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: patient recorded as having no known allergies to drugs attending: chief complaint: neck swelling major surgical or invasive procedure: fiberoptic intubation history of present illness: ms. is a 62 year old female with a h/o of dvt on coumadin and multiple myeloma with amyloid s/p allo-transplant in in remission until recent evidence of slow disease progression, who presents with chief complaint of pain with swallowing since yesterday evening, accompanied by hoarse voice. she denies any difficulty breathing. she states that she is able to swallow liquids with some difficulty but is unable to swallow solids. onset of symptoms was yesterday evening with sudden onset of neck swelling, preceded by a sore throat which has since resolved. she states that the episode of neck swelling may have been preceded by some coughing, but otherwise is unable to identify a trigger for her symptoms. . of note, she received donor lymphocyte infusion on and due for follow up today in clinic. she has had two prior episodes of epiglottitis/supraglottitis in and requiring intubation. . on arrival to the ed, her vs were: t98.9, hr 103, bp 134/71, rr 12, and spo2 95% on ra with no evidence of respiratory distress. her inr was 10 and she received vitamin k 10 mg po x 1. she was scoped by ed resident and epiglottis was visualized; reported as non-inflamed, non-beefy, and non-exudative. . ros: she currently has no problems voiding. she has also had hematuria since yesterday morning. urine was initially the color of cranberry juice but is now a slightly lighter shade. she has no dysuria, fevers, chills, nausea, vomiting, or pain. past medical history: 1) multiple myeloma stage iii with amyloidosis dx'd in , s/p melphalan, vincristine, adria and prednisone and then vincristine, doxorubicin and dexa, with recurrence followed by auto bmt and then mini-allo-bmt in 99 and again with recurrence had donor lymphocyte infusion from brother in 2) osteopenia s/p zometa infusions 3) htn 4) bladder/tongue amyloid 5) dvt l ij, l sup femoral, l popliteal 6) s/p tonsillectomy 7) supraglottitis x 2 8) hx of disseminated herpes in 9) urge incontinence social history: she is married and lives in , 2 children, one grandson. she admits to occasional etoh and denies any h/o tobacco/ivdu. she is a retired office manager in a law firm. family history: hyertension, no malignancies physical exam: vs: t98.9, bp 146/90, hr 96, rr 20, spo2 95% on ra gen: wd/wn, comfortable, nad. heent: normacephalic, atraumatic. clear oropharynx. neck: supple with soft, non-fluctuant symmetric midline swelling. no masses or palpable lymphadenopathy. no carotid bruits on auscultation. lungs: normal respiratory effort. lungs cta bilaterally. no stridor. cardiac: rrr. nl s1 and s2. no m/r/g abd: soft, non-distended. no suprapubic or flank pain. +bs extrem: warm and well-perfused. no clubbing/cyanosis/edema. skin: multiple papular lesions with hyperpigmentation over lower back and abdomen with satellite lesions extending over similar areas as well as inner left thigh. some healing areas of excoriation on back. pertinent results: 62 f with multiple myeloma with amyloid s/p allo-transplant , received donor lymphocyte infusion , coumadin on dvt, here with supraglottitis and elevated inr. . 1) supraglottitis: ct neck without contrast showed a large phlegmon with 80 percent supraglottal narrowing and edema, aretinoid edema. she was given decadron, ppi, unasyn for epiglottitis, ivig to help with infections because of her acquired hypogammaglobulinemia from multiple myeloma. ent emergently assessed the patient following admission and found her to have significant supraglottic edema, edematous aretinoids, with low threshold for additional swelling. she was planned for awake intranasal fiberoptic intubation and transferred to the icu. she was intubated while awake with 6.0 fiberoptic ett, then subsequently self-extubated, was reintubated under sedation again with fiberoptic scope. ct neck on showed improvement in swelling but still unsafe to extubate. per ent recommendations, she was treated with decadron, iv diphenhydramine, and iv ranitidine as empiric therapy for allergic angioedema. ultimately, patient self-extubated on , doing well, ent eval appreciated. continue to monitor respiratory status. unasyn has been converted to augmentin. . etiology may be epiglottitis, for which she has a previous history in and . infectious causes of supraglottitis possible, as are non-infectious causes in this bmt patient such as post-transplant lymphoproliferative disorder and graft-versus host disease. c1 esterase deficiency also possible. - id consulted, will continue unasyn. need to consider possible involvement (infection) of vasculature in the neck. h.flu likely as patient susceptible to encapsulated organisms. - await tryptase, c1 esterase to eval for c1 esterase deficiency - id recommends mri of neck w/o contrast to eval. possible involvement of vessels. . 2) dvt: most recently . supratherapeutic inr elevated to 10 on admission, now resolved. on coumadin for dvt, started on fluconazole after dli, interaction with warfarin known, likely contributing to inr 10. she received vitamin k 10 mg po in the ed and 2 which normalized inr. heparin gtt initiated with normalization of inr, bridging back to therapeutic coumadin level. . 3) htn: consider restarting home meds of hctz and verapamil while npo. blood pressure has been under fairly good control while intubated. -restarted hctz 25mg po qday. . 4) hematuria: urology consulted and felt her hematuria to be possibly c/w urinary obstructive symptoms, likely secondary to elevated inr. renal us was negative for hydronephrosis or any abnormality identified within the kidneys. hematuria now resolved. - plan to restart detrol . 5) hyperglycemia: likely steroids. continue riss. - will decrease decadron to 5mg and continue to wean as above. s . 6) fen: advance diet to regular as tolerated. . 7) ppx: h2 blocker, bowel regimen brief hospital course: 62 f with multiple myeloma with amyloid s/p allo-transplant , received donor lymphocyte infusion , coumadin on dvt, p/w with supraglottitis and elevated inr. . 