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: plavix / simvastatin / tape / hydrochlorothiazide / eptifibatide attending: chief complaint: chest pain, angina, shortness of breath major surgical or invasive procedure: intubated, extubated history of present illness: 57yo gentleman with h/o cad s/p 2 mis, renal transplant for wegener's granulomatosis, htn, dyslipidemia, and paroxysmal afib p/w accelerating angina. he c/o pain in his jaw, which then moves to his throat and then the middle of his chest; feels like pressure. symptoms are provoked by activity and associated with dyspnea. patient states that symptoms began a few months ago and have been worsening in the sense that they come on with less stimulus (now just with walking across the room) and only resolve with nitro. he also reports feeling exhausted. he has had a cough productive of large amounts of white sputum x 1 week. +sinus congestion, which he reports feeling like it is dripping down the back of his throat and collecting in his lungs. he also notes subjective fevers at home and nausea with episode of non-bloody emesis in the ed. he has had diarrhea about 5 times a day, "like minestrone soup." he denies sore throat, abdominal pain, or dysuria, and he only gets headaches when he takes the nitroglycerin. of note, he does endorse pnd and orthopnea as well as ankle edema. he reports 10 pounds of weight gain in the last week. . in the ed, his vs were 100.7, tmax 102 89 120/68 18 97% ra. he was given asa 325mg and tylenol 650mg as well as metoprolol 5mg iv. levaquin 750mg po was administered at 16:00 for concern of pneumonia. ekg showed st depression in v4-v6 as well as i and avl and upsloping st elevation in v1 and v2. troponin was 0.27 (last trop 0.04 in ). patient was evaluated by the cardiology fellow, and a heparin gtt was ordered, but not started per nursing notes. patient was also seen by transplant nephrology fellow. past medical history: -paroxysmal atrial fibrillation, not on coumadin -esrd s/p living donor (sister) renal transplant in -cad: - s/p acute mi with palmaz lad and rca stents - s/p rotablation and hepacoat stent to the d1 in , treated with brachytherapy for instent restenosis in - s/p taxus stent in rpl in - s/p two cypher stents placed in the rca - cath in with 60-70% ostial stenosis of lad, moderate diffuse disease of lcx, 60% proximal of rca with in stent restenosis with a 70% in the pl branch taxus stent(for latest cath, see pertinent results) -denies h/o dm; however, sugars have been elevated in past -chronic angina -hypertension -hypercholesterolemia -wegener's granulomatosis (renal/pulmonary involvement) diagnosed s/p cytoxan/prednisone x 1y initially, anca neg. since (chronic proteinuria); now s/p renal transplant in -idiopathic pericarditis -gerd -anxiety, endorses dysthymic symptoms but not depression -gout -umbilical hernia repair -restless leg syndrome . outpatient cardiologist: nephrologist: dr. transplant nephrologist: pcp: . allergies: plavix--rash simvastatin--myalgia tape--rash hctz--unkown reaction social history: social history is significant for the absence of current tobacco use; quit 25 years ago. there is no history of alcohol abuse; he endorses rare etoh. no illicit drugs. married with 3 children, lives w/ wife and youngest daughter. family history: there is no family history of premature coronary artery disease or sudden death. mother had cva at 46. sister with scleroderma and another sister with . physical exam: vs - 99.7 131/78 91 20 96% ra 175 pounds gen: pale-appearing middle aged male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, with some pallor but no cyanosis of the oral mucosa. no xanthalesma. neck: supple. jvp of 5cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. +crackles, l>r with good air entry b/l. abd: soft, nt, mildly distended. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. somewhat diaphoretic. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: laboratory data: ck 198 troponin 0.27 ck-mb 4 hct 25 cr 2.3 . ekg demonstrated nsr with old q wave in v3 but new st depressions in v5-v6 and i, avl as well as st elevations in v1 and v2 as compared with prior dated . . cxr : two views of the chest: there are slight increased patchy opacities in the right lower lobe, which is seen to project posteriorly on the lateral view. this may represent an early/developing pneumonia. the left lung is clear. the aorta is tortuous. small kerley b lines suggest mild interstitial edema. the bony thorax is normal. impression: 1. possible early/developing right lower lobe pneumonia. 2. mild interstitial edema. . echo : the left atrium and right atrium is moderately dilated. a left-to-right shunt across the interatrial septum is seen at rest c/w a small secundum atrial septal defect.left ventricular wall thicknesses and cavity size are normal. there is moderate regional left ventricular systolic dysfunction with focal hypokinesis of the basal half of the inferior and inferolateral walls and distal lateral and anterior walls. the remaining segments contract normally (lvef = 35 %). