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: aspirin / nsaids attending: chief complaint: erythematous eyes, dysuria major surgical or invasive procedure: flexible sigmoidoscopy history of present illness: 36-year-old man with plasma cell leukemia, d+119 after ablative (flu/cy/tbi) cord sct, complicated by skin and gut gvhd, now on velcade (c1d32) for persistent plasma cell dyscrasia in his bone marrow, presents with erythematous eyes and dysuria. three days ago he started experiencing irritation in his eyes bilaterally. they felt dry and itchy. no visual changes, blurry vision or double vision. he reports some clear discharge. two days ago he also develop severe dysuria without any hematuria, with the pain worst at the beginning and end of urination. no abdominal, back pain, nausea, or vomiting. no fever. no penile lesion or discharge. scharge. . he presented to clinic on with these symptoms, was diagnosed with possible ocular gvhd and uti and was started on cyclosporine eye drops and levofloxacin. his urinalysis and urine culture came back negative. gc still pending. he re-presented to clinic on with persistent symptoms and was admitted. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies blurry vision, diplopia, loss of vision, photophobia. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations, lower extremity edema. denies cough, shortness of breath, or wheezes. denies nausea, vomiting, constipation, melena, hematemesis, hematochezia. denies arthralgias or myalgias. denies rashes or skin breakdown. no numbness/tingling in extremities. all other systems negative. past medical history: * diagnosed with plasma cell leukemia, treated with 3 cycles of hypercvad part a and velcade * autologous stem cell transplant, cr * found to have brachial plexus involvement with plasma cell leukemia, bmbx shows relapse with 10-20% plasma cells. * cytoxan, velcade, dexamethasone x 1 cycle * xrt to brachial plexus, total dose 3600 cgy * it mtx * hypercvad part a + velcade * hypercvad part b * velcade and revlimid * single revlimid 15 mg/day x <1 cycle * cytoxan/velcade/revlimid x 1 cycle for disease progression * revlimid at 25 mg/day * continues 25 mg/day revlimid with pulse dexamethasone of 20 mg x 4 days * last dose of revlimid prior to transplant. * double cord blood transplant for plasma cell leukemia. conditioning regimen was myeloblative using fludarabine, cytoxan, and tbi. post transplant complications: *neutropenic fevers, ultimately resolved with removing tunnelled line *c.diff *hhv6 viremia, not treated, followed by id *dvt of right arm, not anticoagulated *acute gvhd, grade 1 skin- treated with topical and systemic steroids. pmh: plasma cell leukemia s/p transplant (as in hpi) status post gunshot wound to left leg, status post bilateral knee surgeries. social history: lived alone prior to transplant, but since transplant, is staying with his mother. currently unemployed but previously worked as a phlebotomist at . social etoh use. + marijuana use. he has 2 children. family history: mother and father are both alive and well. mother's family has history of dm, htn, and cad. he doesn't know much about his father's side of the family. possible history of cancer, but no history of leukemia or blood disorders. pt has a sister and two children ages 16 and 8, all of whom are healthy. physical exam: admission exam: vs: t 97.2, bp 128/94, hr 88, rr 20, 100%ra gen: young man lying in bed in some discomfort from recent dysuria, in nad, awake, alert heent: conjunctivae erythematous bilaterally with clear discharge, eomi neck: supple, no jvd cv: reg rate, normal s1, s2. no m/r/g. chest: resp unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, nt, nd, no hsm, bowel sounds present msk: normal muscle tone and bulk ext: no c/c/e, 2+ dp/pt bilaterally pertinent results: admission labs: 01:40pm urea n-20 creat-1.0 sodium-138 potassium-4.5 chloride-101 total co2-24 anion gap-18 01:40pm alt(sgpt)-50* ast(sgot)-26 ld(ldh)-219 alk phos-98 tot bili-0.4 01:40pm albumin-4.1 calcium-9.2 phosphate-3.2 magnesium-2.1 01:40pm wbc-13.2* rbc-3.65* hgb-12.8* hct-39.0* mcv-107* mch-35.2* mchc-32.9 rdw-18.7* 01:40pm neuts-76* bands-0 lymphs-8* monos-16* eos-0 basos-0 atyps-0 metas-0 myelos-0 01:40pm hypochrom-normal anisocyt-2+ poikilocy-occasional macrocyt-3+ microcyt-normal polychrom-occasional 01:40pm plt smr-low plt count-107* discharge labs: 12:00am blood wbc-6.2 rbc-2.39* hgb-8.3* hct-25.3* mcv-106* mch-34.8* mchc-32.8 rdw-25.1* plt ct-18* 12:00am blood neuts-87* bands-0 lymphs-10* monos-3 eos-0 baso-0 atyps-0 metas-0 myelos-0 12:00am blood glucose-185* urean-17 creat-0.8 na-137 k-4.0 cl-104 hco3-24 angap-13 12:00am blood alt-15 ast-15 ld(ldh)-643* alkphos-94 totbili-0.6 imaging: gi biopsies: colonic mucosa with focal prominent apoptosis and focal cryptitis, crypt regenerative and degenerative changes, consistent with graft versus host disease (grade ) in the appropriate clinical setting. no definite viral inclusion seen. hsv and cmv immunostains are negative. ct abdomen/pelvis: impression: persistent colonic wall thickening along the ascending and transverse portions, probably more so than distally, consistent with an inflammatory or infectious causes of colitis including potentially graft versus host disease. echo: the left atrium is elongated. