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 77-year-old gentleman with a history of coronary artery disease who is status post coronary artery bypass graft and mitral valve replacement in . the patient awoke on the day of admission with paroxysmal nocturnal dyspnea which was not improved with getting out of bed. the patient denied any history of the same and is able to walk two miles every day without dyspnea or chest pain. the patient was taken to an outside hospital where he was found to be in respiratory distress. the patient was placed on -level positive airway pressure and was transferred to for further treatment of his congestive heart failure. prior to his transfer, the patient was given lasix and solu-medrol with improvement in his respiratory status. at the time, the patient denied any chest pain or diaphoresis. the patient had not had any chest pain since his coronary artery bypass graft. the patient denied any recent changes in his medications or dietary indiscretions. past medical history: 1. status post mitral valve replacement with a #27 and coronary artery bypass graft times four in . 2. paroxysmal atrial fibrillation; status post permanent pacemaker for tachy-brady syndrome. 3. chronic obstructive pulmonary disease (with an fev1 of 1 liter). 4. status post cerebrovascular accident in (treated with t-pa with no residual). 5. depression. 6. borderline diabetes. 7. hypertension. 8. hypercholesterolemia. preoperative medications: 1. k-dur 20 meq by mouth once per day. 2. hydralazine 25 mg by mouth four times per day. 3. isordil 30 mg by mouth three times per day. 4. aspirin 81 mg by mouth once per day. 5. lasix 80 mg by mouth once per day. 6. zocor 20 mg by mouth once per day. 7. verapamil 120 mg by mouth once per day. 8. fluoxetine 20 mg by mouth once per day. 9. nexium 40 mg by mouth every other day. 10. coumadin. allergies: the patient has reported an allergy to intravenous contrast as well as ace inhibitors. concise summary of hospital course: the patient was admitted to for further workup of his congestive heart failure. an echocardiogram obtained on the day of admission revealed an ejection fraction of 55% with a flail mitral leaflet, 3+ mitral regurgitation, elevated pulmonary artery pressures, decreased right ventricular systolic function, and no regional wall motion abnormalities. the patient's initial cardiac enzymes were negative for a myocardial infarction. the patient was started on diuretics. the patient was also noted on admission to have elevated liver function tests with an aspartate aminotransferase of 147, alanine-aminotransferase of 100, alkaline phosphatase was 552, and total bilirubin was 0.4 this was initially attributed to hepatic congestion from heart failure. the patient was also noted to have an elevated white blood cell count. it was felt that the patient had a bronchitis or pneumonia; however, subsequent sputum cultures were negative. a pulmonary medicine consultation was obtained due to the patient's developing hemoptysis. they felt the hemoptysis was due to the patient's congestive heart failure and anticoagulation for atrial fibrillation and recommended following chest x-rays and obtaining a computed tomography scan. they felt the patient was at moderate risk for surgery as the patient had a fev1 of 1 liter. the patient had a computed tomography scan of his chest and abdomen which was negative for any evidence of malignancy. the patient was also started on natrecor to aid in his diuresis. the patient was taken to the cardiac catheterization laboratory on prior taking the patient to taking the patient to surgery. the cardiac catheterization showed a pulmonary capillary wedge pressure of 28, pulmonary artery pressure of 90/39, and left ventricular end-diastolic pressure of 19. there was a totally occluded mid left anterior descending artery, totally occluded proximal left circumflex, totally occluded proximal right coronary artery. there was a patent saphenous vein graft to first obtuse marginal, and second obtuse marginal, and left anterior descending artery. there was an 80% lesion in the saphenous vein graft to the posterior descending artery. the lesion was stented with a cypher stent. the patient also underwent an evaluation by the dental service preoperatively for his mitral valve replacement. the dental service recommended an oral surgery consultation for extraction of several teeth. the patient was seen by oral surgery, and they recommended extraction of teeth prior to being taken to the operating room. on , it was noted that the patient's lower extremities were cool but with dopplerable pulses. it was noted late in the day that the patient developed a diffuse erythematous rash for which he was treated with benadryl. a neurology service consultation was obtained to evaluate the patient for his operative risk due to his prior cerebrovascular accident. carotid ultrasounds were obtained which showed mild plaque in the right and left internal carotid arteries