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: hypoxia major surgical or invasive procedure: none history of present illness: history of present illness: pt is 57 yo active female with pmh notable for osteoperosis, newly diagnosed with dermatomyositis 2 months ago with rapidly progressive ild now transferred from osh for worsening hypoxia. in early , pt developed a rash (not itching or painful, looked like red papules) on her toes, knuckles and elbows after working in the bushes in her yard. she also noticed her eyes were sensitive to light and swollen. she was diagnosed as possible poison and treated with prednisone, which caused her symptoms to improve. however, after the prednisone course ended, the symptoms came back. pt was subsequently seen be a dermatologist who did a biopsy, which diagnosed dermatomyosotis w/ mildly elevated cpk's and anti-jo1 antibody negative. pt did not have muscle weakness, pain or any trouble breathing during this time. ct chest showed low levels of interstitial fibrotic changes. started on oral prednisone. . in mid-, pt was seen by a rheumatologist who started azothioprine for a few days, which was quickly discontinued bc pt developed loss of sense of smell and taste. pt was continued on prednisone at escalating doses (80 mg). pt started developing some muscle and joint pains off and on. end of , pt had a pan ct to r/o malignancy, which showed a suspicious pancreatic mass. it was thought malignancy might be the cause underlying dm/ild and treatment was tailored to avoid cytotoxic agents and evaluate the underlying malignancy. in early , pt received solumedrol and then ivig treatment, which resulted in some improvement of symptoms. pt grardually developed shortness of breath, having trouble with exertion, climbing up stairs. also reports some proximal muscle weakness in her legs/hips (deep knee bends). . end of , pt had a egd and colonoscopy that were negative, and then a eus which showed a normal pancreas. 2 days ago, pt saw her pulmonologist who reports desaturation to the mid 80's on exertion, sent home on oxygen, but recalled to the hospital after chest ct showed significant worsened interstitial infiltrates bilaterally. sent to for evaluation of hypoxia. . on arrical to the floor, pt is lookign weak, with troubled breathing, taking a breath every sentence. pt denies any pain. pt was satting 94% on 6l nc. states her sob prevents her from even walking to the bathroom. . review of systems: admits to lbs weight loss, denies fever/chills. admits to night sweats frequently over the past few months. admits to red papules on knuckles, joint and muscle pains. admits to sob, dry cough. denies abdominal pain, dysuria, changes in bm. past medical history: hyperlipidemia (not on statin) osteoporosis social history: lives in stratum nh. runs a deli with her husband. 2 sons, 20 and 21, students at unh. 1 pack/day smoking hx for 15 years, quit 30 years ago. etoh 0 drinks/week. no illicit drugs since the 60s. family history: father - diabetes, emphysema, died of chf at 82 mother - uncle - colon cancer cousin - lupus known hx of autoimmune disorders - no ra, scleroderma, sjogren's.. physical exam: t= 96.6 bp= 132/78 hr= 87 rr= 22 o2= 94 6l physical exam: general: pleasant, well appearing, having difficulty breathing, speaks about a sentence before needing to catch breath. heent: facial and chest redness - faded heliotope rash. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. white exudate on tongue. neck supple, no lad. thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . no jvd. lungs: tachypneic, short shallow respirations. ctab, good air movement biaterally. abdomen: soft, nt, nd. bs x4. extremities: full rom. no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. skin: gottron's papules on the mcp and pip joints of hands, less prominent on feet. faded rash on chest- like a shall rash. neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. normal strength throughout, except 4.5/5 on r hip. + reflexes, equal bl. normal coordination. gait assessment deferred. psych: listens and responds to questions appropriately, pleasant pertinent results: labs on admission 13.6>33.7<222 133 | 100 | 20 ---------------182 3.8 | 21 | 0.7 ldh 686 cxr on admission: findings: no previous images. there is severe interstitial change diffusely involving both lungs, most prominent at the bases. no acute focal pneumonia or vascular congestion or cardiomegaly. the findings are consistent with the clinical diagnosis of dermatomyositis with severe interstitial lung disease. ct chest on admission: overall appearances are consistent with pcp and superimposed mild subpleural interstitial lung disease. multiple central or lucent areas within the abnormal lung could represent focal air trapping or uninvolved secondary pulmonary lobules. no pneumothorax or pleural effusion. enlargement of the gallbladder could represent acalculous cholecystitis in the current setting. clinical correlation is advised. 