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. regional left ventricular wall motion is normal. there is mild global left ventricular hypokinesis (lvef = 45%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. no masses or vegetations are seen on the aortic valve. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: no valvular vegetations seen. mildly dilated and hypokinetic left ventricle. mild mitral regurgitation. mild pulmonary hypertension. chest ct: impression: multifocal bronchopneumonia, most severe in the right upper lobe. though this is most likely bacterial in etiology, the nodular configuration of some of the opacities also raises the possibility of fungal organisms, especially if the patient is neutropenic. chest ct: impression: resolving multifocal pneumonia with most marked improvement of the right upper lobe consolidation. however, area of persistent opacification within the right upper lobe now demonstrates cavitations with no clear fluid collection. differential considerations include bacterial or fungal infection. echo:the left atrium is normal in size. color doppler study suggests possible small interatrial shunt consistent with stretched patent foramen ovale or small atrial septal defect. (last beat of clip ). left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. there may be trace aortic regurgitation (better seen on study of ). the mitral valve leaflets are structurally normal. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. no vegetation seen (cannot definitively exclude). chest ct:impression: 1. improving multifocal infection including decreased size of cavitary lesion in the right upper lobe. no new or worsening areas of lung or airways disease. 2. new small pericardial and trace pleural effusions. u/s:impression: persistent thrombus in one of the right brachial veins. brief hospital course: 36-year-old man with plasma cell leukemia, d+119 after ablative (flu/cy/tbi) cord sct, complicated by skin and gut gvhd, now on velcade (c1d32) for persistent plasma cell dyscrasia in his bone marrow, presented with erythematous eyes and dysuria. . # red eyes: concerning for infection vs. ocular gvhd. he was treated empirically for chlamydia with azithromycin. ophthalmology was consulted who felt that this was most likely gvh. symptomatically, he felt better about his eye discomfort by the time of discharge, and a f/u appointment was made with ophthalmology. of note, chlamydia was checked (as has gc) and both were negative. rpr was also nr. . # dysuria: bk virus from the urine was positive, and so ivf were given for the patient to encourage urination and to avoid clot formation. dysuria improved throughout hospitalization. . # brbpr: pt developed brbpr during hospitalization, and out of concern for gvh, flex sig was done with bxs taken. no viral inclusions were seen on bx, and a cmv immunostain was done which was negative. ct abd/pelvis without contrast (gvien myeloma hx showed findings c/w gvh of the colon diffusely. the patient was initially made npo with tpn but slowly weaned up to a full diet prior to discharge as steroids were added. he was discharged on prednisone 20bid for his gvhd. he was also on cellcept 1000mg on discharge. tacrolimus was stopped given concern for autonomic dysfunction and ttp. . # plasma cell leukemia: we continued the pt's acyclovir and po vanc for ppx. he refused many of these doses, however we encouraged him to take these medications. we also continued the mmf prednisone was changed as above. during the patient's treatment for gvhd his iga level started to rise, peaking at 2072. he was treated with 2 doses of velcade and 1 dose of cytoxan. soon after these doses he developed autonomic dysfunction (see below) and so further treatment was held. on d/c ig a was 576. . # bradycardia and orthostatic hypotension: during the course of his treatment for cavitary pneumonia (see below) and plasma cell leukemia with velcade/cytoxan, the patient suddenly developed bradycardia to the 30s and 40s with concomitant, symptomatic orthostatic hypotension. he was transferred to for episodes of bradycardia, for which he was evaluated by cardiology service. echocardiogram was done that showed no evidence of structural heart disease to explain ecg or telemetry findings and he had no evidence of conduction