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: luq pain x 1 month, w/u at major surgical or invasive procedure: ct-guided biopsy history of present illness: 56m w/minimal pmhx who p/w gradual onset luq dull pain/"pushing" x ~1 month. some radiation to l flank, worse lying down, slightly relieved w/walking. he presented to the system, where initial dx included constipation, treated with laxatives with no relief of pain. currently the patient reports 7/10 intensity abdominal pain. at the va: ldh 726, ct showed massive lad in retrocrural nodes into upper abdomen involving celiac nodes; concerning for lymphoma. he was prepared for biopsy of the area, but was unable to complete procedure secondary to discomfort (?chest pain). he was discharged yesterday and presents to to transfer his care to this facility. pt states he does not want to go back to va for any care. pt also notes nausea, "dry heaves" ~4-5x in past 2 weeks. +anorexia, ~30 lbs unintentional wt loss over past 6 wks. +feverishness, +ns +chills. profound fatigue and generalized weakness. constant diarrhea x 2 yrs, taking frequent "stool hardener" ?kaopectate, which he recently self-d/c'd. no current bowel problems. past medical history: arthroplastic surgery on knee. no history of cad social history: lives with wife and 2 daughters in area. he smoked 1.5 ppd x 40 years, "quit 4 days ago." works as a letter carrier, but has taken sick for past week. approximately 6 drinks per week. family history: daughter with leukemia, diagnosed . she receives care in . no other family history of malignancy. physical exam: pe: vs t98.7, p72, bp 161/75, r18, spo2 95% ra gen: alert, oriented male in no distress. appears slightly older than stated age. heent: pharynx clear, poor dentitions. no cervical lymphadenopathy. cv: no jvd. s1 s2 with no murmurs. lungs clear. chest: no lesions. abd: nontender over cm, no hsm by palpation or percussion. nonobese. guaiac negative stool per er report. ext: no c/c/e x4. pertinent results: 02:30pm glucose-84 urea n-17 creat-0.8 sodium-141 potassium-4.6 chloride-101 total co2-28 anion gap-17 02:30pm alt(sgpt)-15 ast(sgot)-20 ck(cpk)-52 alk phos-107 amylase-24 tot bili-0.4 02:30pm lipase-16 02:30pm ck-mb-notdone ctropnt-<0.01 02:30pm wbc-9.9 rbc-4.12* hgb-12.4* hct-35.9* mcv-87 mch-30.2 mchc-34.7 rdw-12.5 02:30pm plt count-302 ct abdomen: in the upper abdomen, there is a large heterogenous mass consistent with confluent adenopathy measuring up to 9.4 x 7.8 cm. it surrounds the aorta and celiac axis with tethering of the left gastric artery. a 3.1 x 1.9 cm periportal node is also seen. 1. large heterogenous splenic mass. heterogenous bulky retroperitoneal adenopathy surrounding the aorta and celiac artery. areas of necrosis are seen. these findings are concerning for lymphoma. 2. left renal exophytic cyst. possible right renal cyst. pathology: overall, the findings are of a high grade, non-hodgkin b-cell lymphoma. given the high proliferation fraction, the differential diagnosis includes a high grade diffuse large b-cell lymphoma versus an atypical burkitt lymphoma. cytology: overall, findings are of a high-grade cd10-positive b-cell lymphoma. differential includes atypical burkitt's vs large b-cell lymphoma. ct chest: impression: 1) right hilar lymphadenopathy measuring 17 mm in diameter, as well as slight prominence other bilateral hilar nodes. in the clinical setting of lymphoma, involvement of lymphoma in the right hilar nodes is suspected. correlative fdg pet or gallium imaging may be helpful. 2) calcified subcarinal node, with multiple calcified granulomas, representing prior granulomatous infection. 3) non-calcified pulmonary nodule measuring less than 5 mm in diameter, as described above, probably related to the prior granulomatous infection, however, please follow up these lesions on future ct scans. 4) gynecomastia. 5) interval development of small amount ascites, measuring 43 hounsfielunits, which raises the possibility of hemoperitoneum following recent biopsy. : tte: conclusions: 1.the left atrium is mildly dilated. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). 3.right ventricular chamber size and free wall motion are normal. 4.the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. 5.the mitral valve leaflets are structurally normal. no mitral regurgitation is seen. 6.there is no pericardial effusion. : bone marrow biopsy- normocellular marrow for age with multiple lymphoid aggregates : ct abdomen: there has been interval decrease in the size of the splenic lesion. previously, it measured 11.5 x 11.1 cm and now measures 10.0 x 8.6 cm. it is now more heterogeneous in appearance with low attenuation areas consistent with necrosis. small amount of higher attenuation fluid is noted at the inferior margin of the spleen consistent with peri-splenic hematoma. the retroperitoneal mass of bulky adenopathy involving the proximal abdominal aorta and left diaphragm has also decreased in size. previously, it measured 9.4 x 7.8 cm and now measures 7.6 x 6.6 cm. areas of low attenuation are also seen consistent with necrosis. : gastrointestinal mucosal biopsies, two: a. esophagus: 1. active esophagitis, with ulceration. 