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 68 year old male, retired fighter pilot, with a medical history significant for advanced chronic obstructive pulmonary disease, anxiety and depression who has deteriorated significantly over the past two months requiring hospitalization. he was separated from his wife in and has been living alone on in an isolated situation, diagnosed with depression several years ago by his primary care physician and has undergone a slow decline over the past several years. he has had several episodes of pneumonia but was doing reasonably well until of last year when he developed bronchitis which progressed to pneumonia and he was admitted to hospital. since that point his decline has resulted in traumatic weight loss and the development of skin necrosis and ulceration in the bilateral lower extremities and tips of his fingers during his last hospital stay. despite an aggressive workup during the involvement of many specialists, they were unable to pinpoint the exact etiology of the problem. the patient denied any fevers, chills or sweats, hemoptysis, new neurological, musculoskeletal or gastrointestinal complaints. he denies issues with his kidneys, pancreas, liver, gallbladder and heart. past medical history: 1. history of atrial fibrillation; 2. anxiety/depression; 3. chronic obstructive pulmonary disease. past surgical history: unremarkable. medications on admission: 1. protonix 40 mg p.o. q. day 2. thiamine 50 mg p.o. q. day 3. lovenox 40 mg p.o. q. day 4. toradol 15 mg intravenously q. 6 hours prn for pain. 5. vancomycin 500 mg intravenously q. day 6. ciprofloxacin 500 mg p.o. b.i.d. 7. doxycycline 100 mg p.o. q.i.d. 8. solu-medrol 30 mg intravenously q. 8 hours 9. albuterol inhaler allergies: the patient has an allergy to procaine, novocaine, anesthetics and penicillin. social history: significant for a 45 year pack year history of smoking. family history: unremarkable. physical examination: on physical examination the patient was afebrile with vital signs stable, sating 93% on room air. the patient was a thin cachectic male who appeared in minimal to moderate distress. head was atraumatic, normocephalic. sclera were anicteric. neck was soft, supple with no masses noted and no carotid bruits. lungs were clear to auscultation bilaterally, however, breath sounds were slightly decreased, no wheezes noted. heart was regular rate and rhythm with no murmur. thorax was symmetrical without any lesions. abdomen was scaphoid, soft, nontender, nondistended. extremities showed no cyanosis, clubbing or edema, however, they did show larger areas of ulceration and necrosis, right greater than left in the lower extremities, upon which the skin appeared to be sloughing off of his body. the patient also had some areas of punctate ulceration necrosis on his hands as well. neurologically, the patient had no deficits. further detailed lower extremity ulcerations, the patient had two large necrotic ulcerations directly inferior to the right kneecap and then from approximately mid calf down the patient had large reddish ulcerations with minimal bleeding in a patchy distribution. on the left lower extremity the patient had minimally bleeding ulceration on the left forefoot that did not extend superiorly to the ankle. hospital course: the patient is a 68 year old male with severe chronic obstructive pulmonary disease, malnutrition, lower extremity ulcerations of unknown etiology who presented to the thoracic surgery service for further evaluation and treatment of multiple problems. on hospital day #2, the patient went for chest x-ray which demonstrated no definite pneumonia or cardiac failure, prominence of the right aortic contour concerning for ascending aortic aneurysm. the patient then went for a computerized tomography scan on hospital day #3 which revealed head computerized tomography scan which showed no intracranial pathological process, computerized tomography scan of the torso which demonstrated no evidence of malignancy, diffuse extensive emphysema with small peripheral patchy opacities, extensive vasculopathy with suggestion of infrarenal aortic stenosis and post traumatic dilatation, an ascending aortic aneurysm measuring 4.2 cm and a prominent left adrenal gland. at this time multiple consultations were obtained. pulmonary consultation evaluating the patient's pulmonary function tests were performed which demonstrated severe emphysematous pattern consistent with the patient's disease process. pulmonary then recommended various nebulizer treatments which were enacted. on , the patient was seen by psychiatry for increasing anxiety, depression and possible delirium change in mental status. psychiatry recommended haldol prn for agitation and also recommended checking tsh, b12 and folate levels which were all normal. there were no further recommendations made at this time, and the patient's mental status had improved over the course of the hospital stay. on , the patient was also seen by nutrition consultation which recommended boost supplements t.i.d. and calorie counts and q. day weights to monitor nutritional status. also on , the patient was seen by the dermatology service who made an assessment of vasculitis of unknown origin or an embolic phenomenon. two punch biopsies were taken at this time, one from the right lower extremity and one from the left index finger and these were sent to pathology for further analysis. also on , neurology saw the patient. they reviewed the computerized tomography scan which was normal and had no recommendations at this time. on , vascular