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: iodine attending: chief complaint: transferred to for evaluation of pulmonary hypertension. major surgical or invasive procedure: central line placement. swan-ganz catheter placement. history of present illness: mrs. is a 79 year-old woman with history of polycythemia on hydroxyurea, raynaud's phenomena, hypertension, transferred from osh to on for workup of new hypoxemia and pulmonary hypertension. she was in her usual state of health until approximately one month ago, when she began experiencing fatigue with exercise. prior to one month ago, she was able to climb a flight of stairs without difficulty and walk several blocks, denying any exercise limitation. she was working for her son in a gift shop until 3 weeks ago, at which time she began to note dyspnea with climibing one flight of stairs at her home and that she needed to take frequent breaks from what were typically small domestic tasks. other symptoms included mild ankle edema, and "swollen abdomen" noted by her pcp. notes generally poor appetite with little interest in food. her pcp ordered chest x-ray and started her on ciprofloxacin for pneumonia (per patient). she was also referred for an tte due to pleural effusions, which revealed a markedly dilated right ventricle, moderate aortic regurgitation and moderate mitral regurgitation. at hospital, she underwent chest cta which was negative for pe. there was a right sided effusion which was tapped with results consistent with transudate. also noted to have mediastinal adenopathy. during her hospitalization, patient was found to have acute kidney injury and per nephrology consutation felt to be secondary to poor renal perfusion from impaired left ventricular filling. patient was transferred to for futher management. she was also initiated on cap treatment with levofloxacin, which was completed at transfer to for further management and work-up of her hypoxemia and pulmonary hypertension. upon arrival at she was hemodynamically stable at direct admission to the floor. she remained hemodynamically stable with an oxygen requirement of 4 lpm. she had repeat ct scan of the chest without contrast and a repeat echo. these findings confirmed osh results with tr gradient 56-64, severe tr, mild mr, mild lvh, rvh, marked rv dilation with abnormal septal motion. pulmonary and cardiology were consulted and she underwent pulmonary artery catheter placement for planned close monitoring, trial of potential vasodilator drugs and diuresis in the icu. also has noted dark urine since arrival to , along with abdominal pain in her luq to llq, which felt like a "toothache" to her. it was not colicky in nature and resolved spontaneously. review of systems denies snoring or nightime dyspnea or awakenings though notes her "son thinks i have sleep apnea" for unclear reasons. denies fever, chest pain, syncope or lightheadedness, bleeding episodes, abdominal pain, nausea/vomiting prior to coming to hospital. denies headache, weight loss, night sweats or fever. denies history of liver disease, heart disease, venous thromboembolic disease. history of blood transfusion with delivery of child 50 years ago. past medical history: 1. polycythemia , diagnosed about , on hydroxyurea about 10 years. followed by dr. , who has controlled disease well for many years. 2. raynaud's phenomenon diagnosed "as a child" 3. kidney stones, last > 10 years ago per patient 4. hypertension 5. osteoarthritis 6. avascular necrosis of the femur or humerus (unclear) 7. osteoporosis 8. cataracts 9. chronic renal insufficiency, baseline creatinine about 1.0. social history: lives with daughter, able to care for self without limitations prior to this illness. never been on home oxygen before. is the primary carer for her daughter who suffers from some social difficulties - possibly autism spectrum. also has another two children - one son and a daughter. employment: worked in gift shop until three weeks ago, denies environmental exposures. no tuberculosis exposures. no travel. no hiv risk factors. husband died of mesthelioma. asbestos exposure likely prior to their meeting (he worked in a ship yard in his 20s). tobacco: never alcohol: very rare (once a year). family history: no family history of pulmonary disease. husband died of mesothelioma after working in a shipyard; pt states they met years after he worked there and was never exposed to any shipyard clothes and never visited the worksite. son has osa. sister has 'low white cell count' and sees a hematologist. physical exam: on admission: general appearance: elderly female, mildly tachypneic with speech. heent: dry mucous membranes, perrl though minimal reactivity, eomi. neck: jvd to ear at 60 degrees. r ij pa cath. no