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: persistent hypotension major surgical or invasive procedure: picc line placement blood transfusion history of present illness: 73 yo m who presents to micu with fever and hypotension has past medical history of multiple myeloma and plasmacytoma. he reports that he was in clinic on for blood transfusion and was noted to have slight elevation in temperature to ~100. he was told to return for temp over 100.3 and shortly after getting home, his measured temp was 101. he came to the ed. at this time he denied any lightheadedness, presyncope, chest pain, dyspnea. also denied hematuria, hematochezia, melena, dysuria. reports normal urine output. . of note, he recently finished a 14 day radiation therapy treatment to his t10-11 and sacrum on day prior to admission. during this treatment course his wbc, hct, and plts have been noted to be decreasing to wbc of 1.5, hct of 24.8, and plt of 28 in clinic today. . in the ed, initial temp 101.8 and systolic bp in the 120s; however, blood pressure began to drop despite 4l of fluid boluses. blood culture obtained. ua negative in the ed. patient was given 2 g cefepime. no ekg was performed in the ed. . on the floor, patient was alert, conversant, and without complaints. . review of sytems: (+) fever, recent weight loss (-) chills, night sweats, headache, sinus tenderness, rhinorrhea, or congestion. denied cough, shortness of breath, chest pain or tightness, palpitations, nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits, specifically no melena or hematochezia. no dysuria. denied arthralgias or myalgias. past medical history: past medical history: oncologic history: the patient was diagnosed with multiple myeloma after developing right and then left hip pain in 3/. imaging studies performed at demonstrated metastatic bone lesions in the left acetabulum and an l1 laminar lesion with mass effect on the thecal sac, but no primary mass was seen within the abdomen/pelvis. a bone scan on showed activity in the left acetabulum, right iliac , l1 vertebra, and left ribs. of note, a cervical spine mri and brain mri performed in had demonstrated degenerative changes and spondylosis but no metastatic disease. on , a biopsy of right iliac bony lesion demonstrated plasmacytoma. by immunohistochemistry, the plasma cells were cd138 positive, kappa restricted by immunoglobulin light chain staining (confirmed by in-situ hybridization for immunoglobulin light chains). lambda stain was essentially negative. they did not aberrantly co-express cd20, and bcl-1 was predominantly negative. by mib-1 staining, the proliferation fraction was approximately 70%. an spep performed on demonstrated monoclonal iga kappa, with quantitative ig levels showing igg 829, iga 1899, igm 122. upep was negative. a beta2 microglobulin level was 3.7. a bone marrow biopsy performed on showed a mildly hypercellular bone marrow for age with trilineage hematopoiesis and an atypical plasma cell infiltrate consistent with involvement by plasma cell myeloma. he completed xrt on to hip, ribs and back and was started on bortezomib/dexamethasone on . additional medical history: 1. adenoma of the colon. - diagnosed with a colon mass by screening colonoscopy in - status post right colectomy with 0/22 ln involved. - follow-up colonoscopy in that unremarkable. 2. polymyalgia rheumatica, treated in with prednisone. 3. history of benign prostatic hypertrophy. 4. basal cell carcinoma. - status post resection from the left upper back in 07/. social history: the patient lives with his wife; he has three children and nine grandchildren. he worked at stop & shop supermarket in the past and now works part-time as a driver for a private car company. he smoked cigarrettes for 30 years, quitting 20-25 years ago. he drinks two beers per day. family history: the patient's mother died of an mi at age 80 and had a history of peptic ulcer disease. he does not know his father's medical history. he has three children, two daughters and one son, who are well. physical exam: gen: nad heent: perrl, eomi, oral mucosa slightly dry, oropharynx benign neck: supple, no lad card: rr, nl s1, nl s2, no m/r/g pulm: ctab with no wheezes abd: bs+, soft, nt, nd, no hsm ext: no c/c/e, dp 2+ bilaterally neuro: oriented x 3, good concentration on saying days of week backwards, cn ii- xii intact psych: mood and affect appropriate pertinent results: microbiology: - blood culture, routine (final ): staphylococcus, coagulase negative. , , blood cx's - no growth to date imaging: cxr: no acute cardiopulmonary process. ruq u/s: impression: 1. gallstones and sludge are seen in the gallbladder. no evidence of cholecystitis. 