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 48 year-old man with a history of crest syndrome times 25 years and a more recent history of dyspnea on exertion worsening over the past several months. the patient was admitted to the hospital in late and diagnosed with severe pulmonary hypertension by echocardiogram and right heart catheterization, which showed a pulmonary artery pressure of 86 and a pulmonary capillary wedge pressure of 19. the patient was discharged on on bosentan 62.5 mg twice a day as well as lasix. he took the bosentan for a month without relief, then stopped for ten days due to loss of insurance and then restarted at 125 mg twice a day. the patient notes that he did not fill his lasix prescription following the discharge and did not check his daily weights. over several days after restarting the bosentan the patient noted increasing dyspnea on exertion, shortness of breath, bilateral peripheral lower extremity edema, paroxysmal nocturnal dyspnea, and increasing orthopnea. he was referred to the emergency department where he was admitted for the initiation of continuous infusion flolan treatment, which had previously been planned for a week after the time of his deterioration. review of systems: at the time of admission revealed severe right digital pain in the right upper extremity secondary to raynaud's. the patient denies fevers or chills, nausea and vomiting, chest pain, abdominal pain, change in bowel habits, melena or bright red blood per rectum. past medical history: 1. crest syndrome diagnosed 25 years ago. the patient has a history of digital ulcers secondary to raynaud's phenomenon and is status post right laparoscopic sympathectomy in without symptomatic relief. 2. gastroesophageal reflux disease with esophageal stricture. 3. pulmonary hypertension first noted on echocardiogram in and recently diagnosed as described in the history of present illness. the patient is on 4 liters of home o2. 4. mild restrictive lung disease with a decreased dlco. 5. history of upper gastrointestinal bleed. 6. status post left hernia repair. allergies: the patient notes nausea and vomiting with morphine and codeine and itching with percocet. physical examination on admission to the floor: vital signs temperature 98.9. pulse 73. blood pressure 108/48. respirations 15. o2 sat 92% on room air. the patient was alert and oriented times three and complaining of digital pain. he was in no acute distress. the pupils are equal, round and reactive to light. extraocular movements intact. his mucous membranes are moist with telangiectasias. there was no cervical lymphadenopathy. the patient did have jugulovenous distention to about 16 cm. lung examination revealed diffuse mild crackles throughout bilaterally with resonant percussion. heart examination showed a regular rate and rhythm with a normal s1 and a split s2 with a loud p2. there was also a 2 out of 6 systolic ejection murmur heard best at the left upper sternal border. extremity examination revealed no clubbing or cyanosis. the patient did have 1+ edema in the lower extremities bilaterally to the mid calf level. the calves were discolored with multiple brownish red indurated nodular lesions, which were nontender. the upper extremities had significant digital ulceration on digits one through four of the right hand. neurological examination was notable for intact cranial nerves and intact strength and sensation in the upper and lower extremities bilaterally. laboratory data on admission: white blood cell count 6.7, hematocrit 34.9, platelet count 211. electrolytes sodium 139, potassium 4.0, chloride 103, bicarbonate 25, bun 18 and creatinine 1.2 with a glucose of 94. admission electrocardiogram showed normal sinus rhythm, t wave inversion in 1, 2, and 3 with poor r wave progression and t wave inversion in v1 through v5. there were also new t wave inversions in 2, 3 and avf. hospital course: the patient was admitted to the micu on . he was ruled out for myocardial infarction and diuresed with lasix. a swan-ganz catheter was placed and the flolan was started on . a hickman catheter was placed by general surgery on and the patient was called out of the micu to the medical floor. the flolan was titrated to 9 nanograms per kilogram per minute with moderate flushing, headache and nausea. these side effects were treated with compazine and vicodin. a flolan dose of 10 nanograms per kilogram per minute was attempted on , but was decreased back to 9 nanograms per kilogram per minute due to hypotension to 90/45. the patient did note improvement in his dyspnea on exertion in the days following the flolan initiation. an outside agency provided flolan teaching for the patient's sister who will prepare the flolan at home. a flolan nurse will visit the home daily in the week following discharge. also during this admission pain service was consulted regarding the patient's digital ulcer pain. the pain was treated with oxycontin with vicodin for breakthrough. oxycontin was increased from 30 b.i.d. to 30 t.i.d. on , but was changed to 40 b.i.d. on secondary to increased sedation. in addition, on the patient complained of severe throat pain and pharyngeal edema and exudate were noted on examination. a culture was sent and amoxicillin was started for a presumed strep throat. the patient was discharged to home in stable condition. discharge status: good. discharge diagnoses: 1. crest syndrome. 2. pulmonary hypertension. discharge medications: 1. flolan 9 nanograms per kilogram per minute intravenous infusion. 2. oxygen 4l by nc 3. furosemide 60 mg po q.d. 4. coumadin 1 mg po q.h.s. 5. oxycontin 40 mg po b.i.d. 6. vicodin one to two tablets po q 6 hours as needed for pain. 7. lorazepam 0.5 mg po t.i.d. 8. prazosin 1 mg po t.i.d. 9. diltiazem sr 480 mg po q.d. 10. compazine 10 mg po q six hours prn nausea. 11. pantoprazole 40 mg po b.i.d. 12. sucralfate 1 gram po q.i.d. 13. ferrous sulfate 325 mg po q.d. follow up plans: the patient is to follow up within the next two weeks with dr. in pulmonology, dr. his primary care physician, dr. his rheumatologist. these appointments have been scheduled for him. , m.d. dictated by: medquist36 d: 03:49 t: 09:27 job#: procedure: insertion of totally implantable vascular access device [vad] diagnoses: esophageal reflux congestive heart failure, unspecified other chronic pulmonary heart diseases raynaud's syndrome systemic sclerosis streptococcal sore throat 

Answer: The patient is high likely exposed to