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: keflex / cephalosporins attending: chief complaint: shortness of breath and edema major surgical or invasive procedure: plasmapheresis/hemodialysis catheter placement history of present illness: pt is a 51 y/o f call-out from micu after admission for likely ttp. please see excellent msiii note for full details, but briefly, pt had been in usoh being treated for foot cellulitis x 2weeks with keflex. after 10 days keflex, she began to note full body non-raised rash, petechiae over arms, and larger confluences on her legs. keflex d/c'd, given benadryl, and started on doxycycline, which she said made her feel sick. pt noted increased fatigued, over her baseline, increasing sob with exertion. . in the ed, initial laboratories remarkable for anemia with a hct of 25.7 and thrombocytopenia 85,000. bun/cr 83/10. she was afebrile but hypertensive. heme/onc and renal consulted. rbcs and rbc casts in urine. smear positive for schistocytes. plasmapheresis initiated for presumed ttp. she was given nitro paste, tylenol, solumedrol 500mg iv x1, and labetalol 400mg po x1. a r ij pheresis catheter was placed. . in micu, improvement in thrombocytopenia and elevated ldh s/p pheresis and hd x3. she was hemodynamically stable and called out to floor. pt still oliguric. . on floor, she has no complaints exceot some mild fatigue on exertion; however, she reports feeling better with improved breathing and able to lie flat without sob/orthopnea. she denies any pain. ros negative for recent diarrhea, no viral uris, no icterus or changes in the color of her skin or urine. denies dysuria, chest pain, confusion, fevers, or ataxia. past medical history: none social history: lives with husband and 2 of her 3 children. denies tobacco, drinks occasional social etoh, and denies ivdu. is rn in day surgery. family history: no known clotting d/o, no pe or dvt; m with + miscarriage physical exam: vs: 99.3 185/110 86 20 93 % ra gen: well appearing, nad heent: faint scleral icterus, perrl, eomi, op clear neck: rij in place, nl lad cv: rrr, nl s1/s2, 2/6 sem (flow murmur) pulm: bibasilar crackles at bases bilaterally abd: soft, nt/nd, +bs, no masses ext: trace pitting edema, warm, good pulses neuro: alert and oriented, appropriate skin: irregular 1cm left upper back lesion nontender, raised, pink (known to pt). numerous small papules over entire back; non-pruritic pertinent results: . . . . . . . . dic labs negative dat negative ldh high, haptoglobin low . positive anca negative. hepatitis screen: negative, hep sab postive. . . imaging: . peripheral blood smear (per dr. : prominent neutrophils (mature); low platelets with some large forms and no platelet clumps; occasional hypochromic red cells; on average 5 schistos per hpf ( schistos noted in every field examined in the thin area of the slide). . cxr: mild chf . renal u/s: no hydro; small to moderate bilateral pleural effusions . echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional systolic function (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. impression: no left ventricular outflow tract obstruction or significant valvular disease seen. symmetric left ventricular hypertrophy with preserved systolic function. brief hospital course: 51 y/o female patient with microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure thought to be the result of scleroderma renal crisis. . # microangiopathic hemolytic anemia/thrombocytopenia: the final cause for and thrombocytopenia is still not completely clear, though it was likely somehow associated with her scleroderma renal crisis. initially, pt was tought to have ttp/hus (she met 3 out of diagnostic 5 criteria) and was treated by plasmapheresis. adamst13-actvity was low but at a level significant enough to induce ttp; no adamst13-inhibitor was found. inciting factors were not fully clear, keflex was considered initially. patient was screened for cryoglobulin, anticardiolipin-antibodies, lupus-anticoagulans, hep a,b and c serology, c3, and c4, which were all within normal limits. improvement in thrombocytopenia and elevated ldh s/p 1st cycle of pheresis. however, pheresis was discontinued as she did not seem to be improving significantly with it. pt was found to have elevated (1:1280--pre-plasmapheresis). this along with notable skin findings and hx of raynauds raised suspicion for scleroderma with associated renal crisis. . # scleroderma: this diagnosis was made primarily on clinical finding: the pt's sclerodactaly, h/o raynauds as wel as her (+) . pt did not have (+) anti-scleroderma antibody titers--however, this test is not specific. pt underwent