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: naprosyn / oak attending: chief complaint: sob and hypoxia major surgical or invasive procedure: vats history of present illness: please see micu admission note for full details of initial presentation. briefly, pt is a 63 y/o f hx nhl s/p chop who has since developed progressively worsening sob and doe (baseline is 2lnc at home). she presented to osh, received steroids and was transferred to for rule out pe. cta was negative; however, because pt initially was unable to wean from nrb, she was admitted to micu. in micu, she was started empirically of levaquin for dry cough, diuresed to lasix (20mg iv x2) with total los negative 1.9l and oxygenation improved to 94-95% 4lnc. . upon arrival to medical floor, she reports feeling better. further hx obtained. she tells me that her sob and doe really started after chop and also after a trip to fla in where she stayed in and contracted "black mold." this was diagnosed with bronch and bx at hospital (and per dr. notes this may have been aspergillus). she reports being treated with 60 mg prednisone for at least 2 months. notably, whenever she tried to come off prednisone, her sob got worse requiring hospitalization. this happened twice. . currently, she feels somewhat better. ros + cough green-yellow sputum increased in thickness x few weeks. + headache, no cp, palpitations, fever, chills, + nightsweats, + weight gain post chemo. she denies le swelling. past medical history: # nhl dx in s/p rchop. thought to be in remission. no xrt # hypertension # cerebral aneursym s/p clips # osa: did not use cpap for a long time # hypothyroid social history: sh: pt lives with partner. retired mail carrier. has 3 cats. no known asbestos exposure smoking: quit in etoh: none family history: father: asthma mother with severe ra sisters with copd physical exam: admission pe: 97.2 153/68 89 93%4lnc o2 sats gen: pleasant, obese, speaking comfortably heent: clear op, mmm neck: supple, no lad, no jvd cv: rr, nl rate. nl s1, s2. no murmurs, rubs or lungs: dry, velcro-like crackles bilateral lung-fields abd: soft, nt, nd. nl bs. no hsm ext: no edema. 2+ dp pulses bl skin: no lesions neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. + reflexes, equal bl. psych: listens and responds to questions appropriately, pleasant . pe: 97.2 120/68 95 18 96% 2.5lnc o2 sats pe: 97.2 153/68 89 93%4lnc o2 sats gen: pleasant, obese, speaking comfortably heent: clear op, mmm neck: supple, no lad, no jvd cv: rr, nl rate. nl s1, s2. no murmurs, rubs or lungs: occaisonal wheezes, no labored breathing abd: soft, nt, nd. nl bs. no hsm ext: no edema. 2+ dp pulses bl skin: no lesions neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. + reflexes, equal bl. psych: listens and responds to questions appropriately, pleasant . pertinent results: cta chest/abd/pelvis: impression: 1. no evidence of pulmonary embolism. 2. no evidence of pneumonia. 3. no evidence of acute intra-abdominal pathology. 4. portocaval lymphadenopathy 5. diffuse airtrapping throughout the lungs with emphysematous change. . cxr: portable upright chest radiograph: the heart size is normal. the mediastinal and hilar contours are unremarkable. the left costophrenic angle is excluded due to limited positioning. visualized lungs are clear. there is no large effusion. a right internal jugular catheter terminates in the lower svc. impression: no evidence of pneumonia or chf. . echo: the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality. normal cavity sizes with low normal left ventricular systolic function. mild mitral regurgitation. mild pulmonary artery systolic function. . high resolution chest ct: again seen are diffuse scattered areas of ground-glass opacity throughout the lungs bilaterally, in a somewhat mosaic pattern. allowing for differences in technique, this appearance is little changed compared to . findings are increased compared to . areas of both increased density and increased lucency are seen suggesting mixed infiltrative and obstructive process. there are no focal consolidations. airways are patent to the subsegmental level. air trapping is seen on expiratory phase images. there is no pleural or pericardial effusion. scattered mediastinal lymph nodes are seen; however, none appear to meet ct criteria for pathologic enlargement. there are no pathologically enlarged hilar or axillary lymph nodes. limited views of the upper abdomen are grossly unremarkable. no suspicious lytic or blastic osseous lesions are identified. right-sided port again identified. impression: diffuse multifocal ground-glass opacities in a predominating mosaic pattern, worse when compared to , little changed from . airtrapping seen on expiratory phase images. findings are most concerning for hypersensitivity reaction. other diagnostic considerations include possibly drug reaction or bronchiolitis obliterans. . pulmonary report spirometry, lung volumes, dlco study date of 10:23 