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: hyperkalemia, bleeding major surgical or invasive procedure: hemodialysis history of present illness: 72 year old male with esrd on hd and mantle cell lymphoma noncompliant with hd or chemotherapy for the last 4-6 weeks presenting from home for evaluation of bleeding facial wound. the patient has been refusing all therapy for his known chronic medical conditions, which is well documented in omr notes. per his sister, he had been functioning well until the last week when he stopped taking his medications. he has been intermittently taking kayexelate at home. he reports stopping his medications because "there are so many pills." he otherwise reports feeling "great" with a normal appetite (diminished per his sister), good energy level, denied chest pain, shortness of breath, fever, chills, abdominal pain, constipation, diarrhea, nausea or vomiting. the day prior to admission he developed epistaxis and bleeding from a right facial wound. the bleeding was difficult to control and the patient came to the ed tonight for evaluation of his epistaxis. . in the ed, vitals were 96.1, 157/61, 83, 16, 99% ra. his epistaxis was controlled as was the bleeding from his facial wound. because he looked cachectic and ill the ed team put him on a monitor and found peaked t waves. ekg done demonstrated peak t waves and wide qrs as well as diffuse t wave and st changes. potassium 8.8. he was treated with 4 grams calcium gluconate, 1 amp bicarb and insulin/d50 and potassium returned at 7.9. he was given another amp of bicarbonate and insulin/d50 and was transferred to the micu for emergent hd. past medical history: 1. esrd on hd: after long history of cri without medical follow up. started hd via tunnelled line but has been noncompliant over the last 4-6 weeks. 2. mantle cell lymphoma: presented with weakness in and found to be pancytopenic. bone marrow biopsy consistent with mantle cell lymphoma, fish positive for 11;14 translocation. treated with 2 cycles rituxan then loss to follow up. 3. diastolic murmur: echo with 1-2+ ai 4. seborrheic dermatitis 5. right inguinal hernia repair social history: sh - retired messenger. lives at home with his sister. tobacco/etoh. family history: nc physical exam: pe: 97.2, 178/54, 73, 20, 98% ra gen: elderly, cachectic male, dry blood around nose and lesion on right cheek covered. alert and oriented x 3, answered questions appropriately. asking for coffee and eggs heent: perrl, op clear without petechiae, dry blood around nostrils bilaterally, covered right facial lesion, dry blood and small excoriations on face and neck. neck: jvp at 7 cm, bleeding skin excoriations car: rrr ii/vi dm across precordium resp: ctab-poor effort abd: nephrostomy tube intact, site clean, soft, nontender, nondistended +bs ext: no edema, petechia of shins bilaterally skin: diffuse 1-2 mm pustules, petechiae and excoriations of skin neuro: + asterixis pertinent results: 11:21pm glucose-125* urea n-101* creat-13.6*# sodium-145 potassium-4.8 chloride-106 total co2-17* anion gap-27* 11:21pm calcium-8.0* phosphate-5.7* magnesium-2.3 11:21pm wbc-3.1* rbc-2.74* hgb-8.2* hct-23.2* mcv-85 mch-30.0 mchc-35.5* rdw-17.2* 11:21pm plt count-38* 06:03pm type-art temp-37.3 po2-102 pco2-25* ph-7.37 total co2-15* base xs--8 03:25pm glucose-103 urea n-98* creat-12.5*# sodium-142 potassium-3.9 chloride-108 total co2-15* anion gap-23* 03:25pm wbc-3.1* rbc-2.94*# hgb-8.7*# hct-25.0*# mcv-85 mch-29.5 mchc-34.7 rdw-17.1* 03:25pm plt count-39* 03:25pm pt-13.9* ptt-27.0 inr(pt)-1.2* 11:05am urine color-amber appear-cloudy sp -1.010 11:05am urine color-amber appear-cloudy sp -1.010 11:05am urine rbc-18* wbc-5 bacteria-few yeast-none epi-0 11:02am type-art po2-69* pco2-23* ph-7.50* total co2-19* base xs--2 11:02am lactate-2.0 11:02am freeca-1.12 08:20am glucose-79 urea n-195* creat-21.4* sodium-143 potassium-8.3* chloride-110* total co2-10* anion gap-31* 08:20am calcium-8.7 phosphate-6.3*# magnesium-3.4* 08:20am calcium-8.7 phosphate-6.3*# magnesium-3.4* 08:20am plt count-50* 08:20am pt-14.2* ptt-150* inr(pt)-1.3* 04:35am comments-green top 04:35am k+-7.9* 03:48am k+-8.6* 03:00am glucose-141* urea n-192* creat-22.0*# sodium-140 potassium-8.8* chloride-109* total co2-6* anion gap-34* 03:00am estgfr-using this 03:00am ck(cpk)-66 03:00am neuts-32* bands-2 lymphs-59* monos-7 eos-0 basos-0 atyps-0 metas-0 myelos-0 03:00am plt smr-very low plt count-38* 03:00am pt-14.0* ptt-27.9 inr(pt)-1.2* chest (portable ap) reason: assess for infiltrates medical condition: 72 year old man with hyperkalemia, mantle cell lymphoma reason for this examination: assess for infiltrates examination: ap chest. indication: lymphoma. a single ap view of the chest is obtained on at 10:24 hours and is compared with the most recent study performed on . patient has a right- sided dual-lumen catheter with its tip in the expected location of the cavoatrial junction. linear densities again seen in the left and right midlung zones likely represent fibrosis since they were present on the prior examination. linear atelectasis of the left base. no evidence of acute infiltrate or pleural effusion. brief hospital course: the patient is a 72 yo m with esrd and mantle cell lymphoma, presenting to ed with epistaxis and found to be hyperkalemic to 8.8 with classic ecg findings after being off hd and chemotherapy x4-6weeks and off medications x1-2weeks. he was admitted for emergent hd. . # hyperkalemia: on arrival to pt. found to have peaked t waves on telemetry. ekg done demonstrated peak t waves and wide qrs as well as diffuse t wave and st changes. his k was found to be 8.8. pt. reported non-compliance with hd for approx weeks. he was given kayexelate, 4 grams calcium gluconate, 1 amp bicarb and insulin/d50 with decrease in k to 7.9. pt. was given additional 1 amp of bicarbonate and insulin/d50 and