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: simvastatin / pravastatin attending: chief complaint: cough, hypotension major surgical or invasive procedure: none. history of present illness: 84 y/o m with hx of esrd on hd, wegner's granulomatosis on chronic steroids, afib/flutter, hx of prostate cancer and baseline low bps who presented to an outpatient office visit today due to 3 days of productive cough with yellow sputum. no hemoptysis. he was also feeling very weak and had a hard time getting out a bed this morning. his wife took his temperature and it was 100 (which is high for him). his sputum has been yellow and increasing in thickness the last few days. he denies any other symptoms like nausea, vomiting, diarrhea, abdominal pain, headaches, fainting, dizziness. he does have a hx of falls and unsteadiness, especially when he first stands up. he fell about 2-3 weeks ago and hit his head. had a head ct in the ed that was negative at that time. . in the ed, initial vitals were t 98.6, p 67, bp 67/40, r 20 and 93% on ra. he received stress dose steroids with methylprednisone 125 mg once, ceftriaxone 1 gm iv once and azithromycin 500 mg iv once. he required 4l nc. he had a cxr that showed a new r effusion and questionable increased opacity in the rll, although difficult to tell based on his chronic lung disease. . on arrival to the floor, he is feeling well. he still is coughing, but is feeling better from when he first came to the ed. past medical history: -wegner's granulomatosis, dx c-anca + and bx +, on cytoxan/steroids -dm 2 on insulin since , typical a1c around 7.5% -esrd on hd -monoclonal gammopathy most likely a smoldering multiple myeloma -htn, well-controlled -bronchiectasis with baseline grossly abnormal cxr -sss with intermittent afib and bradycardia -mitral regurgitation -chronic anticoag (indication: af) on coumadin -prostate cancer --> radiation therapy , normalized psa -radiation proctitis with rectal bleeding --> laser rx - gi bleed radiation proctitis -malignant melanoma left thigh s/p excision -anemia attributed to ckd -r ingunal hernia -s/p appy -s/p l inguinal hernia repair -hyperlipidemia -fe deficiency -tuberculosis: latent, patient had a history of tuberculosis with treatment in sanitarium in 's, h/o inh toxicity so no treatment of latent tuberculosis - mac: bronchoscopy with bal was performed on , and afbs found on smear c/w mac per lab results/id consult. patient opted to forego mac therapy -hx of pericardial effusion, no drainage needed -question of an inflammatory musculoskeletal condition as above social history: lives with wife. 1 son. tobacco. ~1 drink etoh/day. the patient is retired, was employed as an international business consultant. married, lives with second wife. has a phd in industrial engineering. he was born in europe, in eastern , and has traveled throughout the world over his lifetime. he came to the united states in . his first wife died in . he is a very active individual, walks regularly. he is a former mountain climber, tennis player, and skier. he enjoyed playing soccer in his younger yrs. he smoked only during wwii and dc'd in with none thereafter. there is no history of drug use. he reports consumes espresso and an occasional cocktail before dinner. family history: patient reports a history of diabetes only in his maternal grandmother. his father died at an older age with complications of infection. there is no familial pattern of malignancy, hypertension, or heart disease. physical exam: general appearance: no acute distress eyes / conjunctiva: perrl, pupils dilated, conjunctiva pale head, ears, nose, throat: normocephalic lymphatic: cervical wnl, supraclavicular wnl, cervical adenopathy cardioascular: (murmur: systolic), irregularly irregular peripheral : (right radial pulse: diminished), (left radial pulse: diminished), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: crackles : at r base; mild at l base), otherwise clear, with good airmovement to the bases abdominal: soft, non-tender extremities: right lower extremity edema: absent, left lower extremity edema: absent skin: cool, cool hands, warm feet; brusing on arms and legs; thin skin neurologic: attentive, responds to: not assessed, movement: not assessed, tone: not assessed, a+ox3 pertinent results: labs on admission: 12:34pm lactate-2.3* 12:20pm glucose-283* urea n-58* creat-6.0* sodium-135 potassium-5.0 chloride-92* total co2-30 anion gap-18 12:20pm estgfr-using this 12:20pm ld(ldh)-279* 12:20pm crp-58.8* 12:20pm wbc-5.7 rbc-3.40* hgb-11.1* hct-33.0* mcv-97 mch-32.6* mchc-33.6 rdw-17.5* 12:20pm neuts-93.4* lymphs-4.3* monos-1.9* eos-0 basos-0.3 12:20pm plt count-123* 12:20pm