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: delerium and hypoxia major surgical or invasive procedure: uf history of present illness: mr. is an 86 year-old man with wegener's c/b esrd, dm2, atrial fibrillation and chronic right pleural effusion who was found to be delerious at today with hypoxia to 89% on ra that corrected to 93% on 2l. patient also complained of loose stools for the past several days while at rehab. dr. referred the patient to the ed for further evaluation. of note, the patient was admitted from for the treatment of pna. in the ed, initial vitals were 98.5 120 128/76 24 95% 2l. labs notable for wbc 4.9 90.6%n, hct 29.9, inr 2.9, probnp , lactate 1.9, vanco 28.2. blood cultures were sent. cxr showed pulmonary edema with persistence of rll>rml,rul opacities (also seen was known r-sided effusion that has been worked up extensively by interventional pulmonology). given concern for hcap, patient already had a therapeutic vanco level and received ceftriaxone 1g iv, azithromycin 500mg iv, and flagyl 500mg iv. on arrival to the floor, patient was sleeping but easily aroused and was able to answer questions appropriately. denied any pain, felt comfortable. coughing with ronchorous breathing and slightly tachypnic. past medical history: - wegener's granulomatosis, dx c-anca + and bx +, on cytoxan/steroids - dm 2 on insulin since , typical a1c around 7.5% - esrd on hd (m/w/f via lue avf) - 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 - tia , no residual deficits social history: lives with wife who is his caregiver. son. retired, was employed as an international business consultant, has a phd in industrial engineering. born in eastern . came to the united states in . very active individual before onset of wegener's in - former mountain climber, tennis player, and skier. - tobacco history: during wwii, stopped - etoh: glass of wine with dinner nightly - illicit drugs: none family history: grandmother: dm father: kidney infection sister: tia x 2 (80s) physical exam: physical exam on admission general - elderly man lying in bed, a&ox3, nad, aox3 heent - ncat eomi mm dry op clear neck - supple, jvp flat ~ 10cm h2o heart - pmi non-displaced, rrr, nl s1-s2, no mrg lungs - decreased breath sounds bilateral bases; rhonchorous left base; breathing unlabored, no apparent respiratory distress abdomen - nabs, soft/nt/nd, no masses or hsm, no cvat extr - cool, 2+ dp pulses; lue avf with bruit/thrill skin - scattered ecchymoses lymph - no cervical lad neuro - aox3 and although some responses are inappropriat physical exam on discharge expired pertinent results: admission labs 07:05pm lactate-1.9 07:00pm glucose-151* urea n-19 creat-2.6*# sodium-145 potassium-3.4 chloride-100 total co2-31 anion gap-17 07:00pm alt(sgpt)-20 ast(sgot)-43* ck(cpk)-158 alk phos-123 tot bili-0.6 07:00pm lipase-42 07:00pm ck-mb-6 ctropnt-0.21* probnp-* 07:00pm vanco-28.2* 07:00pm albumin-3.1* calcium-8.6 phosphate-2.7 magnesium-1.7 07:00pm wbc-4.9 rbc-2.61* hgb-9.5* hct-29.9* mcv-114* mch-36.3* mchc-31.7 rdw-19.0* 07:00pm neuts-90.6* lymphs-4.9* monos-4.3 eos-0.2 basos-0 07:00pm plt count-65* 07:00pm pt-30.1* ptt-46.8* inr(pt)-2.9* 03:00pm vanco-13.0 01:15am pt-30.2* inr(pt)-2.9* pertinent labs 04:20am blood wbc-5.7 rbc-2.77* hgb-9.5* hct-31.9* mcv-115* mch-34.4* mchc-29.9* rdw-18.3* plt ct-66* 07:30am blood hypochr-2+ anisocy-2+ poiklo-2+ macrocy-3+ microcy-occasional polychr-normal spheroc-occasional ovalocy-3+ schisto-1+ burr-1+ ellipto-occasional 10:18am blood pt-33.5* ptt-52.4* inr(pt)-3.3* 07:30am blood esr-110* 04:44am blood glucose-328* urean-48* creat-3.6*# na-137 k-5.3* cl-94* hco3-24 angap-24* 04:18am blood ck-mb-5 ctropnt-0.21* 04:44am blood calcium-8.2* phos-7.5* mg-2.1 12:14pm blood hbsag-negative hbsab-negative hbcab-negative 05:00pm blood crp-212.4* ekg minimally irregular supraventricular tachycardia, most likely atrial fibrillation. left axis deviation. left anterior fascicular block. qs deflection in leads v1-v2 consistent with prior anteroseptal myocardial infarction. 