lesions. 2. 5-mm calculus at the right ureterovesical junction. 3. interval development of small ascites and worsening of the pericardial and small right pleural effusion. ct ap : impression: 1. disease progression with increase in size of several liver lesions, splenic lesions and retroperitoneal lymph nodes as described above. 2. overall, more heterogeneous appearance of the liver raises concern for significant disease progression in the liver. ultrasound examination is recommended to confirm the presence of multiple subcentimeter hypodense lesions as this is a new finding. 09:54am plt count-28* 09:54am neuts-69.8 lymphs-13.1* monos-8.5 eos-8.0* basos-0.5 09:54am wbc-4.3 rbc-3.16* hgb-9.6* hct-27.5* mcv-87 mch-30.3 mchc-34.8 rdw-19.9* 09:54am cyclsprn-186 09:54am albumin-3.4 calcium-9.4 phosphate-3.9 magnesium-1.7 09:54am alt(sgpt)-17 ast(sgot)-29 ld(ldh)-358* alk phos-82 tot bili-1.2 09:54am glucose-117* urea n-36* creat-1.4* sodium-141 potassium-4.2 chloride-107 total co2-24 anion gap-14 09:15am gran ct-2820 09:15am plt count-25* 09:15am neuts-69.4 lymphs-14.8* monos-7.9 eos-7.3* basos-0.5 09:15am wbc-4.1 rbc-3.09* hgb-9.5* hct-26.7* mcv-86 mch-30.9 mchc-35.7* rdw-20.1* 09:15am cyclsprn-153 09:15am calcium-9.3 phosphate-3.6 magnesium-1.6 uric acid-5.5 09:15am alt(sgpt)-20 ast(sgot)-27 ld(ldh)-363* alk phos-79 tot bili-1.1 dir bili-0.5* indir bil-0.6 09:15am urea n-23* creat-1.2 sodium-139 potassium-3.7 chloride-106 total co2-25 anion gap-12 12:20pm urine mucous-rare 12:20pm urine hyaline-1* 12:20pm urine rbc-2 wbc-1 bacteria-few yeast-none epi-0 12:20pm urine blood-tr nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 12:20pm urine color-yellow appear-clear sp -1.007 brief hospital course: #. diffuse large b-cell lymphoma: s/p mini-muds w/ cells given on . wbc recovered well, but with persistent low platelets concerning for slow engraftment v. autoimmune phenomena posttransplant v. disease-related issues, or gvhd (though there were no other signs of gvhd to support this). given ct findings of increased size and number of , increased ldh, and bm read, concern for recurrence of disease v. hemophagocytic syndrome. bm bx day 30 concerning for hemophagocytic cells and hemophagocytic syndrome. ct torso () to eval for further progression and for abdominal pain etiology noted unchanged to slightly larger lns and liver lesions. mri negative for leptomeningeal disease, lp results positive for hhv-6, otherwise, non-diagnostic study given paucity of cells. started etoposide/decadron/cyclosporin as per hlh protocol to treat disease as well as hemophagocytic syndrome as patient developed mental status changes and high fevers. patient had significant clinical response with recurrence of neutropenia after doses. decadron and cyclosporin slowly weaned down. started on on gcsf on with subsequent increase in counts. patient then began to develop increased back pain and mental status changes. ct of cap showing progression in liver and splenic disease as well as increase in size of lymphanopathy. patient also began to develop increasing liver function tests (voriconazole dc'd due to hepatotoxicity with no improvement). plan was for bm biopsy but patient refused. given increased mental status changes and fevers, concern for recurrence of hlh. patient was given an additional dose of etoposide. subsequently patient began refusing all treatment. after much discussion, patient and family were in agreement regarding discontinuation of care. focus was changed to comfort care. patient passed away on comfortably and with family at bedside. . #. fever: the patient had been febrile when neutropenic during his last admission and had been treated with cefepime (d/c'd ), flagyl, caspo, and vanco (dc'd ), all of which were weaned as he defervesced. imaging, cultures and screens for c. diff were unrevealing and he had been transitioned to fluconazole, acyclovir and bactrim for prophylaxis. on admission he had no localizing symptoms, but did have a line which was a potential infectious source. he had one day of loose stools but this was in the context of taking stool softeners for constipation. suspected line infection v. fungal pulmonary infection v. disease recurrence v. hemophagocytic syndrome. all infectious work up was negative including cmv, ebv, parvovirus, toxoplasma, measles, hhv-8, adenoviral pcr, salmonella stools studies and numerous blood and urine cultures. b-glucan/galactomannan negative. patient did become positive for hhv-6 both in peripheral blood and cns. in addition to broad spectrum antibiotics, patient was treated with foscarnet and one dose of cidofovir. given decreased calcium, foscarnet was discontinued and patient was restarted on acyclovir for ppx as hhv-6 had cleared in the peripheral blood. patient then began spiking fevers on his last week of admission despite broad spectrum antibiotic medications including antifungal therapy. this was thought to be due to progressive disease versus recurrence of hemophagocytosis. patient was given additional dose of etoposide as above, then began to refuse further treatment. . #. bradycardia, prolonged qtc: patient did have episode of torsades, though due to cyclosporine and fluconazole, respectively. ep saw patient and felt no risk of torsades now that off fluconazole. actually resolved with pulling back picc line. patient had no further episodes. . #. nutrition: patient unable to tolerate pos. was on tpn for the majority of his admission. nutrition followed on a daily basis. . medications on admission: 1. cyclosporine modified 25 mg capsule sig: five (5) capsule po q12h 2. folic acid 1 mg tabletpo daily 3. hexavitamin 1 cap po daily 4. fluconazole 200 mg tabletpo q24h 5. acyclovir 200 mg capsule two (2) capsule po q8h 6. metoprolol tartrate 25 mg tablet 0.5 tablet po bid 7. oxycodone 5 mg tablet 1-2 tablets po q4h (every 4 hours) prn 8. nifedipine 90 mg tab,sust rel osmotic push 24hr po daily 9. senna 8.6 mg tablet 1 tablet po bid 10. docusate sodium 100 mg capsule po bid 11. saliva substitution combo no.2 thirty (30)ml mucous membrane qid 12. bactrim 80-400 mg tablet one tablet po once a day. discharge medications: na - expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: venous catheterization, not elsewhere classified spinal tap incision of lung parenteral infusion of concentrated nutritional substances biopsy of bone marrow biopsy of bone marrow injection or infusion of cancer chemotherapeutic substance diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified paroxysmal ventricular tachycardia bone marrow replaced by transplant other malignant lymphomas, unspecified site, extranodal and solid organ sites other specified cardiac dysrhythmias chronic systolic heart failure other ascites hypercalcemia neutropenia, unspecified hemophagocytic syndromes 

Answer: The patient is high likely exposed to