pt-24.4* ptt-34.2 inr(pt)-2.3* 12:20pm sed rate-60* 04:26pm pt-25.4* inr(pt)-2.4* images: __________________ chest xray history: desaturation, worsening effusion. impression: ap chest compared to chest radiographs since , most recently and : since , previous small right pleural effusion has decreased and what was probably aspiration or asymmetric edema in the right lower lobe has cleared. moderate cardiomegaly, severe left upper lobe pleural parenchymal scarring with bronchiectasis and emphysema are longstanding. dual-channel catheter ends in the svc and upper right atrium respectively. no pneumothorax. _____________________ ct- l shoulder ; impression: non-displaced fracture of the posteroinferior glenoid. _____________________ ct- chest ; impression: 1. bilateral non-hemorrhagic pleural effusions; improvement of right effusion leading to resolution of right lower lobe collapse; relatively unchanged left effusion. 2. interval resolution or decrease of previously described pulmonary nodules, likely representing a resolving infectious process; no new nodules seen. 3. stable-appearing bronchiectasis. 4. l1 compression fracture, new from prior study but of indeterminate age. 5. left renal cyst. _____________________ labs at discharge: 06:00am blood wbc-4.3 rbc-3.07* hgb-10.0* hct-30.0* mcv-98 mch-32.7* mchc-33.4 rdw-18.4* plt ct-120* 06:00am blood plt ct-120* 06:00am blood pt-23.8* ptt-33.6 inr(pt)-2.3* 06:00am blood glucose-101* urean-46* creat-4.9*# na-140 k-4.8 cl-97 hco3-34* angap-14 06:00am blood calcium-7.8* phos-4.1 mg-1.9 brief hospital course: # cough/hypoxia: the patients cough - hypoxic episode was likely from an infection, either bacterial vs. viral infection (he does have hx of h1n1 earlier this year). his cxr on admission was unrevealing for large consolidation, but he does have a new right sided pleural effusion. in the setting of no generalized fluid overload, the effusion may also be secondary to infection or secondary to progressing wegners with pulmonary involvement, although none in the past. as the patient is also on chronic steroids, pcp pna may also be on the differential. in the micu the patient was started on broad antibiotic coverage for community acquired pneumonia (ceftrixone, azithromycin). sputum cultures, a urine legionella and blood culture were negative. the patient's antibiotics were narrowed to levoquin. pt respiratory status improved during the next week. he had no requirement for o2. he did receive an albuterol nebulizer treatment during an episode of choking on his secretions. this episode self-resolved without complications. . .# afib/flutter: ekg in flutter, well rate controlled without a nodal blocker (would want to avoid given orthostasis and hypotension). the patient was therapeutic on coumadin. during his stay he had at least 1 episode of aflutter with rvr that last 5 minutes and self-resolved. coumadin was held on the night of as antibiotics were started and procedures were considered for the next day. coumadin was restarted at 1mg/daily since he began taking the levoquin however it decreased from 3.1-->2.3 today and was increased to 1.5mg daily. his inr must be checked daily at rehab until he is off of levoquin and stable. . # fever: the patient had a temperature of 100 (baseline 96 degrees usually) on which was likely secondary to the pneumonia. other etiology could be a line infection in his hd line. no pain or tenderness or redness. blood cultures were negative. he remained afebrile for several days before discharge. . # hypotension: the patient's blood pressures were mildly below baseline. etiologies considered included adrenal insufficiency from chronic steroid use, mild infection versus early sepsis. the patient was not warm or -dilated. a stress dose of steroids was given overnight (hydrocortisone 100mg q8hrs). taper of the steroids should be initiated on to 50mg q8hrs. the patient reported that baseline systolic blood pressures were in the 80s at home. he was given midodrine 5mg to improve his pressure (given at 8am, 2pm and 6pm). however he continued to exhibit hypotension with some unsteadiness while standing and ambulating. . # wegners: stable, just had involved kidneys in the past; have been following esr/crps and adjusting steroid dosing based on that. currently on steroid taper of 15mg prednisone daily for the next three days, and then 10mg daily after that, with a plan to subsequently taper to 5 mg then off. . # shoulder pain: the patient reports left shoulder pain for some time after a fall. an xray of his shoulder revealed a small lucency at glenoid. in the setting of acute trauma, a fracture is not excluded. a ct of the left shoulder was ordered for further