adenopathy. chest: diminished breath sounds at bilateral apices, bilateral basilar crackles. cardiac: +prominant rv impulse. s1, loud p2 with fixed split s2 (though more notable with exhalation), ?r sided s3. regular rate. sm at llsb. abdomen: +pulsatile liver. soft, non tender currently, slightly distended though tympanic throughout without clear evidence of ascites. spleen tip not clearly palpable but ?increased size by percussion. back: no cva tenderness. site benign. extremities: trace to 1+ le pitting edema, digits slightly darker in color without evidence of ulceration. neuro: cn ii- intact, strength 5/5 in ues and les. no asterixis. psych:alert, oriented, appropiate upon discharge: vs: t 97.0 hr 85 bp 124/70 (100-124 systolic over past 24 hours) rr of 20 and saturation of 93% on 6l oxygen via n.c. general appearance: elderly female, slim, appears stated age. heent: dry mucous membranes, perrl, eomi. neck: jvd to ear at any angle. no adenopathy. chest: diminished breath sounds at bilateral bases, some fine dry crackles to the middle of the lower lobe posteriorly. cardiac: s1, loud p2 with fixed split s2. regular rate. sm at llsb. abdomen: soft, non tender currently, no evidence of ascites. spleen tip not clearly palpable but increased size by percussion. back: no cva tenderness. site benign. extremities: no edema, clubbing, cyanosis. neuro: cn ii- intact, strength 5/5 in ues and les. no asterixis. psych: alert, oriented, appropiate. pertinent results: admission labs and important data from the admission blood 10:40pm blood wbc-14.0* rbc-5.23 hgb-14.5 hct-47.3 mcv-91 mch-27.7 mchc-30.7* rdw-21.1* plt ct-322 10:40pm blood neuts-88.6* lymphs-6.2* monos-2.9 eos-1.5 baso-0.9 10:40pm blood pt-16.8* ptt-32.2 inr(pt)-1.5* 10:40pm blood plt ct-322 10:40pm blood glucose-100 urean-48* creat-1.3* na-144 k-4.3 cl-109* hco3-24 angap-15 10:40pm blood alt-35 ast-36 ck(cpk)-15* alkphos-108 totbili-0.7 10:40pm blood albumin-3.6 calcium-8.9 phos-3.5 mg-2.1 12:05pm blood caltibc-369 ferritn-30 trf-284 04:41am blood tsh-11* 03:56pm blood free t4-1.2 12:05pm blood hbsag-negative hbsab-negative 08:18am blood anca-negative b 08:18am blood -negative 10:40pm blood rheufac-<3 04:27pm blood -negative cntromr-negative 07:05am blood crp-21.8* 01:48am blood hiv ab-negative 12:05pm blood hcv ab-negative 10:50pm blood type-mix temp-36.9 ph-7.36 10:50pm blood hgb-14.5 calchct-44 o2 sat-59 urine 02:49am urine color-dkamber appear-cloudy sp -1.022 02:49am urine blood-lg nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-sm 12:53pm urine rbc->50 wbc-* bacteri-occ yeast-none epi- 11:27am urine casthy-8* 12:53pm urine hours-random creat-130 totprot-69 prot/cr-0.5* 11:27am urine osmolal-329 12:53pm urine u-pep-negative f discharge labs 06:50am blood wbc-15.8* rbc-4.92 hgb-14.1 hct-45.3 mcv-92 mch-28.6 mchc-31.1 rdw-22.4* plt ct-400 07:05am blood neuts-85.6* lymphs-8.1* monos-3.5 eos-2.0 baso-0.7 06:50am blood plt ct-400 06:50am blood pt-14.2* ptt-32.1 inr(pt)-1.2* 06:50am blood glucose-86 urean-37* creat-1.2* na-143 k-4.3 cl-99 hco3-33* angap-15 08:50am blood alt-17 ast-27 ld(ldh)-334* alkphos-94 totbili-1.0 06:50am blood calcium-8.4 phos-3.8 mg-2.0 08:50am blood cholest-145 08:50am blood triglyc-146 hdl-22 chol/hd-6.6 ldlcalc-94 06:20am blood esr-0 cultures 2:29 pm urine source: catheter. **final report ** urine culture (final ): yeast. >100,000 organisms/ml.. other investigations cardiac echo impression: severe right ventricular cavity enlargement with free wall hypokinesis. severe pulmonary artery systolic hypertension. mild symmetric left ventricular hypertrophy with preserved regional/global systolic function. these findings are suggestive of a primary pulmonary process(e.g., pph, osa, chronic pulmonary embolism, bronchospasm, etc.). cardiac echo impression: cor pulmonale; no intracardiac shunt. compared with the prior study (images reviewed) of , no obvious change. cardiac catheterization comments: 1. resting hemodynamics revealed elevated right sided filling pressures with rvedp of 22 mm hg. there was severe pulmonary artery hypertension with pasp of 84 mm hg. there was no significant change in these pressures after 10 minutes of inhaled 100% fio2 or 10 minutes of inhaled 100% fio2 plus no. left sided filling pressures were normal with mean pcw of 15 mmhg. 2. procedure performed from the right internal jugular vein without complications. a swann-ganz catheter was left in place. final diagnosis: 1. severe pulmonary artery hypertension and elevated right sided pressures. 2. no response to inhaled 100% oxygen or no. 3. normal pcw pressure. abdominal ultrasound impression: 1. hepatosplenomegaly in the setting of normal hepatic echogenicity and architecture in combination with enlarged hepatic veins; the constellation of findings can be seen in the right-sided heart failure. 