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: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath pna, asthma exacerbation major surgical or invasive procedure: bronchoscopy history of present illness: 52 y/o f with hx of asthma, sinusitis and hx of cva presented with three day history of shortness of breath on . the shortness of breath was progressive and felt like she just couldn't catch her breath. she did endorse some wheeziness. patient denied fevers, chills, night sweats. she did not have a cough. she had been struggling with a year of sinus pain and pressure and trouble breathing through her nose. . in the ed, vitals were 99.6, 101 axillary, 130, 135/68, 95% on neb. cxr showed bilateral upper lobe infiltrates concerning for pneumonia vs. bronchitis. patient was thought to be at least somewhat immune compromised due to hx of steroid use per ent treatment of sinusitis. patient was admitted directly to micu green. . during her hospitalization, she was initially treated for cap with clinda and levo. also initally recieved methylprednisone for diffuse wheezing. her abx were then broadened to levo and ceftriaxone. while in the icu, patient had bronchoscopy which showed a 40% eosinophilia (she also had serum eosinophilia). she had no risk factors for tuberculosis and afb x1 was negative. pcp smear was negative and ldh was normal. due to eosinophilia, it was thought that patient may have churg-. anca was sent, but negative (although approx 50% of cases ar anca neg). all culture data came back negative so all antibiotics were stopped on . of note, patient had been on iv solumedrol since admission, with plan to start taper of steroids to po once transferred to the floor. . on admission to the floor, the patient is feeling better than she has. still feels very congested in her sinuses and does not think the o2 is helping through the nc because she can't breath through her nose. has dry mouth and is thirsty. breathing has improving, is still mildly dyspneic, but better. she is having a hard time sleeping and seeing some bright colors and shapes when she closes her eyes. these symptoms started when she was started on steroids. denies abdominal pain, nausea, vomitting, but is contipated and hasn't had a bm since being in the hospital. past medical history: 1. cva to ruptured aneurysm - remote, with r-sided residual weakness 2. asthma hx - no pfts 3. r-distal radius fracture 4. pansinusitis - followed by ent - pseudomonas on nasal swab 5. allergic rhinitis 6. anxiety disorder 7. migraine headaches 8. iron deficiency anemia social history: independent adls, does have some help from family members. denies tobacco or ethanol use currently. family history: non-contributory currently physical exam: pe on admission afebrile, sbp 110/60, hr 110, nrb satting 98% gen: well-appearing, well-nourished, no acute distress heent: eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, mmm, op clear neck: no jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: rrr, no m/g/r, normal s1 s2, radial pulses +2 pulm: lungs ctab, no w/r/r abd: soft, nt, nd, +bs, no hsm, no masses ext: no c/c/e, no palpable cords neuro: alert, oriented to person, place, and time. cn ii ?????? xii grossly intact. moves all 4 extremities. strength 5/5 in upper and lower extremities. patellar dtr +1. plantar reflex downgoing. no gait disturbance. no cerebellar dysfunction. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: 08:00pm blood wbc-9.8# rbc-5.28 hgb-15.5 hct-44.4 mcv-84 mch-29.3 mchc-34.8 rdw-13.5 plt ct-256 05:08am blood wbc-17.1*# rbc-4.40 hgb-12.6 hct-37.5 mcv-85 mch-28.7 mchc-33.7 rdw-13.9 plt ct-261 07:10am blood wbc-8.9 rbc-4.33 hgb-12.3 hct-37.0 mcv-85 mch-28.3 mchc-33.2 rdw-13.9 plt ct-261 08:00pm blood neuts-92.0* lymphs-3.8* monos-1.4* eos-2.5 baso-0.3 05:08am blood neuts-94.0* lymphs-3.7* monos-1.5* eos-0.4 baso-0.5 08:00pm blood glucose-148* urean-13 creat-0.8 na-132* k-4.4 cl-95* hco3-26 angap-15 05:08am blood glucose-120* urean-19 creat-0.6 na-141 k-3.7 cl-109* hco3-23 angap-13 07:10am blood glucose-86 urean-13 creat-0.6 na-141 k-4.0 cl-106 hco3-28 angap-11 05:41am blood alt-15 ast-21 ld(ldh)-234 ck(cpk)-292* alkphos-104 totbili-0.2 05:41am blood probnp-481* 07:10am blood calcium-8.8 phos-1.7*# mg-2.1 09:00pm blood type-art temp-39.7 po2-173* pco2-37 ph-7.41 caltco2-24 base xs-0 intubat-not intuba comment-green top 08:07pm blood lactate-1.5 11:19am blood ige-test 08:17am blood aspergillus galactomannan antigen- test 08:17am blood b-glucan-test . imaging: cxr on admission: there is stable mild biapical pleural thickening. there is mild peribronchial thickening, unchanged since the prior examination. there is no focal pulmonary consolidation. the cardiomediastinal silhouette is unremarkable. conclusion: 1. mild peribronchial thickening may indicate reactive airway disease/bronchitis. 2. stable minimal biapical pleural scarring. . cta chest: impression: 1. limited study due to respiratory motion. no central or large segmental pulmonary embolism. no dissection. 2. right upper lobe and left upper lobe pneumonia. . echo: the left atrium is normal in size. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 70%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). there is no ventricular septal defect. 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 mildly thickened. the mitral valve leaflets are myxomatous. the mitral valve leaflets are elongated. there is mild mitral valve prolapse. trivial mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . cxr on discharge: a region of consolidation in the suprahilar right upper lobe is shrinking, perihilar consolidation on the left is not. followup advised for presumed pneumonia, alternatively pulmonary hemorrhage. lower lungs clear. heart size normal. no pleural effusion or evidence of central adenopathy. brief hospital course: 52 y/o f with hx of asthma and chronic pansinusitis who presents with three day history of shortness of breath. treated for pneumonia, but all cultures negative. bronchoscopy showed eosinophilia predominance. most likley diagnosis is anca (-) churg-. . # churg - based on esoinophils seen in bronchoscopy and negative cultures, is the most likely diagnosis. did have history of severe sinusitis and questionable asthma. biopsy from bronchoscopy was still pending at the time