2. the liver is diffusely echogenic, suggestive of fatty infiltration. tte: the left atrium is elongated. the left atrial volume is increased. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the detected pulmonary artery systolic pressure (ra pressure + tr gradient) has increased. no vegetations detected. toe plain film: findings: three views show mild degenerative changes involving the first mtp and ip joints. there is some periosteal reaction along the medial border of the proximal phalanx with the vague suggestion of some irregularity of the mid portion of this bone that could reflect a previous fracture. however, this has no clinical significance. impression: no evidence of myelomatous lytic involvement in this region. pertinent labs: cbc 01:50pm blood wbc-1.5*# rbc-2.86* hgb-8.5* hct-24.8* mcv-87 mch-29.6 mchc-34.1 rdw-17.2* plt ct-28*# 06:30am blood wbc-1.3* rbc-3.09* hgb-8.9* hct-27.1* mcv-88 mch-28.9 mchc-32.9 rdw-16.6* plt ct-43* 12:45am blood wbc-1.2* rbc-2.83* hgb-8.3* hct-23.8* mcv-84 mch-29.3 mchc-34.8 rdw-15.9* plt ct-34* 01:50pm blood plt smr-very low plt ct-28*# 12:45am blood plt ct-34* chemistries 10:50pm blood glucose-109* urean-18 creat-0.8 na-129* k-4.0 cl-94* hco3-24 angap-15 12:45am blood glucose-110* urean-21* creat-0.6 na-132* k-4.1 cl-97 hco3-26 angap-13 lfts 01:50pm blood alt-209* ast-95* ld(ldh)-338* alkphos-366* totbili-0.6 dirbili-0.2 indbili-0.4 12:45am blood alt-110* ast-39 ld(ldh)-351* alkphos-233* totbili-0.7 01:50pm blood calcium-8.8 phos-3.8 mg-2.2 06:30am blood calcium-9.2 phos-2.8 mg-2.5 uricacd-3.8 12:45am blood calcium-8.7 phos-2.4* mg-2.3 hemolysis labs 10:50pm blood hapto-413* 01:50pm blood tsh-2.3 vancomycin troughs 04:01am blood vanco-18.1 lactate level: 02:31am blood lactate-0.8 brief hospital course: this is a 73 yo m with history of multiple myeloma and plasmacytosis s/p xrt admitted with fevers and hypotension after a blood transfusion. # hypotension: likely etiology was septic shock in the setting of fever and neutropenia and hypotension despite adequate fluid resuscitation in the ed. sources included bacteremia from coagulase negative staphylococcus. contaminated blood product was considered, but less likely (see below). concern for adrenal insufficiency in the setting of hyponatremia and long term use of steroids. other infectious etiologies were ruled out (no pna noted on cxr, gallbladder u/s showed no cholecystitis, tte without evidence of endocarditis.) medication effect was also considered, and his terazosin and tadalafil were held. he was initially broadly covered with vancomycin/cefepime, and ciprofloxacin. stress dose steroids were administered, which was tapered to twice the dose of oral dexamethasone than the patient's home dose on discharge, to be tapered at the discretion of his outpatient oncologist. 1/4 bottles of blood grew coag negative staphylococcus. however, given the clinical setting of hypotension, fever, and neutropenia, the patient was treated with a 14 day course of vancomycin and an ir guided picc line was placed. never had definitive evidence of uti (u/a negative but no urine culture sent) but did get 3 days of ciprofloxacin. irradiated, leuko-reduced blood products he received in clinic were cultured by the blood bank, but showed no source organism. noted to have a mouth ulcer, started on acyclovir. cefepime was discontinued once his anc was noted to be greater than 1000. patient was admitted to the micu initially for hypotension and treated with iv fluid boluses as needed, pressors were not required. he was eventually transferred to the floor once his blood pressures were stable. #) multiple myeloma: s/p xrt to sacrum and spine. set up for count checks on discharge. #) anemia: likely due to multiple myeloma. hemolysis labs negative. transfused with platelets and blood per bmt protocol. #) r great toe pain: chronic. no trauma. concerning for gout, but no elevated uric acid levels. plain films showed no evidence of multiple myeloma or acute fracture. controlled with morphine. medications on admission: 1) dexamethasone 2 mg 2) lactulose 30 ml po every 6-8 hours 3) lorazepam 0.5 mg qhs:prn insomnia 4) morphine-ir 15 mg po q4h:prn pain 5) morphine-sr 15 mg po bid 6) nystatin - qid:prn, thrush 7) ondansetron hcl 4-8 mg po q8h:prn nausea 8) pentamidine (last dose was ) 9) prochlorperazine maleate 10 mg po q6h:prn 10) tadalafil 20 mg prn 11) terazosin 10 mg qd 12) docusate sodium 100 mg 13) multivitamin daily 14) senna 8.6 mg - 2 tablet(s) po bid 15) simethicone 80 mg tablet, by mouth four times a day as needed for gas 16) thiamine hcl 100 mg daily discharge medications: 1. