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: mr. is an 80-year-old man with a past medical history of coronary artery disease, polymyalgia rheumatica who presents from outside hospital with episode of chest discomfort and shortness of breath. he was in his usual state of health until one week prior to admission when he began having worsening shortness of breath and dyspnea on exertion while on vacation at . he had worsening shortness of breath on the day prior to admission, an episode of chest pain and went to the emergency department at an outside hospital in . he had electrocardiogram changes which were nonspecific, possible st elevation on lead 1 and l, t-wave inversion in 3 and was ruled out for myocardial infarction with cks and troponin. originally started on aggrastat and heparin which was discontinued on . he was continued on beta blocker and aspirin, started on an ace inhibitor and plavix and received diuresis with intravenous lasix. he was transferred to and at presentation he was with shortness of breath which was improved. no chest pain, no fevers, chills, nausea or vomiting, however he did have a cough productive of brown sputum. past medical history: 1. coronary artery disease, status post cardiac catheterization many years prior notable for 80% right coronary artery stenosis treated medically. 2. prostate cancer three years prior to admission treated with radiation. 3. polymyalgia rheumatica, treated with prednisone from and 4. hcs 5. status post appendectomy 6. diverticulosis, status post resection 7. spinal stenosis 8. dysphasia admission medications: 1. nitroglycerin 2. zocor 3. baclofen 4. aspirin 5. hydrocodone 6. aspirin allergies: he has no known drug allergies. family history: negative social history: the patient works as a banker. he has a 15 pack year smoking history, but quit 40 years ago. admission physical exam: vital signs: temperature was 97.9??????, blood pressure 108/58, pulse 90, respirations 20. o2 saturation is 95% on 4 liters. general: he is a pleasant man in no acute distress. head, ears, eyes, nose and throat: anicteric. oropharynx is clear. jugular venous pressure is 3 cm. heart: regular rate and rhythm, s1 and s2. the patient also has an s3. no murmurs, rubs or gallops. chest: bibasilar wet crackles at the bases bilaterally one half up. abdomen: soft, nontender, nondistended, active bowel sounds. extremities: no edema, 2+ dorsalis pedis pulses bilaterally. warm extremities. neurologic: alert and oriented x3, mentating well. admission labs: notable for cks 45, 29 and 27, troponin less than 0.10 x2 and less than 0.15. white blood count was 13.1, hematocrit 35, platelets 378. chem-7 146, 4.3, 109, 20, 27, 1.1 and 168. his coagulation studies were normal. chest x-ray showed multiple patchy bilateral opacities in the mid and lower lobes, partially obscuring the mediastinal and hilar contours. no preliminary vascular engorgements. hospital course by systems: 1. pulmonary: mr. was aggressively diuresed with lasix, as it was felt that he had pulmonary edema. his oxygen saturation did not improve with his diuresis, in fact it gradually worsened prompting a chest ct scan on which revealed diffuse air space disease predominantly of the mid and lower lung zones consistent with infectious or inflammatory process that were groundless opacities bilaterally. he therefore had multiple serologies checked and a biopsy done through a vats procedure on . the serologies were notable for positive p-anca confirmed by myeloperoxidase and positive rheumatoid factor and an elevated esr, otherwise negative. he had had the biopsy which revealed acute and organizing pneumonitis with interalveolar fibrin deposition and type ii pneumocyte hyperplasia, fresh and organizing vascular thrombi, but no evidence of active vasculitis. stains were negative for evidence of infection. around this time on , he had been transferred to the medical intensive care unit because of worsening respiratory status and intubated. he was started on cytoxan and solu-medrol and improved respiratory wise over the next few weeks. he was extubated on and his sedation was gradually titrated. pulmonary wise, he remained stable, but still had an oxygen requirement on the date of discharge at approximately 2 to 3 liters nasal cannula. 