2. no viral inclusions or tumor seen. 3. methenamine silver stain of the esophagus (slide a) is negative for fungi, with satisfactory control. . b. duodenum: 1. acute duodenitis, with multiple crypt abscesses and focal loss of villi. 2. no viral inclusions or tumor seen. 3. immunostain of the duodenum (slide b) is negative for cytomegalovirus, with satisfactory control. some reagents are not approved for diagnostic use. note: possible causes of the duodenal inflammation include infection and drug injury. :ct abdomen: gallbladder is slightly prominent but demonstrates no secondary signs of cholecystitis. there is a stable appearing,predominantly hypodense lesion within the spleen measuring 8.2 x 7.0 cm. this appears unchanged in size and appearance in the interval. a large paraesophageal soft tissue mass measures 6.5 x 5.5 cm and is grossly unchanged in appearance as well. pancreas and adrenal glands are normal in appearance : ct sinus: impression: minimal ethmoid sinus thickening. evidence of prior right maxillary surgery. otherwise, negative study. : ct abdomen:impression 1. no evidence for splenic, perisplenic, or intra-abdominal hemorrhage. 2. unchanged size and appearance of the splenic hypodense lesion, and peri- splenic fluid collection. 3. unchanged soft tissue mass in the lesser sac, which is presumably a mass of matted lymph nodes. brief hospital course: the patient is a 56 yo male with burkitt's lymphoma. #burkitt's lymphoma - the patient presented to the va with 5-6 day history of luq pain and constipation. a ct scan at wr was notable for lymphadenopathy concerning for neoplastic disease. a repeat ct abdomen on admission was notable for extensive lad, splenomegaly with a splenic lesion. on , ct guided core biopsy of spleen was notable for b cell lymphoma - dlbl vs burkitts. ct chest was done for staging which was notable for enlarged r hilum ln. he then had a baseline tte which suggested an lvef of >55%. a bone marrow biopsy was done which suggested t cell dominant lymphoid profile. there was a small population of cd10 co-expressing b cells; given the known history of a cd10 positive b-cell lymphoproliferative disorder, the findings are suspicious and minimal involvement of the marrow cannot be entirely excluded. he was started on ivfs with amps of bicarb + bicarb tablets for goal urine ph >7 and allopurinol. when his urine ph was greater than 7, he was given his first dose of cytoxan 400 mg iv (). he was given anzemet/decadron prior to chemo for antinausea prophylaxis. in the pm of day 1, he was given his first dose of vincristine 2mg iv x1. the medications were separated in time because he was considered high risk for tls because his ldh was 1100 and rising and he had burkitts with a large tumor burden. tls were checked q3 hours. on day 2, he was given 1600 mg cytoxan in the morning and 80 mg iv doxurubicin in the evening. his ldh increased to max 2900 on day 2 of modified protocol. he did not develop evidence of hyperkalemia, hyperphosphatemia, hyperuricemia, or hypocalcemia. his bicarbonate in his blood rose to 43, so the bicarb in his fluids was decreased. the frequency of tls labs was decreased to q6hours. on day 3, he received it cytarabine + hydrocortisone with no complications and 400 mg iv cytoxan with no complications. on day 4 and 5, he received 400 mg cytoxan with no complications, hematuria, etc. on day 5, he received the second dose of it cytarabine with hydrocortisone with no complications. over the first few days of chemo, the patient also required intermittent doses of lasix to maintain a stable weight and limit bipedal edema. on day 7, the patient noted an increase in his luq pain; a repeat ct of the abdomen showed necrosing tumor decreasing in size. he received his second dose of vincristine on day 7. he tolerated the vincristine well without peripheral numbness/tingling or constipation. on day 8, the patient had continued increased luq pain so he was started on a morphine pca. on day 9 he was started on ivfs with bicarb for goal urine ph >7.0. on day 10, he got methotrexate 6 gm iv. on day 11, he started leucovorin rescue. his 24 hour mtx level was 1.87. on day 12, he was neutropenic. he spiked to 102.4 overnight so he was started on cefepime, blood cultures/urine cultures were sent which were negative. a few hours after having a fever, he started to have profuse watery diarrhea ~2l in 8 hours. flagyl was added for possible c.diff. stool cultures, cdiff and cmv were sent which were negative (cdiff negative x 3). the patient was also started