disease. he was also found to have orthostatic hypotension, with change in blood pressure from 195/105 when laying flat, with hr 40s, siting 139/103 hr 50-70, and standing 77/51 hr 122. the autonomics service was consulted and his dysautonomia was thought likely to be chronic with chemotherapy induced autonomic neuropathy with velcade being the most likely cause. other potential causes were thought to be tacrolimus, which could cause bradycardia, or xrt effects on sympathetic nerve fibers. gvhd was considered as he has a history of gvhd in other systems, however was thought to be very unlikely. he was started on midodrine in the icu but this was discontinued after transfer back to the floor as the patient had supine hypertension. he should follow up with clinic for outpatient testing and in future a workup for paraneoplastic autonomic neuropathy could be considered, however this is unlikely. . # hypertension: metoprolol was discontinued given bradycardia, bp trended up to 200's and hydralazine was stared. he was transitioned to nifedipine with sbp in 150's, he will need follow up with repeat medication titration on discharge. . # pneumonia: the patient developed a r sided pna in the setting of a positive mrsa blood culture during this admission. he was treated with vancomycin with initialy improvement, but developed cavitations in his pna with fever and cefepime was added. cefepime was stopped when the patient developed ttp (see below) but the patient remained afebrile without respiratory compromise. id was consulted and recommended a 6 week course of vancomycin; he will be discharged with a picc line to complete this course. . # ttp: after transfer from the back to the bmt floor, with patient developed ttp with dropping platelets, schistocytes, low haptoglobin, rising ldh and dropping fibrinogen. the transfusion service was consulted and stated that plasma exchange was not an option given that this was unlikely to be an idiopathic antibody mediated ttp and instead more likely a result of his multiple medical problems or medications. cefepime and tacrolimus were d/ced and his counts improved with supportive care. . # rue clot: patient found to have rue clot in r arm at the time of first picc placement; this was persistent after picc was removed; second picc was placed in the same arm but a different brachial vein. the patient had some swelling in his r arm, possibly due to this clot, but was not treated with anti-coagulation due to multiple other medical issues. . # prophylaxis: acylovir, voriconazole, po vanc, bactrim. . transitional issues: - he was started on nifedipine for hypertension and will need bp checks and dose titration - patient will require two weeks of iv antibiotic therapy with vancomycin (to complete ) - patient will need follow up appointment with dr. in infectious disease before completion of vancomycin. he was discharged over the holiday weekend and this appointment could not be arranged. - patient will need repeat rue u/s in one month to make sure that clot has resolved. medications on admission: medications - prescription acyclovir - 400 mg tablet - 1 tablet(s) by mouth three times a day budesonide - (prescribed by other provider) - 3 mg capsule, ext release 24 hr - 1 capsule(s) by mouth three times a day cyclosporine - 0.05 % dropperette - 1 drop ou q12 hours please place 1 drop in each eye every 12 hours. levofloxacin - 750 mg tablet - 1 tablet(s) by mouth daily lorazepam - (prescribed by other provider) - 0.5 mg tablet - 1 tablet(s) by mouth every eight (8) hours as needed for nausea metoprolol tartrate - 25 mg tablet - 0.5 (one half) tablet(s) by mouth twice a day morphine - 30 mg tablet extended release - 1 tablet(s) by mouth twice a day mycophenolate mofetil - (dose adjustment - no new rx) - 500 mg tablet - 1 tablet(s) by mouth twice a day pentamidine - (discharge med) - 300 mg recon soln - 1 recon(s) inhaled monthly your doctor will help you to schedule for this medication. next dose due phenazopyridine - 100 mg tablet - 1 tablet(s) by mouth three times a day for 2 days prednisone - (prescribed by other provider) - 5 mg tablet - 4 tablet(s) by mouth twice a day sulfamethoxazole-trimethoprim - (prescribed by other provider) - 400 mg-80 mg tablet - 1 tablet(s) by mouth daily (daily) tacrolimus - (prescribed by other provider) - 0.5 mg capsule - 1 capsule(s) by mouth once a day ursodiol - 300 mg capsule - 1 capsule(s) by mouth q am, 2 capsules q pm vancomycin - 125 mg capsule - 1 capsule(s) by mouth twice a day voriconazole - (on hold from to unknown for elevated lfts) - 200 mg tablet - 1 tablet(s) by mouth twice a day discharge medications: 1. acyclovir 400 mg tablet sig: one (1) tablet po every eight (8) hours. disp:*90 tablet(s)* refills:*0* 2. budesonide 3 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po