skin bx which, with given her clinical picture, was consistent with scleroderma. the pt was followed by both dermatology and rheumatology, who are scheduled to see her as an outpatient. she will need further evaluation as an outpatient to assess the extent of organ involvement. for instance, she will need a repeat echo to assess pa pressure (her first echo could not assess this) as well as chest ct. . # renal failure: pt presented with acute renal failure that was likely due to scleroderma renal crisis. per rheumatology, this scleroderma renal crisis is typically characterized by acute onset of renal failure with relatively urine sediment, marked hypertension, and can be complicated by microangiopathy. it also is typically seen earlier on in the natural history of diffuse systemic sclerosis, consistent with her otherwise limited past history. pt was also evaluated for idiopathic ttp, ,b,c serologies, c3, c4, spep, upep, aso and anti gbm, which were all within the normal limits. she did receive steroids on admission for initial concern of gn--her admission ua showed rbc casts. however, subsequent ua's did not show rbc casts, and, thus, the steroids were discontinued. given the severity and persistence of her renal failure, the pt was initiated on hemodialysis. a peritoneal dialysis catheter was also placed as the pt was expected to need long-term dialysis. the pt was started on captopril for treatment of presumed scleroderma renal crisis. ace inhibitors are the cornerstone of treatment of scleroderma induced renal disease. this was evidenced by the positive effect it had on her bp. the pt was kept on captopril (and not converted to lisinopril) as she seemed respond better to the captopril than the lisinopril. . # htn: this was first time the patient was noticed to have hypertension (as high as 170/110). she was initially treated with metoprolol but later switched to captopril (as above), along with amlodipine and valsartan. . # pvc: pt was found to have irregular rhythm and monomorphic pvcs. echocardiography revelaed left ventricular hypertrophy but the reason for pvcs was not fully clear. while in hospital she was monitored on tele. . # contact dermatitis: pt developed ichty rash over her back. symptoms got better upon savar cream and anti-allergic bedclothes. . # basal cell carcinoma: pt to have f/u with derm for basal cell lesions on back and chest. medications on admission: occasional motrin or tylenol recently on keflex and doxy discharge medications: 1. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 4. valsartan 160 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. captopril 50 mg tablet sig: three (3) tablet po three times a day. disp:*270 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: microangiopathic anemia and thrombocytopenia probable scleroderma renal crisis probabl basal cell carcinoma discharge condition: good s/p hemodialysis discharge instructions: please call dr. or dr. or go to the ed if you experience shortness of breath, chest pain, fever, chills, redness around your catheter sites or any other concerning change in your condition. . you are to receive hemo-dialysis support at dialysis unit starting on tuesday. . please limit your intake of fluids (as instructed by the renal doctors). . please do not shower or get your pd catheter wet until you are seen by dr. on . . please call your hmo and switch your primary care doctor to dr. (as soon as possible)--this is necessary to do before your appointment with him. . if you decide that you would like to attend the m&m conference on tuesday from 8-9am in the 312/315 conference room, please page dr. #. you may call the main # for the hospital to page: . followup instructions: date/time: at 8:20 with your new pcp, , m.d., phone: (in building ) . date/time: at 12:15 with provider: (rheum lmob) in the phone: . date/time: at 11:45 with provider: , np (dermatology) phone: . date/time: at 1:40 with provider: , md (transplant surgery) . procedure: venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis therapeutic plasmapheresis other open umbilical herniorrhaphy closed biopsy of skin and subcutaneous tissue creation of cutaneoperitoneal fistula diagnoses: thrombocytopenia, unspecified end stage renal disease acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified cardiac dysrhythmias acquired hemolytic anemia, unspecified raynaud's syndrome umbilical hernia without mention of obstruction or gangrene contact dermatitis and other eczema, unspecified cause tetracycline group causing adverse effects in therapeutic use circumscribed scleroderma 

Answer: The patient is high likely exposed to