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: penicillins attending: chief complaint: bright red blood per rectum major surgical or invasive procedure: exploratory laparotomy, splenic flexure takedown, left colectomy, colonic intraoperative lavage, appendectomy, colorectal anastomosis and gastrostomy history of present illness: 82f with sjogrens, vasculitis, gi bleed, htn who p/w gib. pt was recently admitted fr to . that extended admission, pt initially p/w r popliteal dvt, renal failure, chf, and ascites, and was ultimately diagnosed with a poliferative gn, as well as numerous other incidental findings. she was tx w/prednisone and cytoxan and creatinine stabilized. course was c/b thrombocytopenia (etiology ultimately thought to be cytoxan). rij tunneled catheter was placed, and she was treated for significant volume overload with uf. . course also c/b palpable purpura, thought to be vasculitis secondary to sjogren's, hyponatremia, and was started on 10-day course of vanc/zosyn for possible hospit-acquired pna. . her course was also c/b anemia, and a thorough gi workup was undertaken: -egd showed gastritis/esophagitis -colonoscopy showed proctitis with erythema and small ulcers, diverticulosis, and grade 2 internal hemorrhoids, and a cecal polyp. . today, at nursing home, pt experienced ~500cc brbpr and was transferred back to for further evaluation. . in ed ng lavage negative (250cc but no bilious return). she was given 2u ffp. pt was worked up by nf for planned medicine floor admission. however, pt's hct 35->28 & pt had large b.m. of maroon-colored stool. gi contact & will see in am. plan icu monitoring given large blood loss. past medical history: acute renal failure, pauci-immune glomerulonephritis. s/p rij tunneled hd catheter rle dvt gi bleed diverticulosis sjogren's syndrome ?vasculitis pleural effusions, pericardial effusion raynaud's cryoglobulinemia papillary neoplasm is an incidental finding of uncertain significance renal cysts htn hyperlipidemia anemia chf/volume overload hyponatremia hypoalbuminemia peripheral neuropathy paget's disease secondary hyperparathyroidism thrombocytopenia (thought related to cytoxan) hematuria social history: came fr rehab facility. lives at home with 83 yo sister. retired in from career as admin asst.; never married. no children. no smoking hx, and previously etoh drinks/wk. family history: father died at age 35 of stomach ca. mother died at age 89. no known fh of liver, kidney, premature cardiac dx, malig, lupus, or sjogren's. . meds on admission (see end of note) physical : t 95.4 hr 73 bp 194/69 to 220/80 rr 20 95% ra gen: patient appears stated age, found lying flat in bed, in nad heent: sclera anicteric, conjunctiva uninjected, perl, eomi, mmm, no sores in op neck: no jvd, no lad, nl rom cor: rrr nl s1 s2 no m/r/g chest: clear to percussion and asculation abd: soft, nt/nd, +bs. no hsm appreciated. ext: no calf tenderness. no edema neuro: ms , cn ii-xii in tact, ue/le strength 5+ bilaterally, 2+ dtrs (biceps, triceps, patellar), nl cerebellar pertinent results: . . . . . . . . . . . . . . . . . . . . . . . . brief hospital course: a/p: 82f w/mmp including sjogren's, renal failure secondary to proliferative gn, rle dvt, who represents to ed (on same day as discharge after lengthy hospital stay) with gib in setting of coumadin anticoagulation. . # gib: given ffp in ed, holding coumadin, follow inr, consider vit k. after large maroon bms in ed and hct 35->28 (although partly dilutional fr 2u ffp). - follow serial hcts. 2 large-bore pivs. ordered 2u prbc. t&c add'l units. - gi saw pt in ed & plan flex sig in a few hours after saline or tap water enemas . # rle dvt - holding coumadin, given recurrent gib, may require filter. . # proliferative gn/renal failure: cr 2.7 now, somewhat increased from recent baseline of 2.2, though was as high as 4.0 on recent admission. - cont prednisone qd, has been weaning by 5mg per week on alternating days (currently 50mg/45mg, started ) - cont monthly cytoxan (s/p 1st dose on ) - cont lasix (80 daily), calcitriol, vit d, caco3 . # pna: recently started on empiric therapy for ?hospital-acquired pna on vanco/zosyn - was due for last vanco dose 1/8, will dose after level returns. - cont zosyn through . # hyponatremia: stable, continue fluid restriction 1500cc . # anemia: likely multifactorial, w/ contribution from iron deficiency, gi bleeds, and cytoxan. cont epo q m,w,fr . # htn: continue diltiazem, isordil (note: lopressor seems associated w/hypothermia in this pt. will avoid lopressor) . # neuropathy: stable on neurontin . # sjogren's: stable currently. continue artif tears, saliva . # skin: pressure sores - has two sacral decubs. nepro supplementation, wound care. . # fen: low sodium renal diet; fluid restriction; follow lytes ppi - bowel regimen, sc heparin # ppx: sucralfate, ppi; no pneumoboots given known dvt # access: piv # code: full # dispo: back to rehab when stable # communication: questions about this patient and her complex hosptial course may be directed to dr. patient was taken to or on for: exploratory laparotomy, splenic flexure takedown, left colectomy, colonic intraoperative lavage, appendectomy, colorectal anastomosis and gastrostomy pod 1: postoperatively she was admitted to the sicu and kept intubated overnight. she was kept on levo and flagyl. heme-onc was consulted because of bleed and h/o dvt. following the labeling of tc-m red blood cells a gi bleed study was performed over a 9 minute period. the study does not demonstrate any evidence of active gi bleeding. pod 2 vascular surgery was consulted and an a-gram showed: the arterial blood supply of the right colon is unremarkable. there is no evidence of active extravasation or early draining veins. no active bleeding is noted in the small bowel. note is made of diffuse hyperemia of the entire small bowel