evaluation of the glenoid prior to discharge and revealed a non-displaced glenoid fx that should be followed in 4 weeks. for the meantime, his left arm should be placed in a sling and he should do pendulum motions with his arms to avoid a frozen shoulder. . # s/p fall: ct of his neck and head was negative for acute fracture or bleed. . # esrd on hd: stable, has fistula that is not mature on l and r tunneled line. is euvolemic on exam. is mwf patient. revieved hemodialysis today - 750 ml. vitamin d and nephrocaps were continued.. . # hyperlipidemia: the patient was continued on his home statin. . # gerd: the patient had no symptoms of gerd. he was continued on daily pantoprazole. . # diabetes: the patients diabetes was well controlled recently per patient. he was given lantus 20qam per home dose and was put on a sliding scale. blood sugars were in the 200s throughout the day but sometimes were low during the morning. his lantus was decreased today to 16u with breakfast because of fs of 78 this morning. medications on admission: lipitor 20 mg daily lanuts 10 unit qpm humalog sliding scale pantoprazole 40 mg daily prednisone 20 daily urea cream 40% to feet coumadin 2 mg qmwf, 3mg the other days acetaminophen 325 mg q6hrs prn cholecalciferol d3 800 u daily mvi daily discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. tablet(s) 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 6. prednisone 5 mg tablet sig: three (3) tablet po daily (daily) for 3 days. 7. warfarin 1 mg tablet sig: 1.5 tablets po daily (daily). 8. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 9. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 10. midodrine 5 mg tablet sig: one (1) tablet po tid (3 times a day): give at 8 a.m., 2 p.m., and 6 p.m. 11. levofloxacin 250 mg tablet sig: one (1) tablet po daily (daily) for 3 days. 12. acetaminophen 325 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 13. prednisone 10 mg tablet sig: one (1) tablet po once a day: start on . 14. insulin glargine 100 unit/ml solution sig: sixteen (16) units subcutaneous once a day: administered in the morning. discharge disposition: extended care facility: - discharge diagnosis: primary: pneumonia hypotension secondary: esrd on hd wegener's granulomatosis diabetes mellitus bronchiectasis atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the for cough, fever and feeling weak. based on our exam and chest x-ray, we determined that you likely had a pneumonia. you were successfully treated with antibiotics and your fevers went away. during your stay we also managed your blood sugar and your blood pressure. you continued to receive your hemodialysis 3 times a week. we now feel that you were stable to discharge to a rehabilitation facility where you will be able to build up your strength. during your stay we modified several medications. you should: start: midodrine 5mg three times daily @8am, 2pm, 6pm start: levoquin 250mg daily for 3 days change: insulin regimen as newly prescribed decrease: coumadin to 1.5mg daily. you will need to get your inr checked daily at rehab with coumadin dosing adjusted as needed. decrease: prednisone to 15mg daily for 3 days, then 10mg daily. thereafter, would taper to 5 mg daily, then off. please take all your other medications as prescribed by your physician. please continue to work with physical therapy to increase your strength. please follow-up with your primary care appointments followup instructions: please make an appointment from rehab center with your primary care physician: name: , , mph location: /east address: , e/cc-6, , phone: fax: email: please also follow up with these following appointments: department: hemodialysis when: wednesday at 7:30 am department: advanced vasc. care cnt when: tuesday at 10:45 am with: , md building: (, ma) campus: off campus best parking: free parking on site department: cardiac services when: wednesday at 9:40 am with: , md building: campus: east best parking: garage md, procedure: hemodialysis diagnoses: pneumonia, organism unspecified anemia in chronic kidney disease end stage renal disease renal dialysis status esophageal reflux long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation personal history of malignant neoplasm of prostate unspecified fall atrial flutter hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia hypotension, unspecified long-term (current) use of insulin long-term (current) use of anticoagulants bronchiectasis without acute exacerbation other malaise and fatigue personal history of tuberculosis debility, unspecified wegener's granulomatosis closed fracture of glenoid cavity and neck of scapula 

Answer: The patient is high likely exposed to