with a narrowing of less than 40%. the patient underwent an arterial examination of his lower extremities due to the delayed capillary refill and cool temperature. this showed mild-to-moderate right tibial disease with a normal atrial flow in the left leg. early in the morning on , the patient became acutely short of breath and hypoxic. the patient was noted to have cool hands and feet with delayed capillary refill. there was a very erythematous rash on face, torso, thighs, and back. it was decided later in the day to transfer the patient from the floor to the coronary care unit for further workup. upon transfer to the coronary care unit, the patient was started on nipride infusion to try to decrease his pulmonary artery pressures and improve his heart failure. the neurology service read the results of the computed tomography scan which showed a lacunar infarction without evidence of embolic or water shed infarctions. they felt the patient was cleared for cardiac surgery. in the coronary care unit, the patient was mildly improved with afterload reduction. a dermatology consultation was obtained for the patient's rash. there was concern that the patient's rash was early ten versus orthodromic drug reaction versus staph scalded skin syndrome. several punch biopsies were taken. the patient's antibiotics, plavix, and captopril were discontinued. the results of these biopsies showed hypersensitivity dermatitis which was felt to be most likely due to captopril. on , the patient was taken to the operating room with oral and maxillofacial surgery service for teeth extractions. the patient tolerated the procedure well. the patient was placed on clindamycin peri-procedure for endocarditis prophylaxis. blood cultures which were drawn at the time to rule out staph scalded skin were negative. on , pulmonary medicine felt that the patient's preoperative hemoptysis was due to heart failure and anticoagulation. they recommended postoperative pulmonary followup. at this time in the coronary care unit, the patient was on a nipride drip with a stable pulmonary status. the patient's rash continued to slowly improve with some skin fluffing and significant erythema. the patient had an elevated white blood cell count which was felt possibly to be due to the rash. the patient was continued on clindamycin for prophylaxis. cardiac surgery continued to be delayed until the patient's rash improved. on , the allergy service was consulted for the rash which by then diagnosed to be hypersensitivity dermatitis. it had initially been felt that the intravenous dye could be a culprit; however, because of the biopsy results, it was felt that captopril was the most likely etiology. the allergy service noted that it was a .................... process, and skin testing was not a reliable diagnostic tool. however, as an outpatient, they recommended delayed hypersensitivity patch testing using thin testing for captopril. they recommended avoiding captopril and all ace inhibitors. it was felt that perhaps the patient would be a candidate to try an angiotensin receptor blocker at a later date, as there was unlikely to be any cross reactivity. it was felt that the patient was fine to be placed back on plavix. on , with the aggressive diuresis, the patient's creatinine had risen to 2.5 from 1.6. it was decided that the patient would require a pulmonary artery catheter be placed to further determine appropriate management. it was also determined that the patient would greatly benefit from the insertion of an intra-aortic balloon pump to temporize the patient prior to cardiac surgery. when the pulmonary artery catheter was inserted, the cardiac index was 1.7 which improved to greater than 2 with the intra-aortic balloon pump. on , the patient's creatinine had risen to 2.9. the patient was started on a dobutamine infusion to improve cardiac output which also improved the patient's urine output, and the patient's creatinine started to decrease. the patient continued to have mild respiratory compromise. on , the patient's lasix infusion was discontinued as it was felt that the patient was intravascularly dry. the patient continued to make good urine. dr., 02-351 dictated by: medquist36 procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for 96 consecutive hours or more extracorporeal circulation auxiliary to open heart surgery coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization temporary tracheostomy implant of pulsation balloon open and other replacement of mitral valve with tissue graft injection or infusion of nesiritide insertion of drug-eluting coronary artery stent(s) injection or infusion of oxazolidinone class of antibiotics administration of inhaled nitric oxide diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation other chronic pulmonary heart diseases mechanical complication due to heart valve prosthesis cardiogenic shock surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation 

Answer: The patient is high likely exposed to