am spirometry 10:23 am pre drug post drug actual pred %pred actual %pred %chg fvc 2.16 3.23 67 2.35 73 +9 fev1 1.24 2.36 52 1.38 59 +12 mmf 0.47 2.62 18 0.60 23 +27 fev1/fvc57 73 78 59 81 +3 lung volumes 10:23 am pre drug post drug actual pred %pred tlc 5.34 5.26 102 frc 3.03 3.01 101 rv 2.77 2.03 136 vc 2.57 3.23 80 ic 2.31 2.25 103 erv 0.26 0.98 27 rv/tlc 52 39 134 he mix time 4.25 dlco 10:23 am actual pred %pred dsb 14.23 19.09 75 va(sb) 4.26 5.26 81 hb 3.70 dsb(hb)14.10 19.09 74 dl/va 3.31 3.63 91 . cbc 01:15am blood wbc-7.3 rbc-4.30 hgb-13.1 hct-36.9 mcv-86 mch-30.4 mchc-35.3* rdw-16.3* plt ct-322 05:05am blood wbc-6.2 rbc-4.19* hgb-12.8 hct-35.9* mcv-86 mch-30.4 mchc-35.6* rdw-16.2* plt ct-359 05:05am blood wbc-5.1 rbc-4.47 hgb-13.8 hct-38.4 mcv-86 mch-30.9 mchc-36.0* rdw-15.9* plt ct-360 06:30am blood wbc-6.8 rbc-4.78 hgb-14.2 hct-40.6 mcv-85 mch-29.6 mchc-34.8 rdw-15.9* plt ct-444* 05:35am blood wbc-5.3 rbc-4.46 hgb-13.6 hct-38.1 mcv-86 mch-30.6 mchc-35.7* rdw-15.6* plt ct-344 05:20am blood wbc-5.9 rbc-4.35 hgb-13.0 hct-37.1 mcv-85 mch-29.9 mchc-35.1* rdw-15.5 plt ct-370 01:15am blood neuts-80.2* lymphs-17.0* monos-1.4* eos-0.9 baso-0.5 05:10am blood neuts-58.3 lymphs-24.2 monos-9.0 eos-7.3* baso-1.3 . chem7 01:15am blood glucose-125* urean-16 creat-1.2* na-135 k-5.7* cl-98 hco3-27 angap-16 04:40am blood glucose-93 urean-30* creat-1.5* na-142 k-4.3 cl-101 hco3-31 angap-14 05:05am blood glucose-98 urean-24* creat-1.3* na-142 k-4.7 cl-104 hco3-31 angap-12 05:10am blood glucose-95 urean-27* creat-1.2* na-141 k-4.5 cl-104 hco3-26 angap-16 06:30am blood glucose-96 urean-30* creat-1.2* na-143 k-4.6 cl-107 hco3-21* angap-20 05:35am blood glucose-93 urean-28* creat-1.2* na-141 k-4.7 cl-106 hco3-24 angap-16 05:20am blood glucose-104 urean-24* creat-1.1 na-141 k-4.2 cl-101 hco3-26 angap-18 . misc 01:15am blood alt-22 ast-61* ck(cpk)-85 alkphos-53 totbili-0.5 01:15am blood ck-mb-notdone ctropnt-<0.01 probnp-996* 05:19pm blood anca-negative b 05:19pm blood -positive titer-1:40 05:10am blood ige- <2.0 04:40am blood aspergillus galactomannan antigen- negative 04:40am blood b-glucan-negative 10:39am blood type-art po2-64* pco2-52* ph-7.35 caltco2-30 base xs-1 intubat-intubated . pathology lung, right middle lobe, wedge resection (a-d): a) numerous non-necrotizing granulomas, see note. b) subpleural fibrosis with honeycomb change. c) focal organizing pneumonitis ii. lung, right lower wedge resection (e-h): a) numerous non-necrotizing granulomas, see note. b) subpleural fibrosis with honeycomb change. c) focal organizing pneumonitis. note: special stains for afb, gms and psa are negative with satisfactory controls. the differential diagnosis includes an infection process, sarcoidosis and less likely hypersensitivity pneumonitis. dr. has reviewed the case (h & e slides) and concurs. brief hospital course: # dyspnea: the patient was admitted for dyspnea and hypoxia. she was initially requiring an nrb and was admitted to the icu overnight. she was thought to be volume overloaded and diuresed. her hypoxia improved. she was found to be 84% on ra per her hematologist prior to admission. on transfer to the floor, she was 89% ra, 95% 2l. during her hospital stay, her shortness of breath improved subjectively although she still had significant dyspnea on exertion. she received albuterol and ipratropium nebs q6hours; no steroids or advair. she was switched from tiotropium and advair to combivent 4 times daily as her symptoms and oxygenation appeared to improve with frequent nebs. beta-blocker was stopped to avoid bronchospasm. hctz was started instead for high bp. the pulmonary team followed her during her stay. echo showed no evidence of systolic or diastolic heart failure. pft's showed obstrutive pattern with increased lung volumes and reduced diffusion capacity. her work up included: anca- negative; 1:40 (negative); galactomanin and b-glucan negative; ige <2.0; absolute peripheral eosinophilia of 300; hypersensitvity panel negative. high resolution chest ct showed diffuse multifocal ground-glass opacities in a predominating mosaic pattern, worse when compared to . the patient was taken to vats. vats showed numerous non-necrotizing granulomas c/w sarcoidosis. vit d levels and ace-i were wnl. she was stared on prednisone 40mg daily. she was started on bisphosphate and calcium w/ vit d. she was also started on bactrim for pcp . . # purulent discharge from port-a-cath: on , the lumen of the patient's port-a-cath was found to be draining discharge. the iv nurse drew back from the lumen of the port and suctioned out yellow fluid. a wound culture was sent, found to have 3+ pmn's but no organisms grew. blood cultures were sent were negative. the patient showed no sign of systemic infection w/o fevers, leukocytosis or chills. as the patient had not used the port-a-cath for treatment in 6+ months, the port-a-cath was removed at the same time as the vats. . # hypertension: beta-blocker was stopped to reduce any