was transferred to micu for emergent hd. pt. clinically improved and transferred to floor the day after admission. pt. k improved with hd and he was continued on mwf schedule throughout admission. plan to change hd schedule to tthsat based on his prior outpatient schedule. . # esrd - pt. with esrd related to hydronephrosis from anatomic displacement of the left kidney by an enlarged spleen. pt. was maintained on mwf hd schedule during admission as above. he was dialyzed for 2 hours on day of discharge with plan to continue his previous tues., thurs., sat. schedule. during admission pt. has been fully compliant with treatment plan. the patient was also rescheduled to follow up with urology for further care of his nephrostomy tube for as he had cancelled his prior appointments before admission. pt. has chronic anemia related to esrd. he was transfused 2units prbc on , 1unit on units . his hct was 22.0 on admission and on discharge hct 26.7. pt. receiving epo w/ hd. . #. epistaxis/petechiae/pancytopenia: pt. bleeding and pancytopenia most likely secondary to progression of underlying mantle cell lypmhoma, ongoing without therapy. pt. did not receive heparin with hd. plan for platelet transfusion as needed for bleeding (with ddavp) or otherwise >10k however pt. had no further bleeding during admission and required no plt transfusions. . # mantle cell lymphoma - pt. was initially diagnosed in after presenting to with weakness and pancytopenia. on bone marrow biopsy, he was found to have hypercellurlar marrow with involvement by a b-cell lymphoproliferative disorder; staining was positive for cd5, cd19, cd20, and negative for cd10. fish analysis for 11;14 chromosomal rearrangement was positive, consistent with mantle cell lymphoma. he was seen by dr as an outpatient and received 2 cycles of rituximab (last dose ) before he decided that he did want any further medical therapy. pt. reports willingness to pursue treatment. he will follow up with dr. as outpatient for plan for rituximab therapy. appointment scheduled for . . # dementia - likely mixed dat/vascular. patient shows impairment of new learning, is unable to report anything about what he has been told about his cancer or kidney disease. he denies that he wants to die and is compliant with treatment here, and he states clearly that he would want his sister to make decisions for him if he is unable to do so. however, by history, it appears that when he is outside of the hospital his sister has been unable to persuade him to come to dialysis or for other medical treatment. request for appointment of guardianship has been discussed with family and the medical certificate has been completed. pt's. neice has agreed to be guardian. pt. sister has also completed medicaid paperwork. his code status has been verified as dnr/dni with patient and family. during admission the pt. has been compliant with our treatment plan and guardianship has been advised to address future plans. . # htn - pt. noncomplaint with medications prior to admission. pt. had been on metoprolol 25mg daily. he was persistently hypertensive during admission and was started on diltiazem which was titrated to diltiazem er 360mg daily. pt. continued to have systolic bp 150-160s and was started on metoprolol 25mg and titrated up to 37.5 prior to discharge. . # hypercholesterolemia - pt. continued on zocor . on day of discharge the patient was clinically stable and improved after the reinitiation of hd and medical management. he has a history of medical non-compliance and has a baseline dementia. legal guardianship is being pursued. he will follow up in clinic for further management of mantle cell lymphoma and will continue hd on tthsat schedule. the patient will be followed by the group during rehab stay. he should follow up with dr. upon discharge from rehab. medications on admission: colace 100 mg senna nephrocaps paxil cipro after hd toprol tid zocor daily renagel tid . discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 2. sevelamer 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for headache. 7. diltiazem hcl 180 mg capsule, sustained release sig: two (2) capsule, sustained release po daily (daily). 8. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). discharge disposition: extended care facility: house nursing and rehab center discharge diagnosis: primary: 1. hyperkalemia 2. end stage renal disease - hemodialysis dependent 3. mantle cell lymphoma secondary: 1. hypertension 2. hypercholesterolemia discharge condition: stable, improved discharge instructions: you were admitted with bleeding and found to have high potassium levels in your blood. you were continued on hemodialysis with improvement of your potassium level. you should continue to receive hemodialysis as scheduled on monday, wednesdays and fridays. please continue to take your medications as directed. . you also are known to have mantle cell lymphoma and are planned to follow up with dr. in clinic for further treatment. please maintain your scheduled follow up appointment. . please return or call dr. at if you experience chest pain, shortness of breath, weakness or increased fatigue at home. followup instructions: your next hemodialysis session should be saturday, at 3:30pm at / . please maintain your scheduled follow up appointment with dr. scheduled on at 2:00pm. please maintain your scheduled follow up appointment with dr. in urology on at 7:30am for further care of your nephrostomy tube. md, procedure: hemodialysis diagnoses: acidosis hyperpotassemia anemia in chronic kidney disease end stage renal disease pure hypercholesterolemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other malignant lymphomas, unspecified site, extranodal and solid organ sites delirium due to conditions classified elsewhere epistaxis spontaneous ecchymoses 

Answer: The patient is high likely exposed to