0.5 millimeter st segment depression in leads v4-v6 with t wave inversion in lead avl and to a lesser degree in lead i. compared to the previous tracing of , ventricular rate is much faster. t wave inversion is more pronounced in lead avl but less pronounced in leads v4-v5, with similar left precordial st segment depression. an ongoing lateral ischemic process cannot be excluded. clinical correlation is suggested. read by: , intervals axes rate pr qrs qt/qtc p qrs t 131 0 96 304/428 0 -55 173 cxr portable findings: single ap upright portable view of the chest was obtained. the right costophrenic angle is not included on the images. again seen is a large area of right mid-to-lower lung opacity which is better assessed on prior ct from . there is a moderate right pleural effusion with overlying atelectasis, an underlying consolidation cannot be excluded. streaky and fibrotic opacities are seen in the right lung involving the upper, mid and lower lung fields, most noted in the left mid lung field, also seen on the prior study. left apical pleural thickening and calcifications are again seen, consistent with chronic change. no large left pleural effusion is seen. there is no pneumothorax. the cardiac and mediastinal silhouettes are stable. multiple old right-sided rib deformities/fractures are again seen. a left sided stent is again partially imaged. impression: 1. right costophrenic angle not fully included on the images. given this, large area of right mid-to-lower lung opacity is again seen, likely representing combination of pleural effusion, atelectasis and possible underlying consolidation. increased right perihilar opacity. areas of patchy and fibrotic opacities in the left lung again seen, may be chronic. tte the left atrium is mildly dilated. the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets are mildly thickened (?#). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , tricuspid regurgitation is now more prominent. ue fistulogram patent av fistula in the left upper extremity with areas of aneurysmal dilatations in the upper and mid portion of the left arm. the arteriovenous anastomosis is patent however increased velocities were noted. the peak systolic velocity at the level of the arteriovenous anastomosis is 716 cm/sec. within the fistula, peak systolic velocities ranged between 120 and 143 cm/sec. in the distal fistula there is a patent stent however increased velocities were noted at the level of the proximal end of the stent. peak systolic velocities at this level were between 689 and 505 cm/sec. within the stent, the peak systolic velocities ranged between 58 and 244 cm/sec. distally to the stent and within the subclavian vein peak systolic velocities ranged between 47 and 360 cm/sec. peak systolic velocity in the brachial artery proximal to the arteriovenous anastomosis was 47 cm/sec. distally to the anastomosis, the peak systolic velocity was 69 cm/sec. impression: patent av fistula in the left upper extremity with increased peak systolic velocities at the level of the arterial anastomosis and within the proximal margin of the stent. velocities were recorded up to 716 cm/sec in the arteriovenous anastomosis. brief hospital course: 86m w/ wegener's, esrd, afib, dm2, recent tia /w delirium, presenting with delerium and hypoxia admitted for possible pna, expired on # dyspnea/sirs- patient was recently admitted from to for the treatment of hcap and was discharged on vanc/levofloxacin. at hd today, patient was noted to be hypoxic to 89% on ra and was referred to the ed for further evaluation. in the ed, cxr showed continued evidence of right sided opacities. wbc 4.9 is elevated from 3.5 on recent discharge. patient was tachycardic to the 110-120s (in the setting of afib) and tachypnic to the 20s with a concern for pna confering the diagnosis of sepsis. the patient had a therapeutic vanc level in the ed and received 1l ns, ceftriaxone, flagyl and azithromycin for possible pna. the antibiotics were continued overnight, but then d/c'd on hd 2 after repeat cxr showed evidence of pulmonary edema. despite this finding that patient was relatively euvolemic on exam and did not have elevated jvp or marked periperal edema. it is possible that the patient has pulmonary edema in the setting of af with rvr. there is also the possibility of worsening of gpa given recent discontinuation of