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: ace inhibitors / azathioprine attending: chief complaint: anemia major surgical or invasive procedure: none history of present illness: this is a 47-year-old man with a history of dermatomyositis who is currently on steroids, mtx, recently recieved rituximab (), and who recently underwent 1 week of treatment for h. pylori, who was found on routine labs to have a hct of 14 (prior: 33 two months prior). he was not having any symptoms but was called by his rheumatologist and told to go to the ed last night. he did not want to go last night and so presented to the ed in the morning. he reports chronic body weakness 2/2 his myositis but denies any worsening fatigue. he denies any recent chest pain, doe, or sob. . of note he reported one episode of dark brown stool one week prior, but since has had lighter brown stools. he denies any brbpr, n/v, abd pain. he does report chronic fevers at home, states he felt warm coming to the er but this was not unusual for him. he denies any recent cough, uri or dysuria. his rheumatologist added on hemolysis labs, ldh was elevated but the hapto was > 100. . in the ed, initial vs were:4 103 94 18 100. labs were notable for lactate of 2.1, hb of 4 and hct of 14. an inr was 1.3. a cxr showed ?lll consolidation. an ecg was normal and unchanged from prior. gi was consulted in the ed and recommended admit to icu and ng lavage, but ed did not feel ng lavage needed to be done. patient was given 1l fluid, 1u prbc and ordered for another prbc. his vitals at the time of transfer were 99.6, 76, 97/55 14 100% ra. in the ed, rectal exam notable for +brb, with brown stool, guaiac +. . on the floor, the patient feels well. he denies any current n/v, abd pain, diarrhea, melena, brbpr, fatigue, sob, dizziness or cp. . review of sytems: (+) per hpi (-) denies, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: -dermatomyositis on sc mtx 25/wk, medrol taper, and s/p ivig x6 and rituxan x2 -h. pylori positive - 1 week of tripple thereapy. -elevated bp without dx of htn -atypical chest pain social history: tobacco: denies alcohol: denies drugs: denies lives . divorced. works as a computer systems engineer. family history: (as per d/c summary on ) mother - htn father - - siblings with htn physical exam: vitals: t: 99.4 bp: 114/75 p: 77 r: 14 o2: 99% ra general: alert, oriented, no acute distress heent: sclera anicteric, dry mm, oropharynx clear neck: supple, no jvd, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly rectal: external hemorrhoids ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. +2 pitting edema of b/l le pertinent results: 10:11pm ph-7.45 10:11pm lactate-0.9 10:11pm freeca-1.01* 09:12pm hct-25.5*# 09:12pm plt count-376 01:45pm hct-18.9*# 09:31am lactate-2.1* 08:19am comments-green top 08:19am k+-3.8 08:19am hgb-4.7* calchct-14 08:10am glucose-100 urea n-12 creat-0.6 sodium-134 potassium-4.0 chloride-102 total co2-24 anion gap-12 08:10am ld(ldh)-546* tot bili-0.4 08:10am haptoglob-134 08:10am wbc-5.0 rbc-1.95* hgb-4.3* hct-14.9* mcv-76* mch-21.9* mchc-28.7* rdw-16.6* 08:10am neuts-73* bands-0 lymphs-13* monos-11 eos-2 basos-0 atyps-1* metas-0 myelos-0 08:10am hypochrom-1+ anisocyt-2+ poikilocy-occasional macrocyt-normal microcyt-2+ polychrom-normal ovalocyt-occasional teardrop-occasional 08:10am plt smr-normal plt count-469* 08:10am pt-14.5* ptt-34.1 inr(pt)-1.3* 08:10am fibrinoge-332 08:10am ret man-3.2* 03:42pm wbc-5.9 rbc-1.99* hgb-4.3* hct-15.7* mcv-79* mch-21.5* mchc-27.3* rdw-16.7* 03:42pm neuts-74.6* lymphs-11.4* monos-8.3 eos-3.8 basos-0.1 03:42pm plt count-473* 03:42pm ret man-1.5 . cxr : frontal and lateral views of the chest were obtained. patchy left lower lobe opacity is worrisome for pneumonia given patient's history of fever. the right lung is clear. there is no pleural effusion or pneumothorax. the cardiac and mediastinal silhouettes are unchanged. no pulmonary edema is seen. impression: left lower lobe consolidation, worrisome for pneumonia. . discharge labs: 12:27pm blood wbc-7.2 rbc-3.43* hgb-8.7* hct-28.3* mcv-83 mch-25.2* mchc-30.5* rdw-17.4* plt ct-416 12:27pm blood glucose-107* urean-10 creat-0.5 na-137 k-4.0 cl-104 hco3-26 angap-11 08:10am blood hapto-134 brief hospital course: this is a 47-year-old gentleman on mtx, rituxan, and ivig who presents with acute on subacute anemia discovered on routine labs. # anemia, multifactorial: unclear etiology, but likely the result of marrow-toxic drugs patient has been receiving for dermatomyositis (methotrexate, bactrim, omeprazole, and rituxan) in the setting of baseline anemia, versus iron deficiency anemia and occult gi bleed. rituxan can definitely cause a pure anemia; unclear if the other medications cause pure anemias or mixed cytopenias. hemolysis labs were normal, ruling out a destructive etiology of anemia. finally, patient could be losing blood, but again, no clear source. he does have gastritis and an external hemmorhoid, but unlikely to cause such a large drop in hct. patient was initially transfused 5 units of prbcs with appropriate bump in hct. gi was consulted who recommended egd/colonoscopy, though not urgently as hct