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 2. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed: thrush. 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. morphine 15 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 5. morphine 15 mg tablet sustained release sig: three (3) tablet sustained release po q12h (every 12 hours). 6. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 7 days: start date: end date: . disp:*14 gram* refills:*0* 7. prilosec 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 8. dexamethasone 4 mg tablet sig: one (1) tablet po q12h (every 12 hours). 9. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. zofran 4 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for nausea. 13. compazine 10 mg tablet sig: one (1) tablet po every six (6) hours. 14. sodium chloride 0.9 % 0.9 % syringe sig: one (1) syringe injection once a day for 7 days: 5 ml sash and prn. disp:*14 syringes* refills:*2* 15. heparin flush 10 unit/ml kit sig: one (1) kit intravenous once a day for 7 days: sash and prn. disp:*14 syringes* refills:*2* 16. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical q24h (every 24 hours) for 7 days. disp:*7 adhesive patch, medicated(s)* refills:*0* 17. acyclovir 400 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: 1' diagnosis fever and neutropenia hypotension 2' diagnosis multiple myeloma discharge condition: afebrile and hemodynamically stable discharge instructions: you were admitted with a diagnosis of fever, neutropenia (low white blood cell counts) and hypotension. this was either due to a contaminated blood product you received or due to a transient bacterial infection in your blood. you will be treated with a 14 (fourteen) day course of antibiotics total. please take your medications as directed. - vancomycin through the iv for 7 more days. - you were started on acyclovir for a mouth sore. please take this medication at 400 mg by mouth twice a day to prevent further mouth sores. - you may use a lidocaine patch (12 hours on, 12 hours off) daily to help with your back pain. - we added prilosec 40 mg by mouth daily to your regimen to protect your stomach from gastritis, as you are on steroids currently. - you were discharged on a slightly higher steroid dose than you were admitted on due to concern for low blood pressures and adrenal insufficiency. please taper this medication at the discretion of your outpatient oncologist. - your cialis and terazosin were held in the setting of low blood pressure. please restart these medications as directed by your outpatient oncologist. please seek medical attention if you experience fever > 100.4, chills, light-headedness or dizziness, cough with sputum production, severe chest or abdominal pain, diarrhea, a spreading rash, or any other symptoms not listed here concerning enough to warrant physician followup instructions: with your oncologist dr. tuesday, at 1:30 pm. please call if you cannot keep this appointment. please also come to check your counts at the outpatient oncology clinic in 7 this coming thursday at 2:30 pm. procedure: venous catheterization, not elsewhere classified diagnoses: polymyalgia rheumatica long-term (current) use of steroids unspecified septicemia severe sepsis other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure septic shock multiple myeloma, without mention of having achieved remission personal history of irradiation, presenting hazards to health herpes simplex without mention of complication neutropenia, unspecified nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] fever presenting with conditions classified elsewhere other transfusion reaction 

Answer: The patient is high likely exposed to