2. cardiovascular: the patient presented and was ruled out for myocardial infarction. the initial feeling was that he had pulmonary edema from congestive heart failure, however his echocardiogram revealed a normal left ventricular ejection fraction. no significant valvular disease and no evidence of pericardial effusion or tamponade. therefore, the aggressive lasix diuresis was stopped and he was simply continued on aspirin, lasix 40 mg intravenous qd, amlodipine, metoprolol and isordil. his lipitor had been stopped because of elevated cks and his ace inhibitor had been stopped because of his renal function. he did not have any chest pain or new electrocardiogram changes during his hospital course and telemetry was discontinued when he left the medical intensive care unit. 3. renal: the patient developed renal insufficiency which was believed to be secondary to the aggressive diuresis he received upon admission and his bun increased into the 100s and his creatinine increased to a maximum of 3.7 on . it had improved back to 2.2. his urinalysis was noted for muddy brown casts. his fena was 5% and spap and upap were negative. his gbm was also negative. it was felt that he probably did not have vasculitis infecting his kidneys and that it was probably simply acute tubular necrosis. his renal function had improved by the time of discharge to a creatinine of 1.4. 4. musculoskeletal: when the patient had reversal of his sedation, it was noted that he was diffusely weak. this delayed his extubation for a few days. when he was finally extubated, he had difficulty talking. he had difficulty moving his head and difficulty moving his extremities. the neurology and rheumatology services were consulted for this weakness and after thorough investigation including emg nerve conduction studies and a muscle biopsy, the belief was that this was secondary to a steroid myelopathy or a critical illness myopathy believed to improve with time and weaning of his steroids. his strength gradually improved since transfer to the floor and currently he has 3+ strength in his fingers and hands, 3+ strength in his toes and feet and 1+ to 2+ strength in the rest of his extremities. he has 3+ strength in his neck muscles. his extraocular movements are intact. his ldh and ck had been followed for evidence of muscle injury and they had been increasing and now are decreasing. his ldh is currently 363 and his ck is 291 on the date of discharge. 5. heme: his hematocrit has remained relatively stable during this admission. he has no current active bleeding. 6. infectious disease: he is currently not on any antibiotics and has not shown any recent evidence of infection. 7. fluids, electrolytes and nutrition: the patient was having issues with hypernatremia and received d5 water various times during his admission and free water boluses through his tube. because of this and his sodium had improved to 148 on the day of admission, his feeding was done through his nasogastric tube initially and he had a g-tube placed through interventional radiology and the nasogastric tube was removed. his g-tube has been functioning well with low residuals and he has been getting ultracal tube feeds. discharge plan: the plan is to discharge on the following medications. discharge medications: 1. cyclophosphamide 120 mg per g-tube qd 2. heparin 5000 units subcutaneous 3. furosemide 40 mg intravenous qd 4. prednisone 80 mg per g-tube q od x2 weeks, then 70 mg po q od x2 weeks, then 60 mg po q od indefinitely. 5. bactrim double strength 1 tablet per g-tube 3x per week 6. amlodipine 10 mg per g-tube qd 7. metoprolol 75 mg per g-tube 8. isordil 40 mg per g-tube tid 9. lacrilube ointment 1 both eyes prn 10. colace 100 mg per g-tube 11. lansoprazole solution 30 mg per g-tube 12. calcium acetate 1 per g-tube tid with meals 13. aspirin 81 mg po qd 14. albuterol metered dose inhaler 1 to 2 puffs q6h prn 15. atrovent metered dose inhaler 2 puffs q6h prn discharge instructions: he will continue on ultracal tube feeds full strength at a rate of 70 cc per hour. residuals should be checked every four hours and tube feeds should be held for residuals greater than 100 cc. he should receive flushes of 120 cc of water q4h. he should have his cbc checked every week and if his white blood count decreases below 3.5 or his other blood counts remain dangerously low, the cytoxan dose should be decreased. his urine output goal is greater than 2 liters per day because of his cytoxan. he should have active physical therapy. it was notable that he had no functional impairments prior to admission except for increased endurance and early fatigue. final diagnoses: 1. interstitial lung disease 2. acute tubular necrosis 3. renal insufficiency 4. prostate cancer 5. critical illness myopathy 6. positive p-anca , m.d. dictated by: medquist36 d: 11:22 t: 11:34 job#: cc: , m.d. dictated by: medquist36 d: 11:22 t: 11:34 job#: procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization other gastroenterostomy without gastrectomy open biopsy of lung open biopsy of soft tissue diagnoses: acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified acute respiratory failure iatrogenic pneumothorax postinflammatory pulmonary fibrosis toxic myopathy hyperosmolality and/or hypernatremia drug-induced delirium 

Answer: The patient is high likely exposed to