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 / sulfa (sulfonamide antibiotics) / hydrochlorothiazide attending: chief complaint: acute myelogenous leukemia major surgical or invasive procedure: central venous line placement picc line placement history of present illness: 61 y/o f hypertension, hyperlipidemia, and anxiety, presents after referral from for induction chemotherapy for acute myelogenous leukemia. pt initially presented to her pcp for evaluation of persistent fatigue and decreased appetite x 1-2months, and was found to have anemia and abnormal differential on cbc. in note from referring oncologist's initial visit with pt, automated differential from pcp 45.8% monocytes. pt underwent a techinically difficult bone marrow biopsy, and pathology showed hypercellular bone marrow with left-shifted granulopoiesis and increased blasts, consistent with aml. flow cytometry interpretation showed approximately 39% blasts identified, and there were increased monocytic/myelomonocytic cells, suggestive of an m4/m5 subtype of aml. morphologic and cytogenetic/fish analysis was pending at time of report. see below for available details. . of note, over the past several months, pt reports having 2 episodes of the flu, an episode of pneumonia (diagnosed by cxr, treated with z-pak with resolution), and uti (treated with cipro with resolution.) . on review of systems, pt reports low-grade fevers and chills following her bone marrow biopsy last week, but none since. she has pain over the biopsy site on her right hip. otherwise, denies any chest, abdominal, joint, muscle, or other pain. she denies nausea/vomiting. she has occasional diarrhea/constipation that she associates with her hx of dysfunctional bowel syndrome. she denies shortness of breath, palpitations, orthopnea, pnd. she reports occasional migraines with visual auras, none at present. she reports blurry vision recently, that she has seen an optomeetrist for and was told that she did not need correction. she denies hemoptysis, melena, or hematochezia. she endorses fatigue and decreased appetite as mentioned above. otherwise, remaining ros is negative. past medical history: hypertension hyperlipidemia anxiety dysfunctional bowel syndrome s/p hysterectomy, cyst removal s/p appendectomy s/p cholecystectomy bladder suspension surgery with ?r upper thigh nerve impingement:pt says r leg sometimes flops to side hx breast augmentation (silicone) r face/blepharospasm (extends from r front scalp-> r neck): used to have botox injections, but stopped to try and see if it resolves on its own, last dose ~2months ago social history: pt is a homemaker. she lives with her husband in . she spends most days each week baby-sitting her 3 grandchildren. she has 2 children- son age 40, daughter age 37. she denies history of smoking, and drinks alcohol occasionally. family history: maternal aunt had lymphoma. another maternal aunt had cervical cancer. children and sister are healthy. physical exam: vs-t 98.6 bp 140/90 rr 24 hr 70 o2sat 97%ra gen: awake, alert, nad, anxious, obese heent: perrl, eomi, sclera non-icteric, ?canker sore in r upper mouth, otherwise mucous membranes moist without obvious ulcers neck: supple, no palpable lad cv: regular rate and rhythm, no murmurs/rubs/gallops, s1 s2 present lungs: clear to auscultation bilaterally, no wheezes/rales/rhonchi abd: soft, non-tender, non-distended, bowel sounds present, no hsm ext: no cyanosis/clubbing/edema, 2+ dp pulses bilaterally neuro: cn2-12 intact grossly, strength 5/5 diffusely in extremities x 4, sensation intact grossly, coordination intact genital: lichen sclerosis inside labia majora, no other visible ulcers; ecchymosis with induration over right hip, ttp (site of bm bx); resolving faint ecchymosis over left hip (site of prior pain med injection) pertinent results: labs on admission: 138 103 15 96 4.3 24 0.9 . ca: 9.2 mg: 2.2 p: 4.3 . wbc 6.3, hb 10.6, crit 30.1, mcv 104, plt-pending diff: 8%n, 1%band, 30%l, 41%m, 5%e, 0%b, 3%atypical, 12%"other"-pending (anc 567) inr 1.2, pt 14.2, ptt 32 . alt 16 ast 33 ap 46 ldh 354* amylase 63 tbili 0.7 alb 4.5 uric acid 6.4* tsh- pending iron- pending . labs from outside clinic: wbc 7100, hb 11.5, crit 35.7, plt 70k, normocytic diff 10%n, 48%m, 5%atypical l, 32%m, 5%e, anc 710 smear reveals "question of blast", plts of "adequate size" . flow cytometry report (, paraphrased) interpretation: aspirate smears increased cellularity without particles. megakaryocytes are identified. lymphocytes comprise approximately 8% of gated cells, include 2% b-cells, 6% t-cells, and <1%nk cells. there are approximately 30%myeloid cells and 22% monocytes. cd38-bright cells (including plasma cells) are not increased. b-lymphocytes show a kappa:lambda raatio of 1:1. there is no evidence of a monotypic b-cell population. t-lymphocytes show no aberrant antigen expression, and