tid (3 times a day). disp:*90 capsule, ext release 24 hr(s)* refills:*0* 3. folic acid 1 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*0* 4. lorazepam 1 mg tablet sig: one (1) tablet po at bedtime as needed for anxiety or insomnia. disp:*30 tablet(s)* refills:*0* 5. ms contin 30 mg tablet extended release sig: one (1) tablet extended release po twice a day. disp:*60 tablet extended release(s)* refills:*0* 6. mycophenolate mofetil 500 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*0* 7. prednisone 20 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 8. voriconazole 200 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*0* 9. vancomycin 125 mg capsule sig: one (1) capsule po twice a day. disp:*60 capsule(s)* refills:*0* 10. vancomycin 1,000 mg recon soln sig: 1000 (1000) mg intravenous once a day for 10 days: final day . disp:*10 grams* refills:*0* 11. artificial tear ointment ointment sig: one (1) appl ophthalmic qhs (once a day (at bedtime)). disp:*1 bottle* refills:*0* 12. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic tid (3 times a day). disp:*1 bottle* refills:*0* 13. bactrim 400-80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 14. nifedipine 30 mg tablet extended release sig: one (1) tablet extended release po daily (daily). disp:*30 tablet extended release(s)* refills:*0* 15. home infusion supplies to administer vancomycin iv discharge disposition: home with service facility: critical care systems discharge diagnosis: graft versus host disease . plasma cell leukemia health care associated pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , you were admitted to with red eyes and pain when you urinated. we feel that your eyes are likely dry from gvh, and that your urination was painful because of a virus called bk. . while you were here you developed blood in the stool that was concerning for graft versus host disease (gvhd). for that reason, you had a flexible sigmoidoscopy and a ct scan which showed likely gvhd. your hospitalization was complicated by a slow heart rate and variable blood pressure that we think was due to some of the chemotherapy that you received. . finally, you were treated for a serious pneumonia while you were here. you will need to be on two weeks of iv antibiotics when you leave, with last day . this means that you will need to go home with a picc line in place and get home infusions daily. . we made many changes during your admission; please see the attached medication list to see what you should be taking. start folic acid 2 mg once daily start nifedipine note: you will also receive vancomycin infusions once daily through your picc line until . start artificial tears ointment at night; artificial tears drops three times daily increase cellcept to 1000 mg twice daily stop restasis stop metoprolol stop ursodiol . please follow up with your physicians as indicated below. followup instructions: 1. appointments with dr. : dr. is on service next week so will see you on . you will have daily appointments for the first few days; you can then decide with dr. when to followup with him. department: bmt/oncology unit when: tuesday at 3:30 pm building: fd building (/ complex) campus: east best parking: main garage department: bmt/oncology unit when: wednesday at 11:00 am building: fd building (/ complex) campus: east best parking: main garage department: bmt/oncology unit when: thursday at 11:00 am building: fd building (/ complex) campus: east best parking: main garage 2. appointment with autonomic neurology: this office will call you to schedule an appointment with dr. or one of his associates. if you do not hear from them, you can call them at . 3. appointment with ophthalmology: please go to the building on the fifth floor on at 1pm to see dr. . 4. appointment with dr. in clinic: xxxxxxxxxxxxx procedure: parenteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of large intestine injection or infusion of immunoglobulin central venous catheter placement with guidance central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: other and unspecified noninfectious gastroenteritis and colitis unspecified essential hypertension defibrination syndrome other specified cardiac dysrhythmias bacteremia other complications due to other vascular device, implant, and graft antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use thrombotic microangiopathy surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other specified viral infection methicillin resistant pneumonia due to staphylococcus aureus dysuria polyneuropathy due to drugs acute venous embolism and thrombosis of superficial veins of upper extremity complications of other specified transplanted organ acute on chronic graft-versus-host disease plasma cell leukemia, in relapse 

Answer: The patient is high likely exposed to