1) patient was admitted to the bmt service with spo2 of 95% on room air. on arrival to the floor, her primary complaint was difficulty swallowing and "gurgly" voice since last night. she denied any difficulty breathing. ct of her neck performed on the evening of admission revealed a large phlegmon with supraglottal narrowing and edema, aretinoid edema. she was given decadron, ppi, and was started on unasyn for epiglottitis. she received a transfusion of ivig given her hypoglobulinemia secondary to multiple myeloma. ent emergently assessed the patient following admission and found her to have significant supraglottic edema, edematous aretinoids, with low threshold for additional swelling. she was planned for awake intranasal fiberoptic intubation and transferred to the icu. per ent recommendations, she was treated with decadron, iv diphenhydramine, and iv ranitidine as empiric therapy for allergic angioedema.she was intubated while awake with 6.0 fiberoptic ett, then subsequently self-extubated, was reintubated under sedation again with fiberoptic scope. ct neck on showed improvement in swelling but still felt to be unsafe to extubate. ultimately, patient self-extubated again on and at that point it was felt safe to monitor expectantly without reintubation. id team was consulted and recommended continuation of unasyn. prior to discharge, unasyn was converted to augmentin. . etiology of this event is likely epiglottitis, for which she has a prior history in and . infectious causes of supraglottitis possible, as are non-infectious causes in this bmt patient such as post-transplant lymphoproliferative disorder and graft-versus host disease. c1 esterase deficiency was ruled out with c1 esterase functional assay wnl. suspect recurrent h.flu infection, as patient is particularly susceptible to encapsulated organisms. . 2) dvt: most recently . supratherapeutic inr elevated to 10 on admission, now resolved. on coumadin for dvt, started on fluconazole after dli, interaction with warfarin known, likely contributing to inr 10. she received vitamin k 10 mg po in the ed and 2 which normalized inr. heparin gtt initiated with normalization of inr, bridging back to therapeutic coumadin level. prior to discharge, she was discovered to have multifocal intracranial hemorrhage, and all anti-coagulation plans were aborted. ivc filter placement is indicated in this scenario and will be pursued as an outpatient. . 3) subdural hematomas: on the evening of , ms. complained of headache with radiation to her neck. her husband also reported that she seemed more somnolent and that mental status was not at baseline. neurologic exam was non-focal. at this time, her heparin gtt had been very recently discontinued with plan to transition to lovenox for anticoagulation in the setting of her recent dvt. ct head was performed and revealed bilateral subdural hematomas, right greater than left, predominantly composed of acute blood but also demonstrating subacute components. an mri of the head was performed which revealed no lesion or focus of the bleed and stable area of hemorrhage. prior to discharge, a repeat ct of the head was performed, which showed interval decrease in size of extra-axial collection of the left lateral posterior fossa. she was neurologically intact throughout, and she was discharged home with instructions to return with any changes in status. . 4) hematuria: urology consulted and felt her hematuria to be possibly c/w urinary obstructive symptoms, likely secondary to elevated inr. renal us was negative for hydronephrosis or any abnormality identified within the kidneys. hematuria resolved with reversal of inr. . 5) htn: restarted on home regimen of verapamil and hctz following icu course and prior to discharge to home. . 5) hyperglycemia: likely steroids. covered with riss. medications on admission: hctz 25 mg daily detrol xl verapamil 180 mg once a day discharge medications: 1. verapamil 180 mg tablet sustained release sig: one (1) tablet sustained release po q24h (every 24 hours). 2. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 6 days. disp:*18 tablet(s)* refills:*0* 3. dexamethasone 1 mg tablet sig: 3 tablets on sunday . 2 tablets on monday . 1 tablet on tuesday . tablets po once a day for 3 days. disp:*6 tablet(s)* refills:*0* 4. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: home discharge diagnosis: epiglottitis subdural hematoma supratherapeutic inr hematuria multiple myeloma h/o dvt discharge condition: neurologically intact, alert and oriented x 3, guarded for any changes in neurologic status discharge instructions: you were admitted for epiglottitis, and you were intubated to protect your airway. you are being treated with a 10-day course of antibiotics, now day 4. . you were found to have a subdural bleed in your head, likely due to spontaneous bleeding while on coumadin and/or heparin. you should not take any anticoagulation in the setting of this bleed. you were evaluated by neurosurgery who felt this to be stable at the time of discharge. you should follow-up with dr. in one week for reassessment. . if you experience any neck swelling or difficulty bleeding, you should seek immediate medical attention. you should come to the emergency room immediately if you experience any changes in your vision, balance, memory, or alertness. followup instructions: you should follow-up with your oncologist dr. next week. please call ( to schedule your appointment. . dr. in the department of neurosurgery in one week. please call ( to schedule an appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube transfusion of other serum injection or infusion of immunoglobulin diagnoses: abnormal coagulation profile unspecified essential hypertension other specified disorders of pancreatic internal secretion adrenal cortical steroids causing adverse effects in therapeutic use bone marrow replaced by transplant long-term (current) use of anticoagulants personal history of venous thrombosis and embolism subdural hemorrhage supraglottitis unspecified, with obstruction other amyloidosis acute epiglottitis with obstruction 

Answer: The patient is high likely exposed to