2. non-obstructing renal calculi. 3. right pleural effusion. ct chest, without contrast impression: 1)marked enlargement of the pulmonary artery suggests pulmonary arterial hypertension. 2)diffuse mild dilatation of the ascending aorta at 43 mm. 3)moderately large right and small left dependent pleural effusions. 4)diffuse air trapping is consistent with small airways obstruction. 5) rounded atelectasis in the right upper lobe with atelectasis in the middle and right lower lobe. 6)diffuse coronary artery and valvular calcification. 7)periportal edema, splenomegaly and probable varices are incompletely assessed and in the presence of ascites suggests portal hypertension. anasarca in the subcutaneous soft tissues, may be due to hypoalbuminemia. chest x-ray comparison: ; ct from . chest, two views: a swan-ganz catheter has been removed. a right internal jugular sheath is seen with tip in the superior right atrium. tent-like configuration of the heart is compatible with persistent pericardial effusion, progressed. the prominence in the hilar regions are consistent with reported history of pulmonary artery hypertension. the aorta is again calcified and unfolded. small bilateral pleural effusions, greater on the right persists. retrocardiac opacification could represent atelectasis or, less lkely, infection. no overt pulmonary edema. brief hospital course: mrs. is a 79 year-old woman with hypertension and polycythemia , transferred to for workup of new pulmonary hypertension with rv failure. although the etiology is unclear, it is possible that several disease processes are at work: polycythemia is sometimes associated with pulmonary hypertension, however this degree of pulmonary hypertension would be atypical if not impossible. given positive d-dimer and coagulopathy at admission along with negative cta, an alternative explanation would include microembolic or thrombotic disease with the pulmonary vasculature that is sufficiently diffuse to avoid detection on ct. this is also consistent with decreased response to oxygen and nitric oxide on right heart pressure as measured by swan-ganz catheter. some prelinary work-up for vasculitus and systemic disease was negative. chronologically, mrs. was stable on the medical floor, went to the icu for diuresis, close monitoring and determination of pulmonary arterial pressure, including in the context of increased oxygen, nitric oxide and sildenafil. sildenafil was found to be somewhat helpful. she was stable on nasal cannula and transferred back to the floor for monitoring prior to discharge. issues of importance during the stay include the following: pulmonary hypertension and rv failure. newly diagnosed, with symptoms x 1 month, however rv dilation and hypertropy suggest longer chronicity. unclear etiology. abdominal u/s without comment on hepato-pulmonary shunt. no evidence of intracardiac shunt or lv failure given negative echo bubble, no intrapulmonary shunt or pe evidenced on cta chest. negative , anca, anti centromere as well as spep and upep,tsh slightly high but free t4 normal, awaiting anti-scl 70. hiv negative. swan catheter placed in cath lab prior to arrival, with persistantly elevated pap and no response to no. initially diuresed with a lasix gtt and placed on a dobutamine gtt with overall improvement in cardiac function, however pap remained elevated in the 80s/30s. sildennofil was started and goal dose of 20mg tid achieved within one day. mild decrease in pap to 60s/20s, dobutamine stopped and swan removed. lasix stopped and switched to po. hypoxemia. likely explained by vq mismatch in setting of severe pulmonary hypertension; also has bilateral effusions and atelectasis. s/p antibiotic course for cap. respiratory status improved with aggressive diuresis and maintained on daily lasix. echo negative for asd or evidence of r->l shunting. persistant o2 sats in low 90s on nrb, and high 80s on nc but without subjective sob. acute on chronic renal failure baseline reportedly ~1.0, has been in the 1.2-1.5 range here and at osh. mild proteinuria and abnormal microscopy with rbcs and wbcs. did receive contrast at osh (though elevation present prior to scan). acute change differential includes hypoperfusion from heart failure, atn from a number of sources (which was thought to be the case at osh). total los net negative over 7l. relatively stable since admission. polycythemia is seen by outside hematologist, dr , who maintains her on hydroxyurea be given at 500 mg qd; if hct contiune to rise on qd dosing recommend increase to . was also continued on asa. hepatosplenomegaly also with ascites - resolved with diuresis. likley from r heart failure. inr elevated to 1.5 