in the parenchymal space without evidence of active extravasation. the stomach and duodenum are unremarkable on the celiac angiogram. she underwent bronchoscopy that did not show any mucous plugging. pod 8 pt was extubated. pod 9 a duplex doppler: reason: prior popliteal dvt. evaluate for extension from the tibial veins to the common femoral veins. there is no evidence of thrombus obstruction. there is normal compression, augmentation, and phasicity. compared to the prior study, which identified the right popliteal vein thrombus, there is nothing visualized on the current study. pod 10 a speach and swallow study showed: the pt was able to tolerate small cup sips of nectar thick liquid and bites of puree without overt s/s of aspiration. she will require assistance at meals. she will require cues to swallow 2x per bite of food. ms. will likely not be able to take in enough po at this time to maintain weight/nutritional status and should continue being fed primarily via peg, with supplemental po's, with goal of weaning from tube feeds. recommendations: 1.diet: nectar thick liquids/pureed solids ** the pt should continue to be fed primarily via peg at this time with supplemental po's as stated above** 2.pt will require assistance at meals small cup sips of nectar thick liquid always start meal with sips of liquid pt should be cued to swallow 2x per bite alternate between one bite food/one sip liquid 3.consider nutrition consult to determine caloric/supplemental needs for pt receiving tube feeds and po's with goal to wean from peg pod 13 patient is being discharged on a prednisone taper.steroid taper. she is currently on prednisone 35 qd. 35 qd 30 qd - 25 qd - 20 qd 15 qd 10 qd 5 qd note: dr. does not want the patient to be anticoagulated at this point. other consults during her complicated hospital stay include gi and renal. medications on admission: meds on admission: 1. polyvinyl alcohol 1.4 %, 1-2 drops ophthalmic prn 2. artificial saliva prn 3. mvi 4. folic acid 1 mg qd 5. cyanocobalamin 1000 mcg daily 6. neurontin 100 mg tid 7. diltiazem 90 mg qid 8. isosorbide dinitrate 40 mg tid 9. calcium carbonate 500 mg tid w/meals 10. trimethoprim-sulfamethoxazole 80-400 mg 1 tablet po daily 11. calcitriol 0.25 mcg po daily 12. clotrimazole 10 mg troche qid for 7 days 13. ranitidine 75 mg tablet 14. epoetin alfa 10,000 unit/ml solution sig: u inj qmofr 15. warfarin 1 mg tablet hs 16. furosemide 40 mg qam 17. piperacillin-tazobactam 2.25gm iv q8h x 3 days (last dose ) 18. vancomycin: give 1 500mg dose on , then discontinue medication. 19. prednisone 45 mg po qam for 7 doses decrease dose to 40mg discharge medications: 1. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: one (1) dropperette ophthalmic prn (as needed). 2. artificial saliva 0.15-0.15 % solution sig: 5-10 mls mucous membrane prn (as needed). 3. zinc oxide-cod liver oil 40 % ointment sig: one (1) appl topical prn (as needed). 4. lidocaine hcl 5 % ointment sig: one (1) appl mucous membrane prn (as needed). 5. isosorbide dinitrate 20 mg tablet sig: two (2) tablet po tid (3 times a day). 6. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 7. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 8. artificial tear ointment 0.1-0.1 % ointment sig: one (1) appl ophthalmic prn (as needed). 9. acetaminophen 160 mg/5 ml elixir sig: two (2) po q8h (every 8 hours) as needed for pain. 10. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 11. clonidine hcl 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 12. diltiazem hcl 360 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily): hold for sbp < 100 or pulse < 60. 13. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 14. prednisone 10 mg tablet sig: 3.5 tablets po daily (daily): see taper. tablet(s) 15. epoetin alfa 4,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 16. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: extended care facility: - discharge diagnosis: lower gastrointestinal bleeding arf dvt diverticulosis sjogrn's syndrome raynaud's htn hyperlipidemia anemia s/p tunneled line discharge condition: stable discharge instructions: 1. keep wound area clean and dry. take medications as prescribed. seek medical attention if you experience fever, chills, nausea, vomiting, increased abdominal pain, or bleeding. 2. remove staples in one week. 3. steroid taper. she is currently on prednisone 35 qd. 35 qd 30 qd - 25 qd - 20 qd 15 qd 10 qd 5 qd 4. dr. does not want her to be anticoagulated at this point. followup instructions: please contact dr. office at within the first few days after discharge to schedule a follow-up appointment. procedure: parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube open and other left hemicolectomy fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances colonoscopy endoscopic control of gastric or duodenal bleeding arteriography of other intra-abdominal arteries arteriography of other intra-abdominal arteries other incidental appendectomy flexible sigmoidoscopy transfusion of packed cells other irrigation of (naso-)gastric tube other gastrostomy transfusion of other serum control of epistaxis by anterior nasal packing local perfusion of large intestine diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified unspecified essential hypertension long-term (current) use of steroids acute posthemorrhagic anemia iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia other chronic pulmonary heart diseases acute respiratory failure pressure ulcer, lower back personal history of venous thrombosis and embolism other and unspecified coagulation defects diverticulosis of colon with hemorrhage epistaxis acute gastritis, with hemorrhage sicca syndrome nephritis and nephropathy, not specified as acute or chronic, with lesion of proliferative glomerulonephritis 

Answer: The patient is high likely exposed to