on ciprofloxacin for double gram negative coverage. by mid morning of day 13, the patients blood pressures had decreased to 70s-80s/40s-50s and his hr increased to 120s. he also had episodes of projectile vomiting-nonbloody. he was also started on neupogen (per protocol) and b/c the patient was neutropenic and there was concern of typhilitis. he was given over 5 liters ns bolus with no increase in pressures. he was then transferred to the for further management of his hypotension. an a-line was placed and he was started on levophed once in the unit. another 2l of ns were administered and the levophed was weaned off. ct abdomen was performed with oral contrast (through ngt b/c pt unable to tolerate contrast) due to concern for abdominal source, especially typhlitis. his ct abdomen demonstrated some mild wall thickening in the cecum. he remained febrile and vancomycin was started. he again remained febrile with negative cultures so caspofungin was started. repeat kubs were unremarkable, without free air. on day 14, he had coffee ground emesis overnight and guaic + stools so he was started on iv ppi. the coffe ground emesis resolved, but the patient continued to have 1-2l /day watery diarrhea (no infectious etiology had was found) so octreotide was started. the patient continued to have diarrhea with decreased po intake so tpn was started. after days of octreotide, the patients diarrhea decreased to episodes per day. repeat stool studies were again negative. the patients anc began to rise on day 17. he was no longer neutropenic by day 18 so the neupogen was stopped. the vanco and cefepime were also stopped because he was no longer febrile. because the patient was no longer neutropenic, he was able to have an egd which was notable for grade 1 esophagitis and diffuse nodularity of the mucosa of the duodenom. the path from the biopsies were consistent with crypt abscess from drug vs infection. cmv and fungal cultures were negative from the biopsies. it was felt that the etiology of the diarrhea was methotrexate induced. the patient was still afebrile so the caspo was stopped. over the next few days, the patients wbc count increased despite stopping neupogen. by day 21, his wbc increased to 49. flow was sent on the blood and it was found to not be consistent with burkitts. in the setting of such a high wbc, there was concern for cdiff toxin b even though cdiff a was negative x >3 so stool was sent for toxin b and the patient was started on po vanco in addition to flagyl. tgg was also sent to evaluate for celiac sprue. this test was also negative. a repeat abdominal ct was done which was notable for stable mass in spleen, stable paraortic lymph nodes and no thickening of wall of small bowel. the patients diarrhea began to slow down to 2-3 stools per day and his wbc trended down. on day 26, his wbc was 17.6, his t. bili was 1.7, he had only stools per day so it was decided to start part b of modified protocol (ivac). he was given 75% dose of etoposide and ara-c, 100% dose of ifosfamide in light of his elevated bilirubin. the patient was also started on mesna with the ifosfamide. baseline cerebellar check was only notable for minimal intention tremor with finger to nose testing. the patient's cerebellar exam remained stable throughout and s/p the 4 doses of ara-c. he tolerated the 5 days of chemo well. his course was complicated only by minimal nausea decreased with anzemet and ativan. on day 8, the patient received it mtx with no complications. his anc on discharge was 1170. he refused 1 unit prbc prior to discharge. #luq pain - the patients pain was well controlled with po pain meds until after his first round of chemo. the pain then increased and he required a morphine pca for pain control. the pca was stopped in the setting of the patient's acute mental status changes while he was hypovolemic/hypotensive. when he was transferred back to 7 , he was started on a fentanyl pca for pain control. this did not decrease his pain, so he was changed back to a morphine pca. the morphine pca gave him good relief. prior to discharge, he was changed to ms contin and po msir for breakthrough pain. #acute renal failure - in the setting of the patient's hypotensive episode, his creatinine increased to a max of 1.4. his bun increased to 24. his fena was 1.4%. it was felt to be secondary to volume depletion (prerenal). the patient's uo remained 50-100 cc/hour. due to concern for methotrexate toxicity (completed on ) and mtx level 0.36 on , especially in light of sepsis and potential third spacing of mtx, iv leucovrin was increased and hemodialysis was started. his methotrexate level decreased appropriately, and no further hemodialysis was required. #hyperbilirubinemia - in the setting of the diarrhea, hypotension, the patients bilirubin also started to rise. it was mostly direct by fractionation. a ruq ultrasound was