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: no known allergies / adverse drug reactions attending: chief complaint: wegeners granulomatosis major surgical or invasive procedure: ct guided biopsy chest tube placement and removal kidney biopsy history of present illness: 34 y/o m with pmhx of dm i who was recently admitted for work-up of anemia of unclear etiology. he was found to have a hematocrit of 18.9 at his pcp's office. during his admission he was noted to have eosinophilia, coagulopathy, infiltrates and an anterior mediastinal mass. he was seen by hematology/oncology, and pulmonary and thoracic surgery. he received two units of prbcs and hct at discharge was 24.6. haptoglobin was high. bone marrow biopsy showed bone marrow suppression and iron deficiency. he was discharged with iron supplementation. his mediastinal mass felt to most likely be a thymoma, and would tie together all of his other findings including anemia, atypical pneumonia and recurrent sinus infections with eosinophilia and coagulopathy. notably, germ cell marker hcg neg, afp normal. he had a bronchoscopy with bal which was negative for pathogens (some still pending) or eosinophilic predominance. he had an mri of the chest which showed round heterogeneous lesion in the anterior mediastinum measuring 5.4 x 3.9 x 4.7 cm without appreciable loss of signal intensity on out-of-phase imaging with mild enhancement. findings are not consistent with thymic hyperplasia. diagnostic considerations include thymoma versus lymphoma. thoracic surgery decided no biopsy should be performed as risk of seeding the surrounding tissue if this is malignant. he was to follow up with them next week for further management. incidentally during his work up, p-anca was preliminarily positive and thought to be paraneoplastic, but they were awaiting confirmatory results from . on the attg was notified from the lab that the patient was strongly positive for pr3-anca - which has prompted the current admission. patient had labs drawn yesterday and notably his hct was 20.1, wbc: 12.0 on the floor, patient denies complaints. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: dm social history: occasional etoh. no tobacco or illicit drug use. not currently sexually active. has always used condoms in previous sexual relationships. no recent travel family history: no family history of blood disorders. lung cancer in his father physical exam: vitals: 96 109/60 70 19 94% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, mild pallor neck: supple, jvp not elevated, no lad lungs: mild crackles at bl bases, otherwise clear cv: tachycardic regular rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 08:00pm blood wbc-11.6* rbc-2.44* hgb-6.6* hct-19.8* mcv-81* mch-27.1 mchc-33.4 rdw-14.2 plt ct-440 08:00pm blood neuts-76.3* bands-0 lymphs-9.3* monos-3.8 eos-10.3* baso-0.3 08:00pm blood hypochr-3+ anisocy-occasional poiklo-1+ macrocy-normal microcy-normal polychr-1+ ovalocy-1+ 08:00pm blood ret man-4.8* 05:45am blood glucose-176* urean-21* creat-1.2 na-137 k-4.9 cl-102 hco3-28 angap-12 08:00pm blood ld(ldh)-138 totbili-0.4 05:45am blood calcium-8.7 phos-4.5 mg-2.2 08:00pm blood hapto-365* 05:45am blood hbsag-negative hbsab-negative hbcab-negative 05:45am blood hcv ab-negative ua blood nitrite protein glucose ketone bilirub urobiln ph leuks lg neg tr neg neg neg neg 5.0 neg microscopic urine rbc wbc bacteri yeast epi 10:53 18* 4 few none 0 urine chemistry hours creat totprot prot/cr 10:53 random 63 38 0.6* discharge labs: 05:56am blood wbc-14.4* rbc-2.94* hgb-7.7* hct-23.9* mcv-81* mch-26.3* mchc-32.4 rdw-13.7 plt ct-409 05:56am blood glucose-149* urean-29* creat-1.1 na-137 k-4.8 cl-100 hco3-30 angap-12 pathology: renal biopsy: diagnosis: necrotizing extracapillary glomerulonephritis consistent with the anca-associated vasculitic syndrome (see note). note: sections reveal fragments of renal parenchyma containing approximately 33 glomeruli, one or two of which, depending on the level, are globally sclerotic. glomerular necrotizing lesions are noted associated with mild extracapillary proliferation (very small crescent formation). mild interstitial fibrosis and tubular atrophy are noted accompanied by chronic inflammation. of interest is the medullary thick ascending limbs which show apoptotic/degenerative changes. endocapillary proliferation is minimal. the small arteries/arterioles show mild fibrotic changes. larger arteries show intimal fibroplasia.. immunofluorescence studies reveal 4 to 8 glomeruli to be present depending on the level. there is no staining with igg or igm. mesangial iga (minimal), kappa light chain (trace), lambda light chain (minimal), and c1q (minimal) are seen. trace c3 is noted in tubular basement membranes and