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: the patient is a 57 year old female with past medical history of polychondritis, initially diagnosed in , when the patient presented bilateral ear inflammation. since the diagnosis, the patient has been on prednisone as well as trials of methotrexate and cytoxan which she did not tolerate due to increased pulmonary symptoms. because of cough and shortness of breath, the patient was seen by a pulmonologist in , who performed bronchoscopy which revealed dynamic airway collapse. the issue of tracheal bronchial stenting was raised but bipap, cpap ventilation was initiated at that time. the patient was seen by rheumatology clinic here at in , and again in the beginning of at which time her prednisone was decreased to 30 mg from 40 mg once daily. there was a discussion of cellcept, however, that was not initiated. the patient was admitted to hospital in , with respiratory decompensation treated with increased steroids, bipap and nebulizers. she was readmitted on , with increased shortness of breath at rest, subacute in nature and progressive. she denied any chest pain, syncope, diaphoresis, fever, chills or sputum production. she reports not being able to cough up the sputum. at the outside hospital, solu-medrol, levofloxacin, lovenox, pepcid, nebulizer treatment and bipap were started and the patient was transferred to . in addition, the patient was noted to be in rapid atrial fibrillation with a ventricular response rate of 150s which was responsive to diltiazem. past medical history: 1. polychondritis diagnosed in 12/99, with bilateral ear inflammation, low and c-negative. recently treated with prednisone and methotrexate. methotrexate discontinued due to cough. 2. history of breast cancer, status post left mastectomy thirty years ago. 3. history of thyroid nodule. allergies: penicillin, sulfa, hydrochlorothiazide, benadryl. medications on transfer: 1. albuterol nebulizer q4hours. 2. bipap. 3. diltiazem 15 mg q1hour. 4. solu-medrol 60 mg once daily. 5. levofloxacin 500 mg once daily. 6. levoxyl 120 mcg once daily. 7. robinul 1 mg twice a day. 8. lovenox 70 mg subcutaneous once daily. 9. digoxin 0.25 mg alternating with 0.125 mg once daily. family history: noncontributory. social history: the patient smoked thirty pack years, quit about six months ago. physical examination: on admission, pulse 88, blood pressure 127/66, respiratory rate 24, oxygen saturation 92 to 94% on cpap mask set at 10/5. generally, the patient appeared bloated with moon facies using accessory muscles of respiration. skin was pink with dry mucous membranes. head, eyes, ears, nose and throat examination - extraocular movements are intact. neck was obese, no obvious jugular venous distention or lymphadenopathy was noted. the heart had distant sounds, regular rhythm, normal s1 and s2, no obvious murmurs. the lungs had inspiratory wheezes bilaterally. the lungs were without dullness or egophony. the abdomen was obese, mildly distended with decreased bowel sounds, nontender. extremities showed slight edema, no cyanosis or clubbing. laboratory data: from outside hospital on , white blood cells 13.8, hematocrit 38.0, platelet count 311,000. chem7 showed sodium 145, potassium 4.5, chloride 102, bicarbonate 30, blood urea nitrogen 25, creatinine 0.6, glucose 205. digoxin level 1.1. chest x-ray from outside hospital by report showed left basilar atelectasis, no congestive heart failure or infiltrate. ct of the neck performed in , showed diffuse tracheal bronchial wall thickening with associated air soft luminal narrowing with tracheal narrowing most severe just above the level of the aortic arch and main stem bronchi, right upper lobe bronchus and bronchus intermedius. there were also nonspecific patchy ground glass opacities within the upper lobes. electrocardiogram from the outside hospital showed sinus tachycardia at 100 beats per minute, normal axis and normal intervals, left atrial abnormality, right atrial abnormality. no t wave changes or pathological q waves. hospital course: in summary, the patient is a 57 year old female with relapsing polychondritis, breast cancer, status post mastectomy, presenting with two months worsening shortness of breath due to tracheal chondromalacia and dynamic airway collapse. during this hospitalization, the patient's issues included: 1. respiratory failure - initially the patient was on bipap, however, in the setting of desaturation to the mid 80s, the decision was made to intubate. following intubation, the patient underwent bronchoscopy which revealed diffuse airway collapse especially at the trachea and the main stem bronchi. the patient's respiratory failure could also have a component of chronic obstructive pulmonary disease given her thirty pack year smoking history and a bicarbonate on admission of 35. for a possibility of infection contributing to the patient's pulmonary problem, the patient was continued on levofloxacin and flagyl was added. she was continued on her steroids as well as albuterol and atrovent nebulizers. the patient underwent second bronchoscopy on , with bilateral main stem and tracheal stent placements. over the next few days, her sedation was decreased and trials of extubation were initiated. her sputum culture grew gram positive cocci for which she was started on vancomycin in addition to levofloxacin and flagyl. in light of persistent airway collapse distant to the stents, at extensive family discussions, the patient's code status was changed to "do not resuscitate". as sedation was weaned down, the patient expressed wish to be extubated. the patient wished not to be reintubated in case she would not be able to support herself. the patient was extubated on . she was not able to support her ventilation or oxygenation and was pronounced dead at 7:16 p.m. on . the family declined autopsy. cause of death: respiratory failure due to dynamic airway collapse from advanced polychondritis leading to tracheomalacia. 2. infectious disease - the patient did spike fevers for which antibiotics were initiated. besides gram positive cocci in the sputum, all her cultures were negative. 3. rheumatoid disease - polychondritis - the patient was continued on steroids with attempts to wean them. rheumatology consultation was also following the patient. 4. cardiovascular - during this hospitalization, the patient had runs of atrial fibrillation with rapid ventricular response rate for which she was continued on diltiazem and digoxin. 5. endocrine - for her increased blood sugar on steroids, the patient was maintained on nph and regular sliding scale insulin. for her hypothyroidism, she was continued on levoxyl. 6. access - on , right ij was placed without complications. in addition, for monitoring of blood pressure and respiratory status, left radial arterial line was placed. 7. prophylaxis - during hospitalization, the patient was continued on protonix and subcutaneous heparin for prophylaxis. discharge diagnoses: 1. hypoxic and hypocarbic respiratory failure. 2. polychondritis. 3. tracheomalacia and dynamic airway collapse, status post airway stenting. 4. breast cancer. 5. history of thyroid nodule. 6. atrial fibrillation. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances arterial catheterization other intubation of respiratory tract diagnoses: chronic airway obstruction, not elsewhere classified atrial fibrillation personal history of malignant neoplasm of breast personal history of tobacco use pulmonary collapse acute respiratory failure other disorders of bone and cartilage 

Answer: The patient is high likely exposed to