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: history of present illness: the patient is an 84-year-old female with a history of rheumatoid arthritis and hypertension who was in the process of preoperative evaluation for a right knee replacement. she was found to have a urinary tract infection on routine urinalysis on . she was therefore started on bactrim. since then the patient reports nonspecific complaints including increasing fatigue and occasional lightheadedness but denied any chest pain, shortness of breath, nausea, vomiting, or diaphoresis. she does report that her urine did become in color. she experienced a decrease in urine output times two days prior to admission without any dysuria or hematuria. she had laboratories drawn at an outside hospital on which demonstrated an increased white blood cell count with 3 bands. in addition, her creatinine had increased from a baseline of 1 to 2.7. while she was at her primary care physician's office getting her laboratories drawn she continued to complain of lightheadedness and dizziness. she was seen in the clinic on for followup. she was found to have a blood pressure of 110/64 and physical examination revealed no bibasilar crackles. her electrocardiogram showed no acute changes, and a chest x-ray was negative by report. her creatine kinase enzymes and creatinine were found to be elevated and she was sent to the emergency department to evaluate for acute renal failure and to rule out for myocardial infarction. in the emergency department, the patient was afebrile with stable vital signs. her creatine kinases were cycled, and her troponin was negative. her second creatine kinase had an elevated mb fraction. the patient was questioned again about chest pain, angina, shortness of breath, nausea, vomiting, diaphoresis; and she denied all. she was noted at that time to have a maculopapular rash. in the emergency department, she was given lasix 20 mg, and aspirin, as well as 1 unit of packed red blood cells. she was admitted for further evaluation of her acute renal failure and to rule out myocardial infarction. past medical history: 1. rheumatoid arthritis. 2. osteoporosis. 3. hypertension. 4. history of vertigo. 5. no history of coronary artery disease. allergies: no known drug allergies. medications on admission: atenolol 25 mg p.o. q.d., bactrim 1-week total (to be completed on ), fosamax 10 mg p.o. q.d., plaquenil 200 mg p.o. b.i.d., ultra-cal, vioxx 25 mg p.o. b.i.d., meclizine 25 mg p.o. q.d. p.r.n. social history: the patient lives alone is very independent. she walks regularly for exercise. she denies any alcohol or tobacco use. her daughter is her contact at phone number . physical examination on presentation: vital signs were blood pressure 108/48, heart rate 58, respiratory rate 26, satting 97% on 2 liters oxygen. in general, pleasant, in no acute distress. heent revealed extraocular muscles were intact. pupils were equal, round, and reactive to light. the oropharynx was without lesions. cardiovascular had a regular rate and rhythm, a 2/6 systolic ejection murmur at the left sternal border radiating to the axilla. no jugular venous distention. pulmonary revealed crackles appreciated at the lower one-third on the left and lower one-half on the right. abdomen was distended and tympanitic with positive bowel sounds, soft and nontender. no suprapubic tenderness. no costovertebral angle tenderness. foley in place with light yellow urine. extremities had 2+ pitting edema to the feet bilaterally. skin had maculopapular rash over the chest, arms, legs; nonpruritic. neurologically, nonfocal. laboratory data on presentation: white blood cell count 6.9, hematocrit 27.5, platelets 154. sodium 128, potassium 4.2, chloride 95, bicarbonate 22, bun 57, creatinine 3.5, glucose of 111. alt 15, ast 30, alkaline phosphatase 79, total bilirubin 0.2. creatine kinase 263 with an mb fraction of 21, giving an index of 8%. urinalysis was nitrite negative, protein negative, blood negative, 5 red blood cells, 1 white blood cell, no bacteria, 1 epithelial cell. radiology/imaging: electrocardiogram revealed sinus rhythm at 56 beats per minute, primary av block, normal axis, t wave inversions in leads iii and avf. hospital course: the patient is an 84-year-old female with rheumatoid arthritis with a recent bump in her creatinine and a new rash following initiation of bactrim therapy, who was also presenting with a complaint of malaise, positive creatine kinases, negative troponin. her acute renal failure seemed likely secondary to bactrim initiation as well as possibly having been contributed by dehydration and vioxx therapy. the role of her positive creatine kinase enzymes was unclear. she also seemed to be demonstrating a mild congestive heart failure at the time of admission. the patient was ruling in by myocardial enzymes for a myocardial infarction given her elevated enzymes. she was therefore started on an aspirin and lopressor, and her ace inhibitor was held. the patient was started on telemetry, and serial electrocardiograms were followed. the patient was also suffering nonoliguric acute renal failure which was thought secondary to bactrim, possibly exacerbated by dehydration. therefore, the bactrim was held. a renal consultation was obtained, who said that the sediment of the urine did show white cells. they felt like her symptomatology could be consistent with bactrim-induced renal insufficiency. they recommended gentle hydration and withholding of offending agents with consideration for steroid treatment should her renal function worsen. over the course of the next few days the patient's creatinine trended downward