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: weakness major surgical or invasive procedure: intrathecal methotrexate therapy x2 via lumbar puncture history of present illness: hpi: 69 yo man with nhl with cns involvement (lymphomatous meningitis) s/p intrathecal mtx, rituxan, velcade and steroids. patient presented to er on with progressive weakness of both arms and legs for the last 2-3 weeks. he reports that his weakness (b/l arms and legs, r>l) has been ongoing over the past few months worsening over the past few weeks, mainly over the past 5 days. he walks with a cane at baseline, but has noted that walking up stairs with his left leg leading has become increasingly more difficult due to his weakness. he denies symptoms of bowel/bladder incontinence. . on arrival to ed was found to be tachycardic and hypotensive to systolic near 70s. ekg c/w svt. he was given adenosine 6 mg then 12, had a 30 sec break, but reverted to svt. after 1 g procainamide load, he converted to nsr. . additionally in the ed, cta was performed which did not show evidence of pe (h/o dvt on coumadin; inr therapeutic) but with new lul infiltrate. he was seen by neuro in the ed; weakness thought secondary to patient's underlying disease vs. use of velcade. he underwent mri of entire spine which has not yest been read. . he was transferred to the for monitoring. during his 24 h stay patient has remained in nsr. he was started on levofloxacin for possible pna given lul consolidation on imaging although not c/o symptoms of pneumonia. . ros: pt denies fever or chills. no night sweats or recent weight loss or gain. no headache, rhinorrhea or cough,or congestion. denied cough, shortness of breath (except transiently in the setting of svt). denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no melena or brbpr. no dysuria. denied arthralgias or myalgias. no rash. past medical history: nhl (see below) complicated by lymphomatous meningitis rle weakness secondary to plexopathy bilateral upper extremity weakness rle dvt hives intermittently over last couple years raynaud's phenomena lul lesion in s/p inh x1yr s/p appendectomy . onc hx: initially presented with palpable lymph node in the groin in . biopsy revealed diffuse large cell lymphoma. s/p r-chop x 6 cycles, completed in . patient was well until - when he developed right lower extremity paralysis. lp at that time was negative for malignant cells but repeat lp on revealed malignant cells with mri showing increased uptake in the sacral plexus. the patient was evaluated by neurology and thought to have a right lumbosacral plexopathy. the patient underwent ivig therapy without relief. around mid the patient began radiation therapy x9-12 treatments to the sacrum with improvement in pain complaints. he was also initiated on decadron. since the patient receives intrathecal methotrexate every 1-2 weeks. he has regained some use of his right lower extremity. social history: he is retired and worked as a marine engineer. he is married and never smoked. he has approximately 3 alcholic beverages a night. he has never used any illegal drugs. family history: his mother died at 93 of old age. his father died at 75 of heart failure. his sister is 65 and has diabetes and hypertension. he has two healthy daughters. physical exam: vitals: t: 99.2 bp: 119/71 p: 86 rr: 20 spo2: 95% 2l general: awake, alert, nad. heent: nc/at, perrl, eomi, sclera anicteric. mmm, op without lesions neck: supple, no jvd or carotid bruits appreciated pulm: fine crackles left lung base, no rhonchi nor wheezes cardiac: rrr, nl s1/s2, no m/r/g appreciated abdomen: soft, nt/nd, + bs, no masses or hepatomegaly noted. ext: right lower extremity 1+ edema. neurologic: cn 2-12 intact, lue with 4/5 biceps and triceps strength, 2-3/5 right biceps strength, right hip flexor , left hip flexor, right plantar flexion, right dorsiflexion, sensation to soft touch decreased slightly anterior right lower extremity to distal shin. . pertinent results: b-glucan= >500 cxr: comparison is made with prior examination performed one day ago. there is persistent ill-defined airspace disease involving left upper lobe likely related to pneumonia. there is increasing density at the right base with blunting of the right costophrenic angle. findings are suggestive of right basilar atelectasis and small right pleural effusion. cardiomediastinal silhouette is stable. central