contribution to obstructive lung disease. hctz was started instead. ace-i was considered but the patient appeared to be in acute renal failure. she had no secondary indication for an ace-i. . # arf: baseline creatinine from osh records appears to be 0.9-1.0. on admission, she had a creatinine 1.2 which rose to 1.5 then came down to 1.1. the acute renal failure may have been due either to iv contrast or diuresis on admission. no further diuresis was performed and her ins/out kept even. medications on admission: meds on transfer: levofloxacin 750 mg iv qdaily albuterol-ipratropium puff ih q6h:prn fexofenadine 60 mg po bid fluticasone-salmeterol (250/50) 1 inh ih tiotropium bromide 1 cap ih daily levothyroxine sodium 100 mcg po daily metoprolol tartrate 25 mg po bid tricor *nf* 145 mg oral daily acetaminophen 325-650 mg po q6h:prn celebrex *nf* 200 mg oral daily duloxetine 60 mg po daily pantoprazole 40 mg po q24h colace/senna . . home meds: fexofenadine celebrex 200mg po daily nexium 40mg po dialy fluticasone/salmeterol 500/50 tiotropium cymbalta 60mg po daily combivent tricor 145 metoprolol 25mg po bid synthroid 100mcg po daily . discharge medications: 1. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 2. celecoxib 200 mg capsule sig: one (1) capsule po daily (). 3. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 4. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 5. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily (). 6. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 8. combivent 18-103 mcg/actuation aerosol sig: two (2) puffs inhalation four times a day. 9. hydrochlorothiazide 12.5 mg capsule sig: two (2) capsule po daily (daily). disp:*60 capsule(s)* refills:*6* 10. lorazepam 0.5 mg tablet sig: 1-2 tablets po q8h (every 8 hours) as needed for anxiety. 11. bacitracin zinc 500 unit/g ointment sig: as directed appl topical (2 times a day) for 4 days: apply a small amount to vats incisions. 12. prednisone 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*3* 13. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. dextromethorphan-guaifenesin 10-100 mg/5 ml liquid sig: five (5) ml po q6 () as needed for cough for 10 days. disp:*qs ml(s)* refills:*0* 15. morphine 15 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain for 2 weeks. disp:*30 tablet(s)* refills:*0* 16. calcium 500+d 500 (1,250)-400 mg-unit tablet, chewable sig: one (1) tablet, chewable po twice a day. disp:*60 tablet, chewable(s)* refills:*2* 17. fosamax 5 mg tablet sig: one (1) tablet po once a day: take with a full glass of water in the morning. do not lie down within an hour of taking this medication. disp:*30 tablet(s)* refills:*3* discharge disposition: home with service facility: vna of southeastern mass. discharge diagnosis: sarcoid discharge condition: stable, continues to require 2-3l nc to maintain sao2 >92% discharge instructions: you were admitted with shortness of breath and hypoxia. you received a vats and were diagnosed with sarcoid. you have been restarted on prednisone. in addition, you should take bactrim to prevent pcp. is also important that you take calcium and vit d to prevent decreased bone density on prednisone. . the following medication changes have been made: 1. start taking prednisone 2. start taking bactrim 3. start taking calcium with vit d for bone strength. 5. start taking fosamax to prevent osteoporosis while being on prednisone. 6. start taking dextromethorphan with guiafenisin (cough supressant) as needed for cough. 7. stop taking metoprolol 8. start taking hydrocholorothiazide for blood pressure instead of metoprolol. 9. you can stop taking tiotoprium. take combivent 4 times a day instead. 10. you do not need to take advair. 11. take tylenol for mild pain. take morphine ir for severe pain. 12. you can put a small amount of bacitracin on your vats inscisions for a few days while they are healing. . if you have worsening shortness of breath, worsening chest pain, fevers or chills, you should return to the emergency room. followup instructions: should make an appointment with your primary care provider in the next 1-2 weeks. she will need to monitor you for the side effects of prednisone: decreased bone density, diabetes. you should have a dexa-scan to look at your bone density. you should also have your vitamin d and calcium levels monitored as you have been started on a bisphosphonate to prevent osteoporosis. . follow-up with dr. on at 1:30pm on the clinical center for suture removal. . please call dr. for a follow up appointment in the next 1-2 weeks. . md, procedure: incision with removal of foreign body or device from skin and subcutaneous tissue thoracoscopic excision of lesion or tissue of lung diagnoses: unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism sarcoidosis other malignant lymphomas, unspecified site, extranodal and solid organ sites lung involvement in other diseases classified elsewhere 

Answer: The patient is high likely exposed to