as the patient diuresed. the patient remained cardiovascularly stable with creatine kinase enzymes trending downward as well. she remained chest pain free over the next few hospital days. her beta blocker, aspirin, and nitrates were continued. however, the patient's pulmonary function continued to worsen over the next few days. she continued to have low oxygen saturations and required increasing amounts of oxygen to maintain her saturation. in addition, she continued to have rales on examination despite avid diuresis. therefore, it was felt that congestive heart failure was an unlikely reason for the patient's pulmonary problems. a ct scan was obtained which was not consistent with pulmonary embolus. as her pulmonary situation continued to deteriorate, it was felt that she was likely developing acute respiratory distress syndrome. she was therefore evaluated by the medical intensive care unit team for possible transfer. by , the patient was requiring 10 liters to 15 liters by face mask to maintain oxygen saturations of greater than 90%. as part of the workup of her hypoxia, an echocardiogram revealed an ejection fraction of 50% with moderate pulmonary hypertension, and her ct angiogram while demonstrating no evidence of pulmonary embolus did demonstrate increased interstitial infiltrates and areas of ground-glass opacifications. she was therefore transferred to the medical intensive care unit on for management of what appeared to be a noncardiogenic interstitial infiltrate of unclear etiology. she was continued on levofloxacin 250 mg p.o. q.d. and was started on solu-medrol 60 mg intravenously q.8h. a bronchoalveolar lavage was planned to evaluate for infectious etiology of the patient's pulmonary issues as well as to obtain a tissue sample for evaluation of possible hypersensitivity pneumonitis. pending these results, the patient was continued on empiric antibiotic therapy as well as empiric pneumocystis carinii pneumonia coverage and empiric steroids. her saturations remained stable on a nonrebreather over the next few days; however, the patient did not show any improvement in her pulmonary situation. results from the bronchoalveolar lavage did not demonstrate any etiology of the patient's pulmonary pathology. therefore, thoracic surgery was contact for evaluation for possible open lung biopsy. over the course of the next few days the patient's pulmonary situation continued to worsen. on , it was felt that the patient was becoming fatigued and could not longer support her own breathing. therefore, she was intubated and sedated to decrease her work of breathing. levofloxacin and solu-medrol were continued. the patient has remained hemodynamically stable; however, after initiating sedatives for placement of the endotracheal tube, her pressure dropped and responded well to fluid boluses. on , a central line was placed in preparation for a lung biopsy. this resulted in a subsequent pneumothorax which was treated with chest tube placement. the patient tolerated the procedure without difficulty. a lung biopsy was performed later that afternoon. results from the lung biopsy demonstrated extensive fibrosis with virtually no pulmonary architecture remaining. therefore, it was felt that the patient was suffering end-stage fibrosis possibly secondary to a usual interstitial pneumonitis versus an acute interstitial pneumonitis. over the course of the next few days the patient's oxygen requirements and ventilatory support need increased. a family discussion was held to discuss the patient's poor prognosis given the extent fibrosis found on lung biopsy. it was determined that the only possible course of treatment left was a short course of intensive high-dose steroids. the patient's family agreed to this treatment, and the patient was treated with 1 g of solu-medrol intravenously q.d. times three days. over the course of those three days, the patient remained hemodynamically stable but with decreasing blood pressure and had to be started on pressors. she also required increasing ventilatory support and was kept sedated as well as paralyzed. serial blood gases demonstrated increasing acidosis. in addition, the patient's peak pressures increased to well over 40. therefore, at the end of three days of high-dose steroids it was felt that the patient's pulmonary situation had not improved. this was discussed at length with the patient's family who agreed that in this situation the patient would not want to be on a ventilator for the rest of her life. therefore, the focus of care was switched to comfort measures only. the patient was provided with adequate sedation and pain medication. the patient was found to be unresponsive in the afternoon of . telemetry demonstrated no electrocardiac activity. the patient was found to have pupils fixed and dilated with absent reflexes, absent heart sounds, and absent breath sounds. the patient was pronounced dead at 4:30 p.m. on . the patient's family was in attendance at the time of death. the attending, dr. , and the patient's covering primary care physician, . , were contact. the patient deferred an autopsy at the time of death. , m.d. dictated by: medquist36 d: 17:06 t: 10:08 job#: procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy open biopsy of lung diagnoses: urinary tract infection, site not specified acute kidney failure, unspecified hyposmolality and/or hyponatremia iatrogenic pneumothorax postinflammatory pulmonary fibrosis acute glomerulonephritis with other specified pathological lesion in kidney dermatitis due to drugs and medicines taken internally sulfonamides causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to