vessels. in the fibrin preparations, there is considerable (+) segmental staining. albumin stains are non-contributory. electron microscopy studies will be sent as an addendum. pas and silver methenamine stains were done to evaluate basement membranes. masson trichrome preparations were done to study fibrotic changes. findings are those of a glomerulonephritis of the type associated with the anca vasculitic syndromes. the thick ascending limb changes have been reported as a result of drug toxicity (am j kidney dis 31:). mediastinal mass cytology: impression: technically successful aspiration of a predominantly cystic anterior mediastinal mass. fna, anterior mediastinal mass: non-diagnostic specimen consists of scattered macrophages. note: please also refer to flow cytometry report imaging: cxr: comparison chest radiographs dating between to . findings: tiny left apical pneumothorax has decreased in size since the priorradiograph. cardiomediastinal contours are unchanged. bilateral patchy infrahilar opacities have slightly improved. subtle ground-glass opacities are present and shown to better detail on recent ct scan. brief hospital course: mr. is a 34 year-old male with type i dm and recent complicated history and hospitalizations for a mediastinal mass now thought to be a thymic cyst, vasculitis with dah on bal thought to be wegeners granulomatosis (also with renal involvement confirmed on biopsy) whose course has been complicated by pneumothorax s/p chest tube placement and removal s/p high dose methylprednisolone and first dose of rituxan. active issues: # wegeners granulomatosis: the patient has both pulmonary and renal manifestations of wegeners. he was found to have a high titer positive for c-anca after extensive workup of iron deficiency anemia on prior hospitalization. he was treated with iv solumedrol 1gm x 3days then transitioned to prednisone 40 mg po bid. as he did have a mediastinal mass, the concern was that this may be lymphoma and steroids would partially treat, obscuring a diagnosis. a ct guided biopsy of the mass was performed on which revealed it was cystic in nature, not consistent with lymphoma. he will require prolonged steroid treatment so omeprazole, vit d, calcium and bactrim were added for ppx. hepatitis serologies were negative and a ppd was negative on . after renal biopsy confirmed acute changes consistent with wegner's in the kidney, the rheumatology and renal consult teams conferred and decided to treat him with rituxan (instead of cytoxan) due to rituxan's more favorable side effect profile. he was given his first rituxan infusion on without complication and will receive 3 more infusions over the next month. # hyperglycemia/type i diabetes: the patient had worsening control of blood sugars with high dose steroids. despite uptitration of his insulin he remained hyperglycemic and was transferred to the icu for one day for insulin gtt titration. his blood sugars decreased on increased lantus dosing (now at 35 qam and 30 qpm) and an increased humalog sliding scale. had been consulted and educated the patient how to down titrate his lantus dose when his steroid dose changes. he will follow up with his endocrinologist. # anterior mediastinal mass: visualized on previous imaging. appears to be thymic cyst based on fluid aspirated. cytology was nondiagnostic showing only macrophages. per discussion with heme/onc, we cannot definitively rule out lymphoma, but that they felt it is very unlikely to be lymphoma. he was treated with high-dose steroids without change in clinical status which makes it even more unlikely this is lymphoma. their recommendation is to repeat an mri of his chest in 3 months. he does not currently need heme/onc follow up as this is unlikely to be malignancy. # anemia: thought to be secondary to blood loss from likely dah from wegeners. his hct dropped as low as 21, but then rose on its own and was 23 by discharge. he received one unit of prbcs during this hospitalization and was maintained on iron and vit c supplementation. he should have a hct check during follow up to ensure his anemia continues to improve. # hemopneumothorax: complication of mediastinal biopsy. the patient was found to be more hypoxic on , tachycardic and with chest pain on the left. exam was significant for hyperresonance. cxr revealed large hemopneumothorax with mild tension. thoracic surgery was consulted and chest tube placed. the pneumothorax resolved within 24 hours and the chest tube was removed. follow up cxr on showed continued resolution. # leukocytosis: thought to be secondary to steroids. no clinical evidence of infection. transition of care: - patient needs repeat chest mri in 3 months (early ) for follow up of the mediastinal mass. - patient will need continued titration of insulin dosing as his steroid dose changes. - hct check to monitor anemia. - follow up has been arranged with his pcp, , nephrologist, pulmonologist, and endocrinologist. medications on admission: 1. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. insulin glargine 100 unit/ml solution sig: twenty (20) units subcutaneous twice a day. 3. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 4. insulin sliding scale please use attached flowsheet for regimen discharge medications: 1. ferrous gluconate 325 mg (37.5 mg iron) tablet sig: one (1) tablet po tid (3 times a day). 2. ascorbic acid 500 mg tablet sig: one (1) tablet po three times a day. 3. prednisone 20 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*1* 4. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 6. lantus 100 unit/ml solution sig: 35 units in the morning and 30 units at bedtime lantus subcutaneous . 7. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. 8. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 9. humalog 100 unit/ml solution sig: sliding scale humalog subcutaneous four times a day: see attached sliding scale. discharge disposition: home discharge diagnosis: primary diagnoses: wegeners granulomatosis thymic cyst hemopneumothorax secondary diagnoses: diabetes type i anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to for treatment of wegeners granulomatosis. you were started on high dose steroids and ultimately placed on 40 mg of prednisone twice daily. the rheumatologists decided to treat you adjunctively with rituxan as this has fewer sided effects then the mainline treatment for your condition. you will need 3 more doses of rituxan which the rheumatologists will arrange. you had a biopsy of the mass in your chest which was found to be a cyst. you suffered a complication of this procedure which was a pneumothorax (collapse of part of the lung). a chest tube was placed and then removed. cytology from the biopsy was nondiagnostic. hematology/oncology had evaluated you during your stay and felt that it was very unlikely that the mass in your chest was a lymphoma or other cancer, but this has not been definately ruled out. you will need a repeat chest imaging in 3 months to check for any change in the mass/cyst. we will communicate with your primary doctor so he is aware of the need for this repeat imaging. it is important that you avoid non-steroidal anti-inflammatory medications in the future (alleve, ibuprofen, ect). you can use tylenol as need for pain control. otherwise discuss other pain medications with your primary doctor before using. medication changes: increase lantus to 35 units every morning and 30 units every evening use new humalog sliding scale glucose mealtime insulin dose bedtime insulin dose 71-79 mg/dl 0 units 0 units 80-119 mg/dl 12 units 0 units 120-159 mg/dl 14 units 0 units 160-199 mg/dl 17 units 0 units 200-239 mg/dl 20 units 3 units 240-279 mg/dl 24 units 5 units 280-319 mg/dl 28 units 9 units 320-359 mg/dl 32 units 13 units 360-400 mg/dl 36 units 16 units start prednisone 40 mg twice daily start calcium and vit d start bactrim daily start omeprazole 20 mg daily otherwise continue your outpatient medications as prescribed. an endocrinologist from helped manage your blood sugars and recommends decreasing your lantus by 2 units each dose every time your prednisone dose decreases by 5 mg. you should also contact your endocrinologist when your prednisone dose changes. followup instructions: multiple follow up appointments were made for you to follow up with your outpatient providers. it is important that you keep these appointments. name: , location: - rheumatology address: , , phone: appointment: wednesday 3:50pm name: , p. location: primary care address: , , phone: appointment: friday 2:00pm name: , md location: endocrinology address: , , phone: appointment: thursday 8:00am name: , md location: nephrology address: , , phone: appointment: wednesday 3:40pm name: , md location: pulmonary address: , , phone: appointment: 8:40am dr. is out of the office and this was the first appointment available. you should be called with a sooner appointment when he returns. if you don't hear from their office within a week, please call to check if your appointment has been moved. procedure: insertion of intercostal catheter for drainage closed [percutaneous] [needle] biopsy of kidney closed [percutaneous] [needle] biopsy of mediastinum diagnoses: acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure accidents occurring in residential institution diabetes mellitus without mention of complication, type i [juvenile type], uncontrolled wegener's granulomatosis other specified diseases of thymus gland other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to