azathioprine and elevated esr/crp. patient was unfortunately unable to tolerate given hypotension down to the 70s at each subsequent session. his prednisone was increased with rheumatology recommendation but respiratory status did not improve significantly over the subsequent days. midodrine was started as patient's family did not wish to pursue any heroic measures. stress does steroid was not pursued because the patient's family utlimately decided to transition patient to cmo given his progressively worsening respiratory status and hypotension. # gpa/wegner's granulomatosis. patient was initially kept on prednisone 10 mg daily and bactrim prophylaxis. however, given the concern of vasculitis flare with recent discontinuation of azathioprine, it was increased in the setting of his worsening respiratory status as well as elevated crp/esr. # delerium: patient was found to be delerious at hd on day of admission and continued to have an element of delerium on admission the to the micu. delirium improved slightly when seroquel wore off. however, patient continued to have a degree of delirium that is likely underlying inflammatory process and hypoxia. # afib. he initially did not require any rate control. he was kept on home warfarin initially. however, he later required low dose metoprolol for rate control. patient does not require rate control. warfarin was discontinued given supratherapeutic level. # esrd, hd-dependent: on hd qmwh, kidneys affected by wegener's vasculitis. patient had very limited hd sessions given hypotension. # goc. patient and his family were updated daily. his outpatient pcp, , and nephrologist were updated on a regular basis. palliative care was consulted. his hcp was clear about no heroic measures for the patient and ultimately decided that patient would transition to cmo given persistent hypoxia and hypotension, inability to tolerate . patient passed away on . chronic issues: # chronic right pleural effusion. stable on imaging. # diabetes. he was on insulin sliding scale. # elevated tropt, lfts: troponins and lfts were downtrending since recent discharge. # anemia: patient with iron studies suggesting anemia of chronic disease with macrocytosis likely multifactorial from esrd (though on epo), bactrim, mgus, and aging marrow. #. hypothyroidism. he was continued on levothyroxine 137 mcg daily & 25 mcg qod #. mgus / smoldering myeloma: at baseline patient is pancytopenic with wbc in the 3s and hct low 30s with macrocytosis (also noted to be on immunosuppression as described above). #. hyperlipidemia. he was continued on statin and asa. medications on admission: - senna 8.6 mg qhs - docusate sodium 100 mg - atorvastatin 40 mg daily - pantoprazole 40 mg daily - sulfamethoxazole-trimethoprim 800-160 mg 3x/week (mo,we,fr) - aspirin 81 mg daily - cholecalciferol 800 unit daily - sevelamer carbonate 400 mg daily - acetaminophen 1000 mg q8h - levothyroxine 137 mcg daily - levothyroxine 25 mcg qod - prednisone 10 mg daily - folic acid 1 mg daily - warfarin 1 mg daily discharge medications: none discharge disposition: expired discharge diagnosis: respiratory failure end stage renal disease wegner's granulomatosis delirium atrial fibrillation discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: hemodialysis diagnoses: pneumonia, organism unspecified anemia in chronic kidney disease end stage renal disease renal dialysis status mitral valve disorders unspecified pleural effusion diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism atrial fibrillation personal history of malignant neoplasm of prostate personal history of tobacco use hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia acute respiratory failure hypotension, unspecified long-term (current) use of insulin encounter for palliative care do not resuscitate status sinoatrial node dysfunction bronchiectasis without acute exacerbation personal history of malignant melanoma of skin delirium due to conditions classified elsewhere other nonspecific abnormal serum enzyme levels personal history of tuberculosis nonspecific abnormal results of function study of liver monoclonal paraproteinemia wegener's granulomatosis 

Answer: The patient is high likely exposed to