venous catheter is present with tip in the right atrium. . mri spine: compared to the previous study of , there are now new focal signal abnormalities identified from l1 to l5 level. the previously noted subtle lesions in some of these vertebral bodies have increased in size. findings are indicative of lymphoma deposits or metastatic disease. there is increased signal seen on t1- and t2-weighted images in the remaining portions of the lumbar vertebral bodies and sacrum indicative of fatty marrow changes from radiation. focal signal abnormality in the upper sacrum is also identified on the right side, indicative of metastasis or bony involvement by lymphoma. this has also increased since the previous study. there is no epidural mass seen or thecal sac compression identified. impression: new bony metastatic lesions involving the lumbar vertebral body with increase in size of previously noted lesion. no evidence of pathologic fracture or intraspinal mass. . cta chest: 1. no evidence of pulmonary embolus. 2. patchy ground-glass opacity within the left upper lobe, which is new since and likely represent an infectious process. 3. stable 12 mm prevascular lymph node within the mediastinum. 4. multiple low density lesions within the liver, which given history of lymphoma may represent metastates, or given pulmonary findings could represent infection. :mri spine, interval increase in size and # of enhancing metastatic foci in ls spine, no involvment of exiting nerve roots or thecal sac. mri brachial plexus: normal examination of the right and left brachial plexus, without abnormal enhancement. mild degenerative changes of the cervical spine and focus of signal abnormality in the t6 vertebral body. parenchymal abnormalities of the left lung apex. : cxr:progressive l.apical consolidation, ?radiation pneumonitis, r/o tuberculosis 10:49pm glucose-165* urea n-19 creat-0.6 sodium-139 potassium-3.7 chloride-104 total co2-24 anion gap-15 10:49pm calcium-8.5 phosphate-3.3 magnesium-2.0 10:49pm wbc-5.3 rbc-4.01* hgb-12.2* hct-35.5* mcv-89 mch-30.4 mchc-34.3 rdw-17.2* 10:49pm plt count-149* 10:49pm pt-28.8* ptt-27.2 inr(pt)-3.0* 09:00pm ck(cpk)-40 09:00pm ctropnt-0.06* 09:00pm ck-mb-notdone 01:18pm comments-green top 01:18pm glucose-133* lactate-2.7* na+-137 k+-4.1 cl--101 tco2-25 01:10pm glucose-137* urea n-25* creat-0.6 sodium-140 potassium-4.1 chloride-102 total co2-24 anion gap-18 01:10pm estgfr-using this 01:10pm ck(cpk)-57 01:10pm ctropnt-0.05* 01:10pm ck-mb-notdone 01:10pm calcium-9.2 magnesium-2.4 01:10pm wbc-8.1 rbc-4.53* hgb-13.9* hct-39.8* mcv-88 mch-30.8 mchc-35.1* rdw-17.5* 01:10pm neuts-94* bands-3 lymphs-1* monos-2 eos-0 basos-0 atyps-0 metas-0 myelos-0 01:10pm plt count-212# 01:10pm pt-26.8* ptt-28.8 inr(pt)-2.8* brief hospital course: assessment and plan: 69yom with history of nhl with cns involvement presented to the ed with worsening b/l ue and le weakness, found in the ed to be tachycardic to the 180s and hypotensive to the 70s systolic now in nsr and normotensive. . 1.weakness: patient was evaulated by neurology and it was thought that patients weakness was either due to cns lymphatous involvement vs. velade. mri perforemd showed new focal signal abnormalities from l1-l5 and sacral bony involvement looks worse. however, there was no epidural or thecal compression/involvement found. treatment was discussed by dr. . patient was given decadron, and received intrathecal methotrexate and high dose intravenous methotrexate. patient has been working with physical therapy. he continues to regain strenght by the day but still needs to work on his strength with physical therapy as an outpatient. he will follow up with dr. on tuesday at 10:00 for examination followed by admission of his next methotrexate treatment. 2. lul infiltrate: consolidation was visualized on cxr and ct chest. patient had been on decadron and was on bactrim ds qmwf at the beginning of admission. several attempts were made to induce sputum unsuccessfully, the patient was continued on levofloxacin for 14 days. a chest x-rday on showed proessive left apical consolidation. eventually the patient underwent bronchoscopy which showed pcp. , there was some question originally as to whether this was radiation pneumonitis. the patient had already been started on atovaquone 750mg by the time of bronchoscopy. the patient is clinically improving. 