stablilized. bactrim, mtx, and rituxan were discontinued. mr. was started on pantoprazole and 2 large bore ivs were placed. heme/onc was consulted. bone marrow bx was performed on showing red cell precursors and low iron. he was started on iron supplementation. he will follow up with heme for further care. - additionally, an egd/colonoscopy was scheduled for with dr. . he will continue his ppi as well. . # dermatomyositis: chronic condition (symptoms started in ; flair in started on high dose steroid, given two doses of rituxan, and continued on mtx), no evidence of acute flair at this time. patient is on steroids and mtx sc every week. in the icu, mr. was continued on steroids. his mtx and bactrim were held, and he was put on atovaquone for pcp . rheumatology was consulted. they recommended tapering his methyprednisolone to 8mg daily alternating with 4mg daily. he will follow up closely with them. . community acquired pneumonia: cough with positive chest xray. was given levofloxacin 750mg daily for 5 days. . # gastritis/h. pylori: patient completed 1 week of triple therapy for his h.pylori. his discontinued the medications because he thought they made him feel "dizzy." can consider retreating in the future once anemia stable. medications on admission: clobetasol - 0.05 % cream - apply daily to affected area for 2 weeks use once a day to affected area, not exceeding 2 weeks in one month, 60 grams, one refill. leucovorin calcium - 5 mg tablet weekly 12h after mtx, stop daily oral folic acid methotrexate na (preserv free) - 25 mg/ml solution - 1 ml intramuscular injection weekly stop oral mtx methylprednisolone - 8 mg tablet - 1 tablet(s) by mouth daily sulfamethoxazole-trimethoprim - 800 mg-160 mg tablet - 1 tablet(s) by mouth tiw take mo/wed/fri calcium carbonate-vitamin d3 - 600 mg (1,500 mg)-400 unit tablet, chewable - 1 tablet(s) by mouth daily discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever. 2. methylprednisolone 4 mg tablet sig: 1-2 tablets po as directed: please alternate 4mg with 8mg daily, as part of your taper. disp:*60 tablet(s)* refills:*0* 3. atovaquone 750 mg/5 ml suspension sig: 1500 (1500) mg po daily (daily). disp:*500 ml* refills:*0* 4. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 6. levofloxacin 750 mg tablet sig: one (1) tablet po once a day for 4 days. disp:*4 tablet(s)* refills:*0* 7. outpatient lab work cbc. please fax results to: fax: discharge disposition: home discharge diagnosis: anemia, multifactorial iron deficiency community acquired pneumonia dermatomyositis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , . it was a pleasure taking care of you. you came to the hospital because of a drop in your hematocrit. we gave you blood transfusions and your hematocrit came up. we think that your low blood counts are because of multiple causes, including medications and iron deficiency, as well as perhaps slow gi bleeding. you were also diagnosed with a pneumonia and will be given an antibiotic. you will be following up with hematology and rheumatology. you will also need to undergo an endoscopy and colonoscopy described below. . please have your blood counts re-checked within 1 week. . the following changes were made to your medications: 1. methotrexate stopped 2. rituxan stopped 3. methoprednisolone decreased to 8mg daily alternating with 4mg daily 4. bactrim stopped 5. atovaquone 1500mg daily started 6. levofloxacin 750mg daily for 4 days 7. omeprazole 20mg twice daily 8. ferrous sulfate 325mg twice daily started for iron supplementation please take all of your medications as prescribed. please keep all of your follow-up appointments. . return to the hospital if you develop lightheadedness, dizzines, blood in your stools, chest pain, shortness of breath, pain with urination, cough, nausea, vomiting, diarrhea, fevers, or any other concerning signs or symptoms. followup instructions: please see below for your endoscopy and colonoscopy. you will receive a letter with instructions for this, including how to prepare. please avoid any aspirin or nsaid medications until then. please arrive at 9:30 on the . please call with any questions. department: endo suites when: thursday at 10:30 am . department: digestive disease center when: thursday at 10:30 am with: , md building: building (/ complex) campus: east best parking: main garage . 01:00p , a., sc clinical ctr, hematology/oncology-sc . dr. will call you to schedule an appointment with rheumatology procedure: biopsy of bone marrow diagnoses: pneumonia, organism unspecified long-term (current) use of steroids iron deficiency anemia secondary to blood loss (chronic) antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use iron deficiency anemia, unspecified hemorrhage of gastrointestinal tract, unspecified unspecified gastritis and gastroduodenitis, without mention of hemorrhage external hemorrhoids without mention of complication sulfonamides causing adverse effects in therapeutic use other specified agents primarily affecting the gastro-intestinal system causing adverse effects in therapeutic use dermatomyositis other specified aplastic anemias 

Answer: The patient is high likely exposed to