at admission without explanation. albumin 3.6 (though 2.9 on admission). transaminases normal. hepatitis panel negative, fe studies normal. hypertension at baseline takes nifedipine 30 mg cr and toprol xl 50 mg, held in setting of low bp. not restarted given continued normal blood pressure. morbilliform rash developed in pm of . is pruritic. pt states she developed this the last time she got iv contrast, and she had a cta at osh. reviewed meds, and consulted dermatology: lasix and sildenafil unlikely offenders, but most likely is from contrast given pt's known history. written for medications as described in the medication list. dispostion unsuitable for palliation at home given care for daughter (see social history). desired rehabilitation and deferment of decision about hospice. her son and daughter in law will care for her daughter. medications on admission: asa 81 mg qd toprol xl 50 mg hydrea 500 mg on m-w-f, qd other days nifedipine er 30 mg qd recently stopped taking hctz (2 weeks ago due to "dehydration") possibly taking terazosin discharge medications: 1. hydroxyurea 500 mg capsule sig: one (1) capsule po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day): please continue as prophylaxis for dvt while not ambulatory. 4. sildenafil 20 mg tablet sig: one (1) tablet po tid (3 times a day). 5. furosemide 20 mg tablet sig: one (1) tablet po every other day. 6. miconazole nitrate 2 % powder sig: one (1) topical twice a day for 7 days: please apply to groin for relief of yeast infection. . 7. cetirizine 10 mg tablet sig: one (1) tablet po once a day for 7 days: for skin rash. 8. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po three times a day for 7 days: for skin rash. . 9. triamcinolone acetonide 0.1 % cream sig: one (1) topical twice a day for 7 days: for skin rash. discharge disposition: extended care facility: of discharge diagnosis: primary diagnoses: (severe) idiopathic pulmonary hypertension. secondary diagnoses: systemic hypertension (controlled) polycythemia (controlled) discharge condition: stable. discharge instructions: you were transferred to for management of shortness of breath and difficulty breathing in the context of severe pulmonary hypertension (high blood pressure within the vessels supplying your lungs). you initally came to the medicine , but were next care for in the intensive care unit where further fluid could be removed and the pressure within your lung blood vessels monitored while various drugs were trialled. this resulted in the determination of a new medication regimen that now includes sildenafil (viagra) that acts to dilate and reduce pressure within lung blood vessels. in the intensive care unit on these medications your breathing improved and you returned to the medicine . there you were stable on about 6 liters of oxygen per minute delivered by nasal cannulae. this will likely be your new baseline oxygen requirement. we now feel that you are stable enough to go to rehabilitation. please take your medications as directed: - we have added sildenafil (viagra) and furosemide (lasix) to your regimen - we have added some medications to help with the rash that you developed. as you suggested, we also think that this rash is likely due to either contrast media or is a contact dermatitis. we think that it is very unlikely that it is due to your new medications. please attend all follow-up appointments as listed below. if you experience increasing shortness of breath, require more oxygen, chest pain, or any other concerning symptom, please return to the hospital. it will be very important that you come to the hospital if you contract the common cold or another illness, because your capacity to compensate for any worsening of your breathing will be very limited. followup instructions: test for consideration post-discharge: scleroderma antibody. please make an appointment to see your hematologist, dr. . he will be sent a copy of your discharge summary. we suggest that you visit your primary care physician upon leaving rehabilitation: , a. md, dmd procedure: pulmonary artery wedge monitoring right heart cardiac catheterization administration of inhaled nitric oxide diagnoses: pneumonia, organism unspecified unspecified pleural effusion congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute kidney failure, unspecified portal hypertension candidiasis of other urogenital sites hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified pulmonary collapse acute respiratory failure osteoporosis, unspecified primary pulmonary hypertension osteoarthrosis, unspecified whether generalized or localized, site unspecified acute on chronic systolic heart failure raynaud's syndrome polycythemia vera 

Answer: The patient is high likely exposed to