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: regional left ventricular systolic dysfunction c/w cad. moderate mitral regurgitation most likely due to papillary muscle dysfunction. secundum type atrial septal defect. mild pulmonary artery systolic hyertension. compared with the prior study (images reviewed) of , regional left ventricular systolic dysfunction is more extensive (now involving the basal inferior and inferolateral walls), the severity of mitral regurgitation has increased, and pulmonary artery systolic hypertension is now identified. the secundum type atrial septal defect is now better defined. . portable abdominal ultrasound () findings: limited grayscale images of the abdomen do not detect ascites and limited views of the liver suggest normal echotexture. impression: no ascites. . cxr : increased airspace disease is evident by progressive increasing density of the bilateral consolidations, the left now clearly expressing itself as such. there is a subtle motion degradation though lateral costophrenic sulci are still reasonably delineated. heart size is enlarged. impression: worsening airspace disease bilaterally for which bilateral pneumonias most fitting. . abdominal film on indication: abdominal distention, increased dyspnea and difficulty breathing. a single view of the abdomen shows nonspecific non-obstructed bowel gas pattern with predominantly gas-filled large bowel visualized. the appearance is quite similar to a remote prior abdominal film from . on the current study, there are surgical clips overlying the sacrum and there is no evidence for pneumatosis. no ascites . cxr : increased airspace disease is evident by progressive increasing density of the bilateral consolidations, the left now clearly expressing itself as such. there is a subtle motion degradation though lateral costophrenic sulci are still reasonably delineated. heart size is enlarged. impression: worsening airspace disease bilaterally for which bilateral pneumonias most fitting. . echo : the left atrium is elongated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is moderate regional left ventricular systolic dysfunction with inferior/inferolateral and apical hypokinesis with mild hypokinesis elsewhere. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. agitated saline contrast study is suggestive of intracardiac shunt with valsalva release consistent with the presence of a patent foramen ovale (or asd). compared with the prior study (images reviewed) of , ventricular function appears similar. brief hospital course: hospital course: admitted to with nstemi with positive enzymes, (peak trop 0.54, ck 298, ck-mb 6), and ekg with inferolateral 1-2mm st depressions, 1mm st depressions in avl and 1mm ste in avr (has baseline 1-2mm ste in v1, v2). had tte here after admission on confirming the ef of 35% as well as focal hk of basal inferior and inferolateral walls and distal lateral and anterior walls. was started on heparin gtt, integrillin gtt the latter of which was d/c'd on the day of transfer to the ccu. was treated with abx for pna, and pulm also had plan for bronch/ibal but course was complicated by intermittent hypotension and hct drop to 25 for which he was transfused 3 units of prbc's and 1l of ns. after receiving the blood transfusion pt started to experience acute sob this am at around 2:30am. patient was given furosemide 40mg iv with urine output of 700cc in 2 hours. he was also given morphine 1mg iv x 4, and lorazepam 0.5mg iv x 1. no associated fevers with transfusion, although he did spike to 101.3 the day prior. he does have perihilar consolidation and hemoptysis and was followed by pulmonary and ent surgery who at this point recommended no steroids since they did not beleive this to be wegener's flare. he was also followed by renal team for worsening acute renal failure that was though to be pre-renal in etiology. . hospital course: . # pna pt arrived to the ccu in respiratory distress with rr of 40, abg 7.44/18/56/13; bipap was tried but pt was eventually intubated since the ccu teamed feared he was becoming fatigued. pt was found to have bilateral pulmonary infiltrates, r>l, and hypoxia in the setting of a pneumonia and hemoptysis starting after integrillin. dah was suspected. pulm bronched pt showing minimal blood and hemoptysis resolved quickly after intergrillin had been stopped. anca was negative making wegener's very unlikely. the thinking was that pulm hemorrhage was inflammation due to pna. pt was afebrile, without a cough, off oxygen ambulating well with good o2 sats on disccharge. . # chf with ef 35% pt also arrived fluid overloaded and in acute on chronic systolic heart failure after the transfusions. he was given iv lasix over the next couple of days with great results. 2 days into the stay in the ccu pt started autodiuresing, for a total of about 6l for the duration of the ccu stay. repeat echo on was unchaged from . . # cad s/p mulitple stents pt likely had a minor nstemi on admission and definitely had interval inferolateral wall motion abnormalities from prior to admission. the decision was made to continue to medical management and do a stress mibi as an outpatient for risk startification since this all happened in the setting of an acute illness. patients creatinine was also >2 presenting another argument to hold off on doing a cath. plan was for f/u with cards in weeks which was communicated with pt. . # atrial fibrillation on the evening of extubation () pt entered afib with a ventricular resonse rate of 100-120s. lopressor 5mg iv x3 and diltiazem was both tried but unsucessful. therefore, cardioversion was performed with pt returning into sinus rhyhtm. pt stayed in sinus for the remainder of hosp stay until d/c. . # metabolic acidosis/diarrhea/hypokalemia pt had an anion gap of 22 when arriving to the floor, likely uremia. the ag corrected failry quickly, however pt still had an acidosis with a low bicarb since he continued to have diarrhea with 3-5 loose stools per day. pt was therefore given bicarb per renal recommendation with good effect. the cause of the diarrhea was not found in hosp and was negative for c.diff x4, o+p, shigella, salm, legionella among other things. immodium was prescibed with some effect and mycophenolate preparation was changed since the different preparations have different gi side effects. hypokamlemia to 2.4 was repleted