3. hypoxia: very mild, on 2l while in the without o2 requirement previously at home. the etiology was thought to be due to pcpor lul infiltrate. the patient eventually was weaned off o2, and is sating well while sitting. he will go home with o2 at bedtime and when active. . 4. svt: in nsr with normal bps. cta performed in the ed was negative for pe. resolved after procainamide. troponin up to 0.07 max in this setting. case discussed with cards in the and no additional meds/treatments necessary at this time. patient remained in normal sinus rhythm for the rest of the admission. . 5. elevated troponin: ck-mbi normal, troponin was elevated to max 0.08 likely in the setting of his svt which is now resolved. patient continued to be asymptomatic. . 6. nhl: followed by dr. . neuropathy thought secondary to velcade, now stopped. patient had recieved rituxan q2 weeks (has received 3 out of planned 4 doses, last ). plan discussed with dr. . on methotrexate and leucovorin were started and methotrexate levels and labs were followed. patient was given decadron, and urine ph kept above 7 during treatment. patient tolerated the treatment well. . 7. rle swelling: patient has history of rle dvt diagnosed in for which he has been on coumadin. a repeat u/s has been ordered which showed improved clot burden since . patient's coumadin was held and he was started on lovenox. patient will be transitioned back to coumadin for discharge. . 8.increased lft's thought to be due to either methotrexate or bactrim. bactrim d/cd, methotrexate ended, lft's are decreased. ruq ultrasound was performed. . medications on admission: medications on admission: oxycodone 60 mg sustained release po q12h pregabalin 100 mg 3 times a day senna 8.6mg two (2) tablet po 2 times a day as needed. zantac 150 mg po twice a day oxycodone 5 mg po q4-6h as needed for breakthrough pain warfarin 5 mg qhs decadron 3 mg qam - 2 mg qpm . meds on transfer: bactrim ds qmwf oxycodone 5-10mg q4-6h prn breakthrough pain levofloxacin 500mg po q24h dexamethasone 2mg po qpm dexamethasone 3mg po qam ranitidine 150mg po bid oxycodone sr 40mg q12h zolpidem 5mg po hs prn acetaminophen 325-650mg po q4-6hprn discharge medications: 1. atovaquone 750 mg/5 ml suspension sig: one (1) po bid (2 times a day). disp:*60 * refills:*2* 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. disp:*60 tablet(s)* refills:*0* 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 5. fluconazole 100 mg tablet sig: two (2) tablet po q24h (every 24 hours). disp:*60 tablet(s)* refills:*2* 6. dexamethasone 2 mg tablet sig: one (1) tablet po q12h (every 12 hours). disp:*60 tablet(s)* refills:*0* 7. prednisone 20 mg tablet sig: two (2) tablet po bid (2 times a day) for 5 days. disp:*20 tablet(s)* refills:*0* 8. warfarin 5 mg tablet sig: one (1) tablet po hs (at bedtime) for 3 days. disp:*3 tablet(s)* refills:*0* discharge disposition: home with service facility: home care discharge diagnosis: primary: nhl with cns involvment hypoxia superventricular tachycardia seconday: dvt rle weakness discharge condition: stable without further decline in weakness, respiratory status improved. discharge instructions: you were admitted for worsening weakness. you underwent intrathecal methotrexate therapy x2 with no further decline in your weakness. additionally, you were given systemic methotrexate with leucovorin rescue. . please call your doctor or return to the emergency room if you develop worsening weakness, fevers/chills, trouble breathing, bleeding or any other symptoms that concern you. . please be sure to follow up as outlined below. followup instructions: please follow up with dr. on tuesday at 10:00am with an admission to follow for methotrexate treatment. . please follow up with your appointments as scheduled prior to this admission: procedure: parenteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus transfusion of packed cells injection or infusion of cancer chemotherapeutic substance injection of other agent into spinal canal diagnoses: pneumonia, organism unspecified anemia, unspecified pulmonary collapse other malignant lymphomas, unspecified site, extranodal and solid organ sites other specified cardiac dysrhythmias hypoxemia acute venous embolism and thrombosis of deep vessels of proximal lower extremity acute venous embolism and thrombosis of unspecified deep vessels of lower extremity 

Answer: The patient is high likely exposed to