surgery saw mr. , recommendations included noninvasive arterial studies of the lower extremities which demonstrated significant arterial disease on the right lower extremity with flexions of 9 and 6 at the ankle and metatarsal areas respectively on the right lower extremity. in addition, computerized tomography scan was evaluated and infrarenal narrowing of the aorta was noted but thought to be subclinical. dr. , the vascular surgeon at this time, recommended bilateral lower extremity angiogram with possible intervention. in addition vascular surgery recommended silvadene and adaptic dressings to the lower extremity ulcerations b.i.d. on , the patient was seen by nutrition again. the patient was taking in approximately 44 gm of protein and 1400 cal/day which was sufficient for the patient's nutritional needs. the patient was demonstrating a steady weight gain. on , the patient went for bilateral lower extremity angiogram by dr. in the cardiac catheterization laboratory. the patient was found to have near total occlusion of the right common iliac artery and two stents were placed after angioplasty of this area as well as two stents placed in the left common iliac artery. the patient did well post procedure with no groin hematoma, no bruit in the groin. immediately post procedure the patient reported feeling much better in the lower extremities than prior. up until this point the patient had a white count that was hovering between 20 and 24. skin cultures at this point came back only positive for corynebacteria. blood cultures have been negative to date. on , infectious disease saw the patient. recommendations included discontinuing the vancomycin which the patient was on and changing it to linezolid 600 mg p.o. q. 12 hours and continuing the ciprofloxacin. the patient was also recommended to have clostridium difficile sent off which all were negative. on , the patient's punch biopsy by dermatology returned negative for vasculitis in the lower extremity biopsy sample, but the left index finger was positive for vasculitis with definite changes in the small/medium sized arteries. at this time, differential diagnosis included systemic vasculitis or drug vasculitis. multiple systemic laboratory data were sent off including cryoglobulin, c3, c4 which all returned negative. the patient was seen by plastic surgery on for possible skin graft treatment for her lower extremity ulcerations which were somewhat improving. plastic surgery evaluated the patient and made no recommendations at this time, hoping for the patient's ulcerations to heal slightly prior to repeat evaluation assessment as an outpatient. secondary to the patient's persistent high white count the patient was sent for bone scan to rule out osteomyelitis and on the patient was sent and test was negative. post intervention pvrs demonstrated increased flow of arterial supply in the right lower extremity. on , the patient was seen by rheumatology for assessment of vasculitis. additional laboratory data were sent off including esr, crpna which were all negative. tentative diagnosis at this time of the etiology of lower extremity ulceration was drug vasculitis due to vancomycin. on hospital day #13, the patient was seen as fit to be transferred to a rehabilitation center. unfortunately, he was then was found down and hypotensive and required intubation and resusitation and transfer to the icu. the details of which are in a followup addendum. discharge status: to rehabilitation. discharge condition: stable. discharge diagnosis: 1. drug vasculitis. 2. severe pulmonary emphysema. 3. anxiety, depression. 4. peripheral vascular disease. follow up: the patient is to follow up with multiple services, plastic surgery, dr. , infectious disease, dr. , rheumatology, dr. , surgery, dr. in one to two weeks, please call for an appointment, vascular surgery, dr. . medications on discharge: 1. protonix 40 mg p.o. q. day 2. thiamine 100 mg p.o. q. day 3. heparin 5000 units subcutaneously b.i.d. while in bed. 4. combivent inhaler 1 nebulizer q. 6 hours. 5. serevent inhaler 1 disc q. 12 hours. 6. silver sulfadiazine cream apply topically b.i.d. 7. folic acid 1 mg p.o. q. day 8. multivitamin one tablet p.o. q. day 9. aspirin 325 mg p.o. q. day 10. plavix 75 mg p.o. q. day 11. albuterol inhaler one nebulizer q. 6 hours prn 12. ultram 50 to 100 mg p.o. q. 6 hours prn for pain 13. ibuprofen 600 mg p.o. q. 6 hours 14. neurontin 300 mg p.o. q.h.s. 15. solu-medrol 30 mg, 20 mg and 30 mg q. day until mg, 10 mg and 30 mg until mg, 30 mg until mg 20 mg until mg then 10 mg until mg until mg until and 10 mg until , intravenously as directed. 16. linezolid 600 mg p.o. q.12 hrs to be adjusted at follow up. 17. ciprofloxacin 500 mg p.o. q. 12 hours to be adjusted at further follow up. discharge instructions: the patient is to have wound care as directed, silvadene adaptic dressings to lower extremities b.i.d. , m.d. dictated by: medquist36 procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances angioplasty of other non-coronary vessel(s) arteriography of femoral and other lower extremity arteries non-invasive mechanical ventilation percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) cardiopulmonary resuscitation, not otherwise specified closed biopsy of skin and subcutaneous tissue diagnoses: obstructive chronic bronchitis with (acute) exacerbation acute respiratory failure iatrogenic pneumothorax cardiac arrest intestinal infection due to clostridium difficile emphysematous bleb nutritional marasmus arteritis, unspecified 

Answer: The patient is high likely exposed to