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: past medical history: 1. sle diagnosed in complicated by end-stage renal disease requiring cadaveric renal transplant in . she was receiving azathioprine, cyclosporin, and prednisone for immunosuppression. her kidney transplant was very close match and she had no episodes of rejection. 2. left hip avascular necrosis, status post replacement times two in and . 3. hypertension. 4. cataracts, status post surgery. 5. status post cholecystectomy done by dr. at the . 6. hypothyroid. 7. gout. allergies: plaquenil, fosamax, lipitor. social history: the patient is married. she has two sisters, one daughter 16 years of age. she does not smoke. she drinks alcohol occasionally. outpatient medications: 1. percocet. 2. levothyroxine 50 once a day. 3. verapamil sr 240 mg in the morning, 180 mg at night. 4. colace. 5. colchicine 0.6 mg once a day. 6. senna. 7. bisacodyl. 8. zofran. 9. ceftriaxone. 10. levofloxacin. 11. flagyl. 12. protonix. 13. ativan. 14. prednisone taper. 15. heparin subcutaneous. 16. cyclosporin. 17. atrovent. 18. albuterol. 19. allopurinol. 20. morphine. physical examination on admission: vital signs: temperature 96.9, heart rate 92, blood pressure 108/63, respirations 28, oxygen saturation 98% on 4 liters nasal cannula. general: the patient was in moderate respiratory distress, alert and oriented times three. heent: the oropharynx had a wide plaque on the hard palate, also a covered tongue and buccal mucosal. the pupils were equal, round, and reactive to light and accommodation bilaterally. the extraocular movements were intact. neck: no jvd. cardiovascular: regular, no murmurs, rubs, or gallops. pulmonary: crackles two-thirds down bilaterally with no wheezes. abdomen: obese, nontender, nondistended, positive bowel sounds. extremities: no edema, 2+ dorsalis pedis pulses bilaterally, 2+ radial pulses bilaterally. neurologic: cranial nerves ii through xii were intact. laboratory/radiologic data: white cell count 13.3, hematocrit 35.7, platelets 273,000. pt 15, inr 1.5. sodium 133, potassium 4.5, chloride 95, bicarbonate 23, bun 43, creatinine 1.4. alt 40, ast 28, ldh 75, alkaline phosphatase 64, amylase 26, lipase 14, total bilirubin 1.2, ck 25, albumin 2.8, troponin less than 0.01. uric acid 15. cyclosporin level 270. white cell count 1,215, 40 red blood cells, no polys, 4 lymphs, total protein 2.0, glucose 107, ld 341. abg drawn on 4 liters of nasal cannula returned at 7.38, 42, and 37. lactate 2.3. echocardiogram done in was normal. a ct of the chest was done on which showed massive axillary, mediastinal, and hilar lymphadenopathy, with bilateral pleural effusions and collapse of posterior left lower lobe. cta was done on and showed no pulmonary embolism. hospital course: upon transfer to the , the patient was intubated for hypercarbic respiratory distress and chop chemotherapy was started the same night. 1. lymphoma: diagnosed by chest ct confirmed by supraclavicular node biopsy and malignant cells and pleural effusion tap, large b cell lymphoma was positive for ebv virus, burkitt's type with 100% cells dividing. the patient's large tumor burden in the chest and neck was initially treated with the cycle of chop chemotherapy followed by five days of cytoxan and high-dose prednisone. tumor lysis laboratories were followed every six hours. she received aggressive iv fluid hydration with sodium bicarbonate to alkalinize the urine. the urine output was maintained at 80-100 cc per hour. ldh initially was elevated at 4,000. it subsequently decreased and reached a level of 500 at nadir. on day number four post chemotherapy, , a ct of the chest was obtained to evaluate for the interval change. all lymph nodes have decreased in size in general. the patient indeed has severe mediastinal lymphadenopathy with large lymph nodes compressing on the major airways and great vessels of the chest. she developed chemotherapy-induced pancytopenia on day number three postchemotherapy, granulocyte colony stimulator factor was started at 400 mg iv q.d. on , the patient was started on another chemotherapy regimen with an azt and hydroxyurea. because of the risk of azt induced lactic acidosis per abgs, the lactate levels were followed closely. respiratory failure: multifactorial, caused by airway and great vessel compression and obstruction by tumor mass as well as large and growing malignant pleural effusions, hypoalbuminemia leading to third spacing and severe volume overload as well as atelectasis. the patient was initially thought to have pneumonia and was treated with antibiotics without significant success. she was later ruled out for pulmonary embolism with cta. her pleural effusion was tapped on prior to transfer to the ; 600 cc were drained with almost immediate reaccumulation of fluids. during the course of her icu stay on , another attempt was made at therapeutic thoracentesis; however despite large pleural effusions bilaterally on the chest x-ray only 10-15 cc of fluid were obtained. follow-up ct done on showed growing large pleural effusions as well as persisting multiple lymph nodes, described above. the patient