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: vicodin / percocet / darvocet a500 / oxycodone / vancomycin / adhesive tape attending: chief complaint: epistaxis and dark stools major surgical or invasive procedure: hemodialysis esophagogastroduodenoscopy history of present illness: mr. is an 83 y/o man with pmh of cad s/p 3v cabg in , nstemi in with des in left main, esrd on hd, pvd, aaa s/p repair, bullous pemphigoid, h/o ugib 2 months ago, ischemic colitis , who presents with black stool and bleeding through his nose. . he was in his prior state of health until , when he presented to the with blood in his stool. he required a total of 7 rbc units and 2 ffps (with normal inr) with an hct nadir of 24.7. he was initially intubated to protect the airway. he underwent egd on , which showed blood in the esophagus, stomach and duodenum with a clot in the alter that could not be removed. subsequent egd 2 days latar showed only mild inflammation of mucosae. findings were atributed to steroids he was taking for his pemphigus. no biopsies reports available. patient was discharged to rehab on pantoprazole with an hct of 37. . on day of admission at the nursing home, he had multiple bowel movements with black, smelly stools that were concerning for melena. of note, patient reported nose bleed for 1 hour yesterday that dripped through the back of his nose and stopped spotaneously. he denies any abdominal pain, fever, chills, rigors, vomiting blood, cough, shortness of breath, diziness, lightheadedness, chest pain, palpitations. he has been taking his medications as prescribed including omeprazole 20 mg daily (he was on pantoprazole 40 at discharge). there was concern about gib and he was transfered to our hospital for evaluation. . in the er his initial vital signs were: pain 0/10, r 97.3 f, hr 70 bpm, bp 116/40 mmhg, rr 16 x', spo2 98% on ra. he looked comfortable, without abdominal pain and had marroon stools in his rectal vault taht were frankly guaiac positive. his ecg showed nsr without any signs of ischemia. his hct was 29 down from 37 2 months ago. patient had an ngl, whcich showed fluid that cleared. there were no clots or coffee grounds. he received iv protonix x1 and was t&c 2 rbc units. gi was made aware as well as renal (per report) and patient was admitted to the with 2 18g for hemodynamic monitoring. . his course was notable for transfusion of 1 unit prbc for hct drop to 25 from 29. hct remained stable. epistaxis stopped and no evidence of gi bleed since admission. the patient was transferred to the for hemodialysis. also, the patient has a history of a recent diagnosis of squamous cell ca of the tongue base, this was visualized by the icu team and felt not to be the source of bleeding. ent deferred scope to evaluate epistaxis. also evaluated by gi who did not see urgent need for scoping. . on arrival to the medical floor, the patient is resting comfortably with no complaints. has not moved bowels since . no further epistaxis. past medical history: 1)cad -s/p 3-vessel cabg in (lima-lad, svg-rca-occluded, svg-om1/om3 occluded) -s/p nstemi in (des in l main) 2)esrd -lue avf, hd mwf -per patient, has congenital left kidney hypoplasia 3)aaa -s/p repair () 4)pvd -s/p aortobililiac graft in -s/p left cea in ( us showed right ica 70-79% stenosis, left ica 1-39% stenosis) 5)ischemic colitis -admitted for bloody diarrhea, uneventful hospital course 6)spinal stenosis -s/p discectomy and arthrodesis at c5-c6 and c6-c7 -baseline impairment in walking (uses motoroized wheelchair or walker) 7)right renal tumor, suspicious for rcc, undergoing watchful waiting, followed by dr. 8)prostate cancer -s/p brachytherapy in 9)abdominal wall abscess in , s/p i&d, cultures grew actinomyces 10)cholangitis -s/p cck in 11)bullous pemphigoid (diagnosed in ) -dermatologist is dr. 12)s/p cataract surgery on left eye 13) diverticulosis 14) s/p ugib with a possible ulcer on egd that required 7 rbc units and 2 ffps social history: lives alone at residency. he previously worked as a district manager for metropolitan life. 60 pack-year smoking history, quit 10 years ago. occasional social alcohol use. family history: one daughter (53) and son (57), both in good health. one sister with diverticulitis. physical exam: vital signs - t 98.6 hr 67-80 bp 128-136/49-60 rr 18 o2 95% ra gen: nad, pleasant heent: anicteric sclera, mmm, op clear neck: supple, no jvd lungs: ctab with no w/r/r. cv: rrr with 3/6 lusm heard across precordium; median sternotomy scar noted. abd: soft, nt, nd, +bs in 4 quadrants. no g/r/r. extremities: no pedal edema, 1+ dp bilat skin: scattered red raised rash across extremities and torso neuro: a&ox3, cns ii-xii grossly intact, muscle strength 5/5 throughout, sensation grossly intact throughout pertinent results: complete blood count: 02:30pm