agressively. pt was given 20mg daily of k to take at home and to eat banana's, especially if diarrhea continued. pt was instructed to follow up closely with his pcp to have potassium checked on and . . # wegener's disease patient is s/p 6 match donor transplant in with basline cr 1.8-2.1 since . meds were renally dosed, bactrim for pcp while on immunosupression, lisinopril was held due to raised creatinine. sirolimus and cellcept initially continued sirolimus level was normal/elevated, then sirolimus was d/c'd due to concern over pulm toxicity. renal recommended stopping sirolimus and starting tacrolimus once the sirolimus was <5. tacrolimus was in therpeutic range at the time of d/c. . # anemia to 25 with recent baseline hct 25-30 as mentioned above was given 3-4 units of prbc's prior to ccu transfer. blood counts in the ccu improved with hct in 32-33 range and no further transfusions were needed. pt was guaiac negative and no other source of bleeding was identified other than the dah. . pancytopenia of unknown origin anemia as above. also with platelets to high 90s but stable. white count intially low to 2.7 during the acute illness then recovered to normal range. perhaps a medication effect, although bone marrow biopsy may be indicated if persists and other causes are ruled out as an outpt. . medications on admission: (confirmed with patient and wife at time of admission) amlodipine 10mg daily actos 15mg daily ambien 5mg po qhs prn sleep asa ec 325mg daily bactrim ss 1 tab daily cellcept 1000mg colace 100mg po daily ferrous sulfate 325mg daily--not taking labetalol 900mg po bid lipitor 10mg daily lisinopril 5mg po bid nitroglycerin 1-2 tablets 0.4mg sl prn chest pain nitroglycerin 0.4 mg/hr td patch daily with 6 hour patch-free interval at night protonix 20mg daily sirolimus (rapamune) 3mg daily ropinirole (requip) 3mg for restless leg zoloft 50mg po qam discharge medications: 1. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 6. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 7. actos 15 mg tablet sig: one (1) tablet po once a day. 8. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 9. labetalol 200 mg tablet sig: five (5) tablet po bid (2 times a day). disp:*300 tablet(s)* refills:*2* 10. mycophenolate sodium 180 mg tablet, delayed release (e.c.) sig: four (4) tablet, delayed release (e.c.) po bid (2 times a day). disp:*240 tablet, delayed release (e.c.)(s)* refills:*2* 11. ropinirole 1 mg tablet sig: three (3) tablet po bid (2 times a day). 12. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 13. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual once a day: take if experience chest pain. may take on tab q5 minutes for a total of three doses. if chest pain persists please call 911. disp:*120 tabs* refills:*2* 14. protonix 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 15. diphenoxylate-atropine 2.5-0.025 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for diarrhea for 3 days: disp:*20 tablet(s)* refills:*0* 16. tacrolimus 1 mg capsule sig: two (2) capsule po q12h (every 12 hours). disp:*120 capsule(s)* refills:*2* 17. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po twice a day. disp:*120 tab sust.rel. particle/crystal(s)* refills:*2* 18. sodium bicarbonate 650 mg tablet sig: two (2) tablet po three times a day. disp:*180 tablet(s)* refills:*2* 19. outpatient lab work chem-10 and tacrolimus level on and again on discharge disposition: home discharge diagnosis: pneumonia nstemi atrial fibrillation diffuse alveolar hemorrhage due to pneumonia and anticoagulaion acute on chronic systolic heart failure acute on chronic renal failure discharge condition: stable discharge instructions: stemi d/c summ: you were admitted to with a pneumonia, acute on chronic systolic heart failure, acute on chronic renal failure, atrial fibrillation, diffuse alveolar hemorrhage due to pneumonia and anticoagulaion and a small non-st elevation myocardial infarction. please take your previous medications as prescribed with the following changes: - please stop taking sirolimus - please stop taking the nitroglycerin patch unless stable angina - please increase labetalol to 1000mg twice daily (from 900mg) - please start taking myfortic instead of cellcept - please start taking amlodopine 5mg instead of 10mg - please do not take your evening dose of prograf on and restart in the am at 2 mg twice daily on if you develop chest pain, jaw pain, or chest pressure with pain radiating into arm, or if you for any reason become concerned about your medical condition please call 911 or present to nearest ed. - we also gave you nitroglycerin tablets to take if you experience chest pain, please call 911 or your doctor if chest pain recurs even if it dissapears with nitroglycerine followup instructions: provider: , lpn phone: date/time: 2:00 provider: , md phone: date/time: 11:10 provider , md phone: date/time: 3:40 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours injection or infusion of platelet inhibitor insertion of endotracheal tube other electric countershock of heart closed [endoscopic] biopsy of bronchus transfusion of packed cells diagnoses: pneumonia, organism unspecified acidosis subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux pure hypercholesterolemia congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified acute respiratory failure other and unspecified angina pectoris old myocardial infarction surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation acute on chronic systolic heart failure complications of transplanted kidney restless legs syndrome (rls) other agents affecting blood constituents causing adverse effects in therapeutic use wegener's granulomatosis 

Answer: The patient is high likely exposed to