the cd4:cd8 ratio is inverted, at 0.8:1. flow abnormalities that support a dysplastic myeloid population include decreased orthogonal light scatter, decreased cd45 expression, cd11b/cd16 pattern abnormalties, cd13/cd16 pattern abnormalities, and few myelomonocytic cells, cd34-positive blasts are increased,comprising 39% of nucleated cells, and they exhibit the expected immunophenotype for myeloblasts (cd34+, cd13+, cd33+, cd117+, hla-dr+, and negative for most other markers.) findings are suggestive of aml, non-m3 type. presence of increased monocytic and myelomonocytic cells raises the question of an m4/m5 subtype. flow cytometry differential - cd117+ hla-dr+ 34 - cd34+ cd13+ 38 - cd34+ cd33+ 39 - cd34+ hla-dr+ 35 - lymphocytes 8 --b cells 2 ---kappa <1 ---lambda <1 ---kappa:lambda ratio 1.0 --t cells 6 ---cd4 3 --- cd3 3 ---cd4: cd8 ratio 0.8 ---cd3+ cd58+ 1 ---nk cells <1 --monocytes 22 --granulocytes 30 --cd34+ blasts 39 --plasma cells <1 --viability 97 . imaging on admission: none tte/tee: ef > 55%. 2+ mr. evidence of endocarditis. chest ct: 1. worsening of micro-nodules throughout the lungs in a tree-in- distribution, suggestive of worsening viral disease. 2. slightly decreased size of small bilateral pleural effusions. 3. unchanged stranding surrounding the sigmoid colon, consistent with subacute diverticulitis. no abscess. 4. resolution of previously seen mass-like lesion within the cecum which likely represented mixing of fluid and contrast. no definite mass identified. brief hospital course: 61 y/o f with hypertension, hyperlipidemia, anxiety, presenting with new diagnosis of acute myelogenous leukemia, admitted for 7+3 induction chemotherapy. hospital course complicated by fever, neutropenia, and sepsis secondary to fever and neutropenia (likely etiologies vre bacteremia, diverticulitis/typhlitis) and pulmonary nodules noted on chest ct. # aml: pt is newly diagnosed with aml, possibly m4/m5 subtype given monocytic predominance on flow cytometry and bm biopsy. patient underwent 7 + 3 induction chemotherapy (7 days ara-c, 3 days idarubicin) and tolerated it well. however, blasts were still present in her bone marrow biopsy and cbc differential after completion of chemotherapy, indicating residual disease. she had a repeat bone marrow biopsy the day before discharge, the results of which were pending on the day of discharge. she was scheduled to follow-up with her outpatient oncologist on , and have another round of chemotherapy on pending the results of the bone marrow biopsy. #vre bacteremia: hospital course complicated by vancomycin resistant enterococcal bacteremia (4/4 bottles). patient briefly required icu admission. followed by id during admission. central line was removed. patient was treated with daptomycin, meropenem, and voriconazole/micafungin during her neutropenic phase. surveillance blood cx's were negative for four days, after which a picc was placed. tte showed mildly worsened mitral regurgitation, but tee showed no evidence of endocarditis, mitral valve or otherwise. patient was hemodynamically stabilized and was treated with a 14 day course of daptomycin and meropenem starting from (the day she was no longer neutropenic.) # diverticulitis/typhlitis: treated with 14 day course of meropenem after patient was no longer neutropenic. #pulmonary nodules: pt noted to be short of breath and hypoxic with a new oxygen requirement, improved with diuresis with iv lasix. patient briefly required icu admission for her hypoxia. chest ct showed pulmonary nodules concerning for fungal vs. viral infection. treated initially with albuterol/ipratroprium nebulizers and voriconazole, which was later d/c-ed due to lft abnormalities and changed to micafungin. nodules were slightly worsened on repeat chest ct, but patient clincally improved. pulmonary followed patient in-house. decision was made not to bronchoscopy/bal as she clinically improved. anti-fungal were eventually d/c-ed. patient should have repeat chest ct i- high resolution 1 week after discharge to assess for stability/interval change of pulmonary nodules. # hypertension: poorly controlled on patient's home regimen of metoprolol 25 mg po bid, with sbps into the 170s-190s. once patient was hemodynamically stable, increased metoprolol to 50 mg po tid and added amlodipine 5 mg daily, bridged with prn doses of iv hydralazine. patient's blood pressure was 148-150s systolic on discharge with the initiation of calcium channel blocker and increase in beta-blocker. # anxiety: pt has baseline anxiety, which has been augmented by this new diagnosis. pt may experience decreased po intake with nausea during chemo course, so would like to wean her off lexapro for now and address anxiety with po/iv meds. tapered celexa to 20 mg by mouth daily, and controlled anxiety with ativan iv/po as needed. discharged patient on tapered celexa dose with prn oral ativan, as she may likely need chemotherapy to treat her residual disease and may have difficulty with oral medications (requiring iv meds for anxiety). # silicone breast implant: noted to have silicone breast implant leakage, stable on mammogram/ultrasound and chest ct. patient may follow up with the outpatient breast surgeons once chemotherapy is completed. medications on admission: crestor 10mg po daily metoprolol 25mg po bid celexa 40mg po daily discharge medications: 1. lorazepam 0.5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for anxiety. disp:*42 tablet(s)* refills:*0* 2. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 4. daptomycin 500 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours) for 6 days: 600 mg solution start date: end date: . disp:*6 recon soln(s)* refills:*0* 5. ertapenem 1 gram recon soln sig: one (1) gram recon solution intravenous once a day for 6 days: start date: end date: . . disp:*6 grams* refills:*0* 6. celexa 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 7. normal saline flush 0.9 % syringe sig: ten (10) ml injection once a day for 7 days: sash and prn. disp:*14 syringes* refills:*0* 8. heparin flush 10 unit/ml kit sig: one (1) flush intravenous once a day for 7 days: sash and prn. disp:*14 syringes* refills:*0* 9. daptomycin 500 mg recon soln sig: six hundred (600) mg intravenous once a day for 6 days: start date: end date: . disp:*6 units* refills:*0* discharge disposition: home with service facility: critical care systems discharge diagnosis: 1' diagnosis acute myelogenous leukemia vancomycin resistant enteroccocal bacteremia 2' diagnosis pulmonary nodules of undetermined significance hypertension anxiety discharge condition: afebrile, hemodynamically stable discharge instructions: you were admitted for chemotherapy for your acute myelogenous leukemia. your hospital course was complicated by a blood stream infection, which required a brief stay in the intensive care unit. you recovered from this infection, and will be treated with antibiotics. please take your medications as directed. we have made the following changes: - given the liver function test abnormalities, your crestor was held. this can be restarted as an outpatient by your primary care physician. we had added amlodipine 5 mg by mouth daily - we have increased your metoprolol to 50 mg by mouth three times a day. - we decreased your celexa to 20 mg by mouth daily, with ativan as needed for your anxiety. this was done as you will likely need more chemotherapy, and as you may have nausea associated with it, we wanted to decrease the number of medications you would need to take orally. we have given you a limited supply of ativan until you are seen in a hospital setting later this week. - please restart your crestor at the discretion of your outpatient oncologist. - you need to take antibiotics for 6 more days (daptomycin and ertapenem). you will need to have some lab tests checked when you see your oncologist next week. please return to the hospital if you have fever > 100.4, chills, nausea, a worsening rash, abdominal pain, diarrhea, cough with sputum production, or any other symptoms not listed here concerning enough to you to warrant physician . followup instructions: with your oncologist dr. . provider: , md phone: date/time: 2:00 please have your ck levels checked when you see your oncologist next. you will also need a chest ct next week, which has been ordered by your discharging physician and will be followed up by dr. . it is scheduled for , at 9:15 am in the . there is no need at this time to follow up with pulmonary unless you deveolop further symptoms. other appointments: provider: 2-hem onc 7f hematology/oncology-7f date/time: 9:00 provider: 1-hem onc 7f hematology/oncology-7f date/time: 9:00 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart injection or infusion of thrombolytic agent biopsy of bone marrow biopsy of bone marrow closed biopsy of skin and subcutaneous tissue injection or infusion of cancer chemotherapeutic substance diagnoses: unspecified essential hypertension other and unspecified hyperlipidemia anxiety state, unspecified bacteremia antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use dermatitis due to drugs and medicines taken internally surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] obesity, unspecified other and unspecified infection due to central venous catheter drug induced neutropenia acute edema of lung, unspecified diverticulitis of colon (without mention of hemorrhage) acute myeloid leukemia, without mention of having achieved remission infection with microorganisms with resistance to multiple drugs other stomatitis and mucositis (ulcerative) mechanical complication due to breast prosthesis appendicitis, unqualified circumscribed scleroderma blepharospasm 

Answer: The patient is high likely exposed to