blood wbc-12.6* rbc-3.11* hgb-8.8* hct-29.2* mcv-94 mch-28.4 mchc-30.3* rdw-16.7* plt ct-227 08:07pm blood hct-25.2* 03:52am blood wbc-11.2* rbc-3.36* hgb-9.9* hct-30.8* mcv-92 mch-29.5 mchc-32.2 rdw-16.8* plt ct-217 06:26pm blood hct-27.0* 08:10am blood wbc-10.5 rbc-2.94* hgb-8.6* hct-26.9* mcv-92 mch-29.2 mchc-31.9 rdw-17.5* plt ct-222 04:44pm blood hct-27.3* 07:30am blood wbc-8.6 rbc-3.12* hgb-9.1* hct-28.4* mcv-91 mch-29.3 mchc-32.2 rdw-17.1* plt ct-232 07:44am blood wbc-10.8 rbc-3.39* hgb-9.9* hct-30.8* mcv-91 mch-29.2 mchc-32.1 rdw-17.9* plt ct-233 10:30am blood hct-31.6* 02:30pm blood neuts-77.2* lymphs-11.9* monos-7.4 eos-3.1 baso-0.4 . basic metabolic profile: 02:30pm blood glucose-128* urean-107* creat-6.7*# na-137 k-4.4 cl-98 hco3-22 angap-21* 03:52am blood glucose-87 urean-117* creat-7.5* na-140 k-5.4* cl-99 hco3-21* angap-25* 08:10am blood glucose-72 urean-51* creat-4.3*# na-137 k-3.5 cl-96 hco3-29 angap-16 07:44am blood glucose-78 na-140 k-3.4 cl-98 hco3-32 angap- 03:52am blood albumin-3.1* calcium-9.1 phos-5.3*# mg-2.5 08:10am blood albumin-2.9* calcium-8.2* phos-3.6# mg-1.8 07:30am blood calcium-8.7 phos-5.1* mg-1.9 07:44am blood calcium-8.8 phos-4.1 mg-1.8 . liver function tests: 03:52am blood alt-15 ast-32 ld(ldh)-289* alkphos-105 totbili-0.7 08:10am blood alt-9 ast-18 alkphos-95 totbili-0.3 . ecg (): sinus rhythm. there are q waves in the inferior leads consistent with prior myocardial infarction. there is a late transition that is probably normal. non-specific st-t wave changes. left atrial abnormality. compared to the previous tracing there is no significant change. . egd : normal mucosa in the esophagus patchy gastritis in antrum and fundus patchy duodenitis in duodenal bulb otherwise normal egd to third part of the duodenum recommendations: our findings do not account for a bleeding source from esophagus to second part of duodenum continue high dose ppi brief hospital course: this is an 83 y/o man with pmh of cad s/p 3v cabg in , nstemi in with des in left main, esrd on hd, pvd, aaa s/p repair, bullous pemphigoid, h/o ugib 2 months ago, ischemic colitis , was originally admitted to the on with black stool and epistaxis. #. melena/epistaxis - given patient's history, initial concern for ugib due to melanotic stools and history of pud. however, patient had history of severe epistaxis lasting for several hours that corresponded with the onset of melena. initial hct drop since prior discharge led to 1 unit prbc transfusion in the , though patient remained hemodynamically stable. after discussion with gi team, emergent egd was deferred. ent team did not recommend a scope to evaluate epistaxis but will need outpatient follow up. patient remained hemodynamically stable during his icu course with no further bleeding requiring aggressive resuscitation. upon transfer to the medicine floor, hematocrit remained stable in the high 20s, and patient was transfused one more unit during hemodialysis prior to discharge. did not have any further episodes of melena of epistaxis. gi team was re-consulted to discuss utility of scoping procedure given indeterminate source of bleeding in setting of high bleeding risk (chronic aspirin, long-term prednisone for bullous pemphigoid, platelet dysfunction with esrd) and prior significant ugib. patient underwent egd, which did not show any source of bleed to cause melena. patient discharged with po ppi, and close ent follow up. #. anemia - upon admission, hematocrit found to be 29, which is significantly lower from 37 approximately 2 months prior. anemia in this patient likely multifactorial. patient with esrd on hd, diverticulosis, recent epistaxis, history of pud, with ferritin of 510, tibc 192, iron 23, trans 148, folate 15.2, b12 865 on . received 2 units prbcs during hospitalization as above and hematocrit was trended closely. remained hemodynamically stable at the time of discharge with stable hematocrit. #. cad - pt with known cad s/p cabg in and nstemi s/p des in . pt chest pain free and with normal ecg. aspirin was initially held in the setting of melena and hematocrit drop but will be restarted as an outpatient at dose of 81mg daily on , 2 weeks after normal egd. patient continued on home metoprolol and statin. # squamous cell ca of tongue - patient is currently deferring treatment with radiation or chemotherapy. will need follow up with ent as an outpatient. #. pvd/aaa - stable. pt was evaulated with ct during last hospitalization for possible fistula, but work up was negative. he has a graft and has been asymptomatc. #. esrd - renal service followed patient in house. was on m/w/f hemodialysis schedule. started nephrocaps daily per renal recs and discontinued vitamin b complex given initiation of nephrocaps. received one unit prbcs during hd as above and epo with hd. #. bullous