normal and had normal venous flow. the patients peak bilirubin was 8.1 with direct bili of 5.7 on day . hepatitis a, b and c serologies were sent which were negative. the etiology of the hyperbilirubinemia was unknown, and with negative us and ct scan it was felt to be secondary to septic gallbladder (although peaked several days after the episode of hypotension occurred) vs methotrexate effect. the patient remained on actigall 600 mg throughout the admission. his bilirubin trended down to normal on the actigall. #altered mental status - on day 13, in the setting of the diffuse watery diarrhea and hypotension, the patient became lethargic. it was felt that the ativan given for his nausea and his morphine pca could be contributing to his altered mental status so both of these were held. the patients neuro exam was nonfocal during the episode. the patients lethargy resolved after stopping these meds and after aggressive hydration. #depression - the patient has a history of several major depressive episodes. he has been hospitalized at least 2 times for "breakdowns". he was admitted on celexa 40 mg daily and wellbutrin 200 mg . throughout the admission, he remained down with a flat affect. his celexa dose was increased to 60 mg daily with improvement in his mood. he was also seen by psychiatry who felt that he should be maintained on celexa and wellbutrin. #fen - the patient remained on tpn from day 17 until discharge. his electrolytes were repleted as needed. #code - full. medications on admission: meds @ home: wellbutrin 200 mg po bid, celexa 40 mg po qd, colace 100 mg po bid, mvi 1 tab po qd, percocet 1-2 tabs q4-6h. discharge medications: 1. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. citalopram hydrobromide 20 mg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 3. bupropion hcl 100 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 4. acyclovir 200 mg capsule sig: two (2) capsule po q8h (every 8 hours). disp:*180 capsule(s)* refills:*2* 5. ursodiol 300 mg capsule sig: two (2) capsule po bid (2 times a day). disp:*120 capsule(s)* refills:*2* 6. levofloxacin 250 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 10 days. disp:*20 tablet(s)* refills:*0* 7. zolpidem tartrate 5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed. disp:*45 tablet(s)* refills:*0* 8. morphine sulfate 15 mg tablet sustained release sig: one (1) tablet sustained release po q12h (every 12 hours). disp:*60 tablet sustained release(s)* refills:*0* 9. lorazepam 0.5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for nausea. disp:*30 tablet(s)* refills:*0* 10. morphine sulfate 15 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for breakthru pain. disp:*24 tablet(s)* refills:*0* 11. filgrastim 480 mcg/1.6 ml solution sig: one (1) injection q24h (every 24 hours): please inject 480 mcg subcutaneously x 6 days. disp:*10 ml* refills:*0* 12. chlorhexidine gluconate 0.12 % liquid sig: one (1) ml mucous membrane (2 times a day). disp:*60 ml(s)* refills:*2* 13. vancomycin hcl 250 mg capsule sig: one (1) capsule po four times a day for 7 days. disp:*28 capsule(s)* refills:*0* 14. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 7 days. disp:*21 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: burkitt's lymphoma discharge condition: stable discharge instructions: please take all medications as prescribed. if you have fevers, chills, sweats, nausea, vomiting, abdominal pain, increased diarrhea, you should call dr. office or come to the emergency department. temperatures of 100.4 and above should be considered a fever while your white count is low. followup instructions: provider: , md where: hematology/bmt phone: date/time: 2:30 procedure: venous catheterization, not elsewhere classified spinal tap incision of lung parenteral infusion of concentrated nutritional substances hemodialysis insertion of other (naso-)gastric tube esophagogastroduodenoscopy [egd] with closed biopsy arteriography of other intra-abdominal arteries arteriography of other intra-abdominal arteries arteriography of other intra-abdominal arteries transfusion of packed cells injection or infusion of cancer chemotherapeutic substance closed [aspiration] [percutaneous] biopsy of spleen diagnoses: anemia, unspecified tobacco use disorder congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis hypopotassemia nausea with vomiting hypotension, unspecified loss of weight antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use disorders of magnesium metabolism splenomegaly burkitt's tumor or lymphoma, lymph nodes of multiple sites diarrhea of presumed infectious origin mood disorder in conditions classified elsewhere duodenitis, with hemorrhage ulcer of esophagus with bleeding other diseases of spleen unspecified disorder of gallbladder jaundice, unspecified, not of newborn 

Answer: The patient is high likely exposed to