of discharge. with upper lobe opacities and recent steroids could be an rare infectious process like fungal or aspergillosis or silicosis, but based on all the negative smears and cultures, makes it less likely. abx were stopped after three days, was monitored for fevers, and remained afebrile and stable. was initially treated with iv steroids which were transitioned to orals while on the floor. she was sent out on a long 6+ week taper, which will be followed by her pulmonologist. she was started on bactrim for pcp . she will also need careful monitoring of her blood sugars while on steroids. her pcp was called and we discussed outpatient plan before she was discharged. evenutally will need pfts and pulmonary follow up as an outpatient. . # shortness of breath - see above, likely secondary to churg-. was satting fine on room air at the time of discharge. continued albuterol and advair as an outpatient. pt worked with the patient and was able to see that her ambulatory sats were within normal limits and she was moving around at her baseline. . # sinusitis - on recent ct, patient with total opacification of sinuses. is s/p steroids and cipro course for these with plan for outpatient ent surgery this week. has had long standing sinusitis and hx of psuedomonas. sinusitis is at baseline and does not appear to be infected at this time. she will f/u with her ent doctor as an outpatient to discuss the need for surgery for the impacted sinuses. . # asthma - again, likley related to churg-, often precedes the diagnosis by 5-10 years (from uptodate). will continue with advair and albuterol nebs as needed. . # elevated blood sugars - likely was from the steroids, was on insulin sliding scale while an inpatient, but decided not to treat as an outpatient. she will follow up closely and have vna to help check her sugars the first few days after she is discharged home. hope with the taper that they will begin to normalize. . # insomnia - likely a side effect of the steroids, trazadone was used for treatment. . # discharge - was sent home in good condition, feeling well with close followup. medications on admission: albuterol sulfate - 2.5 mg/3 ml (0.083 %) prn amitriptyline - 50 mg qhs azelastine - 137 mcg intranasal ciprofloxacin - 500 for 20 days (?start ) fluticasone-salmeterol 250/50 hydrocortisone - cream prn for rash imitrex - 50 prn montelukast - 10qhs oxycodone - 5 prn prednisone - taper on by ent discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours): please take while you are on prednisone. . disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). disp:*15 tablet(s)* refills:*2* 3. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 4. calcium citrate-vitamin d3 315-200 mg-unit tablet sig: two (2) tablet po twice a day: you need to take two twice a day so that you get 1200 mg of calcium per day and 800 iu of vitamin d per day. 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) ml inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*0* 7. singulair 10 mg tablet sig: one (1) tablet po at bedtime. 8. astelin 137 mcg aerosol, spray sig: one (1) spray nasal twice a day. 9. amitriptyline 50 mg tablet sig: one (1) tablet po at bedtime: please discuss with dr. whether you should restart this medication. 10. imitrex 50 mg tablet sig: one (1) tablet po once and than repeat in one hour as directed as needed for migraines. 11. prednisone 20 mg tablet sig: three (3) tablet po once a day: you will be taking 60 mg for about 6-12 weeks. . disp:*90 tablet(s)* refills:*2* 12. trazodone 50 mg tablet sig: 0.5-1 tablet po at bedtime as needed for insomnia: only take if you need it while you are on the prednisone. disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: 1. churg- disease - biopsy pending 2. sinusitis 3. asthma discharge condition: stable discharge instructions: you were admitted for 3 days of very severe shortness of breath. you were admitted to the intensive care unit and monitored very closely. initially it was thought you might have a pneumonia, so you started on antibiotics. the pulmonologists did a bronchoscopy and found that you had a large amount of cells called eosinophils. this is sometimes associated with a disease called churg- disease. churg- disease is sometimes associated with asthma and sinusitis. it is an autoimmune disease. the best treatment for this type of disease is steroids, so you will need to go home on a pill called prednisone. this pill has some side effects for which you will need to take even more medicines. please start taking calcium and vitamin d. also take bactrim to prevent any other lung infections. please follow up with dr. and the other doctors listed below. you can continue to use your own albuterol nebulizer or inhaler but we also gave you a script for levoalbuterol (xopenex) which helps decrease the increased heart rate. if you don't feel palpitations or that your heart rate is fast with your own albuterol then you don't need to fill the xopenex script. please return to the hospital for any worsening shortness of breath, increased cough, fevers, chills, chest pain, fainting, headaches, or any other concerns. followup instructions: please follow up with dr. in the next 1-2 weeks. please call to make this appointment. please make sure you take the calcium and vitamin d as prescribed and talk to dr. about scheduling a bone density exam and whether or not you should take a bisphosphonate to strengthen your bones. please follow up with dr. for further evaluation of your broken wrist. you xray is at 9am, your appointment with the doctor is at 920. please call if any questions. please follow up with the pulmonologist dr. , , on at 8:30 am. you will have pulmonary function tests first. tel (. please make an appointment with dr. , allergist at (. please call your ent doctor your possible surgery to have your sinuses drained. procedure: closed [endoscopic] biopsy of bronchus closed endoscopic biopsy of lung diagnoses: adrenal cortical steroids causing adverse effects in therapeutic use anxiety state, unspecified iron deficiency anemia, unspecified tachycardia, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus other abnormal glucose other chronic sinusitis drug induced sleep disorders extrinsic asthma, unspecified wegener's granulomatosis 

Answer: The patient is high likely exposed to