pemphigoid - continued on low dose 5mg po daily prednisone initially. contact outpatient dermatologist, who reported that if no active bullae were present, it would be reasonable to taper down prednisone. his dose was reduced to 4mg daily and will be tapered by 1mg per week until discontinued. he will follow-up with his dermatologist as an outpatient. clobetasol ointment could be used for solitary lesions. #. diverticulosis - stable. medications on admission: home medications. * metoprolol 25 mg po bid * simvastatin 40 mg po daily * aspirin 81 mg po daily * ezetimibe 10 mg po daily * omeprazole 20 mg po daily * midodrine 5 mg po qtuthsa prior to hemodialysis. * citalopram 20 mg po daily * prednisone 5mg daily * acetaminophen 325 mg q6 hrs prn pain/fever * simethicone 80 mg po qid * calcium carbonate 500 mg po tid * calcium acetate 667 mg po tid * sevelamer carbonate 1600 mg po tid * senna 8.6 mg po bid prn constipation * colace 100 mg po bid * b complex-vitamin c-folic acid 1 mg po daily * oxazepam 10 mg capsule po qhs * natural tears * guaifenesiin 40 mg ab tid * tramadol 50 mg po q6hrs prn pain * compazine 10 mg po bid prn n/v discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 4. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 5. midodrine 5 mg tablet sig: one (1) tablet po qtuthsa (tu,th,sa): please give prior to hd. 6. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 7. prednisone 1 mg tablet sig: four (4) tablet po daily (daily): take 4mg daily until switch to 3mg daily on . on , decrease to 2mg daily. on , decrease to 1mg daily. 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever / pain. 9. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for epigastric pain. 10. calcium acetate 667 mg tablet sig: one (1) tablet po three times a day. 11. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 12. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. oxazepam 10 mg capsule sig: one (1) capsule po hs (at bedtime) as needed for insomnia. 16. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 17. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po twice a day as needed for nausea. 18. natural tears (pf) ophthalmic 19. calcium carbonate 500 mg (1,250 mg) capsule sig: one (1) capsule po three times a day. discharge disposition: extended care facility: rehab and care center discharge diagnosis: primary: melena epistaxis end stage renal disease secondary: coronary artery disease bullous pemphigoid discharge condition: mental status: clear and coherent level of consciousness: alert and interactive discharge instructions: you were admitted to the hospital for black stools after a nose bleed. you were monitored in the intensive care unit and received 2 units of blood to improve your blood count. imaging of your upper gi tract did not show any signs of bleeding to cause dark stools, and you likely swallowed blood from your nose bleed. your aspirin was held, and you should slowly decrease the amount of prednisone you take to decrease your chances of another bleed. please follow-up with your dermatologist and ent as below. the following changes were made to your medications: 1. held your aspirin. you should begin taking 81mg of aspirin a day on . 2. decreased your prednisone to 4mg daily. on , reduce to 3mg daily. on , reduce to 2mg daily. on , reduce to 1mg daily. you should see your dermatologist as below to discuss this further. 3. increased your omeprazole to 40mg twice daily. you can discuss how long to need to stay on this increased dose at your follow-up appointment with dr. in . started nephrocaps vitamin daily in place of your vitamin b complex. 5. increased your sevelamer to 2400mg three times a day. followup instructions: dermatology provider . on at 11:45. this appointment is at her office on . if you need to reschedule, please call . ent provider . on at 1:40. their office is located at . if you need to reschedule, please call . previously scheduled appointments: provider: , .d. phone: date/time: 2:15 provider: , md phone: date/time: 2:40 procedure: other endoscopy of small intestine hemodialysis other irrigation of (naso-)gastric tube diagnoses: anemia in chronic kidney disease end stage renal disease renal dialysis status esophageal reflux acute posthemorrhagic anemia personal history of malignant neoplasm of prostate coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status peripheral vascular disease, unspecified blood in stool duodenitis, without mention of hemorrhage abdominal aneurysm without mention of rupture unspecified gastritis and gastroduodenitis, without mention of hemorrhage diverticulosis of colon (without mention of hemorrhage) epistaxis neoplasm of uncertain behavior of kidney and ureter malignant neoplasm of tongue, unspecified pemphigoid 

Answer: The patient is high likely exposed to