03:48am blood alt-72* ast-64* ld(ldh)-658* alkphos-53 totbili-0.2 03:07am blood alt-126* ast-177* ld(ldh)-1347* alkphos-91 amylase-29 totbili-0.2 03:23am blood alt-378* ast-424* ld(ldh)-1895* alkphos-109 amylase-36 totbili-0.3 04:11am blood alt-622* ast-1169* ld(ldh)-4116* alkphos-270* totbili-0.2 03:45am blood alt-1113* ast-2595* ld(ldh)-7800* alkphos-255* amylase-117* totbili-0.1 brief hospital course: 57 yo female with recent diagnosis of dermatomyositis and ild two months ago, transferred for worsening hypoxia found to have pcp pneumonia worsening respiratory status despite treatment requiring intubation. #hypoxic respiratory failure: she had been empirically started on bactrim for pcp pna which was confirmed by staining of bal specimen. pt was also started on steroid taper for severe pcp . chest ct showed interstitial disease c/w pcp. was intubated for increased work of breathing/respiratory failure. she became increasingly difficult to oxygenate (requiring fio2s of 65-80% to get o2sats in the high 80s-low 90s) and a repeat ct chest was done which showed worsening of her interstitial disease. she was started on ards-net ventilation protocol. the differential diagnosis of her continued difficulty oxygenating was felt to be severe pcp pna versus pcp pna resistant to bactrim versus pcp pna plus worsening ild versus severe pcp plus . pt was pulsed with high doses of steroids and briefly switched from bactrim to pentamidine, though she was then switched back because of rapidly rising lfts on pentamidine. she was also treated empirically for vap with vanc/cefepime/cipro and also micafungin. treatment c cytoxan was considered for treatment of ?worsening ild, however, it was eventually decided that cytoxan would be more likely to cause harm. despite these treatments, pt's respiratory status continued to decline. an esophageal balloon was placed which showed that a peep of 14 would be optimal for her. her peep was increased to 14 but pt began to desaturate into the 70s on day 9 of her intubation. pt was found to have a pneumomediastinum without pneumothorax which was felt to be unrelated to her acute decompensation. she improved c paralysis c oxygen saturations returning to the high 80s to low 90s. she eventually continued to desaturate despite maximum settings on pressure support. eventually, she developed wide complex tachycardia. she was dnr and expired on . . #pneumomediastinum: noted on x-ray. pneumomediastinum likely pcp bleb popping medially in the setting of high peep, the possibility of esophageal rupture after balloon placement was considered, however, pt did not acutely decompensate as would be expected in someone c mediastinitis. pt was followed closely for several days but did not seem to be worsening. could also be esophageal rupture but would expect pt to be spiking temps etc. pt was followed c serial cxrs. . # ild, dermatomyositis: the patient presented with gottron's papules, helotropic rash, elevated ck, and muscle pain several months ago. followed by rheum in as outpt. had been on steroids for worsening sob and ct scan from osh concerning for mild ild. pt had not been recieving bactrim ppx. myositis autoantibodies were sent but are still pending. . #transaminitis: pt developed rising lfts (doubled every day x ??? days) after starting pentamidine. pentamidine was discontinued and lfts continued to rise. liver was consulted and felt it was most likely ischemia. hepatitis b and c serologies were sent since hepatitis can reactivate in the setting of high dose steroids. . #hyponatremia ?????? pt consisently hyponatremic from 130-136. urine lytes were sent which were c/w siadh. ivf were minimized. . # osteoporosis: fosamax was temporarily d/ced as cannot be crushed and given through ogt. . #elevated ptt: pt developed elevated ptt in setting of tid sc heparin. sc heparin was decreased to and coags were trended daily. . #eye care ??????erythromycin ophthalmic ointment medications on admission: fosamax 70mg q week viactiv vitamin d bactrim ds 2 ds pills q 8 hours since nystatin wash solumedrol 1 g x 3 days discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus diagnoses: acidosis anemia, unspecified acute kidney failure, unspecified other and unspecified hyperlipidemia acute respiratory failure other specified cardiac dysrhythmias hypotension, unspecified pneumocystosis osteoporosis, unspecified postinflammatory pulmonary fibrosis hypoxemia other disorders of neurohypophysis interstitial emphysema dermatomyositis 

Answer: The patient is high likely exposed to