remained on assist-control ventilation, sedated. the plan was to readdress therapeutic pleural tap versus chest tube placement when she is more stable otherwise. infectious disease: soon after initial intubation, the patient began complaining of abdominal pain. on , the abdominal pain worsened. she developed diarrhea positive for c. difficile colitis and was started on flagyl p.o. however, because of the ileus which developed soon after, flagyl had to be changed to iv vancomycin 125 mg p.o. q. six hours was added for the treatment of c. difficile. she developed a fever and was started on cefepime with vancomycin iv. the patient remained afebrile on antibiotics for three days. therefore, ambisome was added to her antibiotic regimen. her other positive cultures included urine and sputum yeast speciated as on . at the time of this dictation, the patient was on cefepime, flagyl iv day number nine, vancomycin iv day number eight, vancomycin p.o. day six, ambisome day number four, azt and hydroxyurea day number three. gastrointestinal/fluids electrolytes and nutrition: as above, the patient developed abdominal pain with kub consistent with ileus on . this was followed by abdominal ct scan which showed dilated sigmoid colon and significant thickening of the jejunum. surgery was consulted due to the concern for typhlitis, infiltration of the small bowel by lymphoma and/or ischemic bowel. the consult felt that the presentation was consistent. their recommendations included conservative medical management and holding tube feeds. tube feeds were started two days after; however, due to severe gastroparesis and ileus, the patient could not tolerate even a minimal amount of tube feedings. on , the patient was taken to interventional radiology and postpyloric dobbhoff feeding tube was placed. of note, during this procedure, significant small bowel wall thickening was also noted. it was also noted that the dye in the small bowel did not move through into ours for the length of the procedure. on , tube feeds were restarted at half strength at 10 cc an hour. the patient was also maintained on tpn. cardiovascular: shortly after intubation, the patient developed paroxysmal atrial fibrillation as well as atrial ectopy. she was initially started on diltiazem drip. subsequently, she required an amiodarone drip times two and one attempt at cardioversion. she was then started on lopressor iv every four hours, amiodarone drip as well as diltiazem drip were discontinued. with regards to her pump, the patient had three echocardiograms done during this admission. the last echocardiogram was done on and showed hyperdynamic left ventricular function with mild outflow obstruction and mild pulmonary artery hypertension, both new compared with a previous study. she had two episodes of hypotension requiring pressors. she was successfully weaned off pressors during both episodes within 24 hours. renal: status post kidney-renal transplant in . because of the concern for post transplant proliferative disorder, she was withdrawn of immunosuppression except for a low-dose of solu-medrol. the patient's creatinine remained stable for the first seven days; however, subsequently, it started rising in the setting of some tumor lysis, multiorgan failure, multiple nephrotoxic medications, and likely renal hyperperfusion. she was maintained on allopurinol. she received blood transfusions to maintain hematocrit above 28. the patient was followed by the renal transplant team. heme: secondary to pancytopenia induced by chemotherapy, the patient required daily platelet transfusions and packed red blood cells every other day. her inr remained elevated despite vitamin k administration. laboratory data was consistent with chronic diffuse intravascular coagulation. access: because of the severe lymphadenopathy, obtaining access was a difficult task. initially, a left femoral line was placed. this was changed to a left internal jugular central line under the ultrasound guidance. however, secondary to thrombosis, the line needed to be discontinued. a right subclavian line was placed on and remained functional at the time of this dictation. communication was maintained with the patient's husband as well as her sister. at the time of this dictation, a family meeting was planned for with the patient's oncologist, dr. , as well as the intensive care unit attending to discuss the patient's prognosis and further treatment plans. the remainder of the patient's course will be dictated at a later date by another physician. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis arterial catheterization transfusion of packed cells transfusion of other serum injection or infusion of cancer chemotherapeutic substance injection or infusion of biological response modifier [brm] as an antineoplastic agent diagnoses: systemic lupus erythematosus atrial fibrillation defibrination syndrome acute and chronic respiratory failure cardiac arrest intestinal infection due to clostridium difficile complications of transplanted kidney burkitt's tumor or lymphoma, lymph nodes of multiple sites 

Answer: The patient is high likely exposed to