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 an 83-year-old female with poorly differentiated adenocarcinoma of the stomach (on chronic prednisone for rheumatoid arthritis) who presented with one episode of hematemesis and coffee-grounds. the patient reports feeling well up until this episode when she felt "clots" in her mouth. the patient does report black stool with constipation as well, but she is on iron therapy. she denies any change in bowel habits. at the rehabilitation facility, the patient's initial vital signs were stable but subsequent hypotension developed to a blood pressure of 80/56 with a heart rate of 132. in the emergency department, a nasogastric lavage revealed frank blood changing to a fruit-punch color with no clearing of bleeding after two liters of fluid. the patient received one unit of packed red blood cells for a hematocrit of 23.9. the patient was admitted to the intensive care unit for further evaluation. past medical history: 1. gastric adenocarcinoma (poorly differentiated); diagnosed in . (a) the patient received no chemotherapy, radiation therapy, or surgical intervention. (b) liver metastases were present on a positron emission tomography scan done at . 2. rheumatoid arthritis (on chronic prednisone). 3. aortic stenosis (with a valve area of 0.9 cm2 and an ejection fraction of 65% on an echocardiogram done at ). 4. status post laparoscopic cholecystectomy secondary to cholecystitis. 5. depression. 6. chronic lower extremity ulcerations. 7. endoscopic retrograde cholangiopancreatography in for pancreatitis. 8. status post colonoscopy in (done at ) which showed diffuse "small/mild diverticula." medications on admission: 1. prednisone 10 mg by mouth once per day. 2. aspirin 81 mg by mouth once per day. 3. calcium carbonate and vitamin d. 4. celexa 20 mg by mouth once per day. 5. pantoprazole 40 mg by mouth once per day. 6. colace 100 mg by mouth twice per day. 7. vitamin b12. 8. iron sulfate 325-mg tablets one tablet by mouth twice per day. 9. celebrex 200 mg by mouth twice per day. 10. glucosamine one tablet by mouth twice per day. 11. vicodin with dressing changes. 12. trazodone 25 mg by mouth at hour of sleep. 13. remeron 15 mg by mouth at hour of sleep. 14. duragesic patch 25-mg patch transdermally q.72h. allergies: 1. benzodiazepines (unknown reaction). 2. penicillin (unknown reaction). 3. the patient's records also indicate opioids allergies; however, she is on opioid therapy without issues. social history: the patient is living in on rehabilitation center in , . she has been there for seven weeks for physical therapy and treatment of her lower extremity ulcerations. she reports tobacco for "many years," but she quit greater than twelve years ago. the patient denies alcohol or drug use. her husband passed away in . she has family nearby; her children and grandchildren. her son and contact throughout this admission was (telephone number ; cell phone number ). code status: the patient is do not resuscitate/do not intubate but wishes for aggressive treatment. physical examination on presentation: physical examination upon admission revealed the patient's temperature was 99 degrees fahrenheit, her blood pressure was 115/58, her heart rate was 107, her respiratory rate was 18, and her oxygen saturation was 95% on room air. in general, the patient was a comfortable elderly woman in no acute distress. head, eyes, ears, nose, and throat examination revealed nasogastric tube was in place. the mucous membranes were dry. the conjunctivae were pale. the neck was supple. jugular venous pulsation was flat. no bruits or radiation of murmurs. pulmonary examination revealed the lungs were clear to auscultation bilaterally. no wheezes or crackles. cardiovascular examination revealed a 3/6 systolic murmur heard everywhere. the patient was tachycardic but regular. the abdominal examination was benign. no hepatosplenomegaly. no masses. there were normal active bowel sounds. extremity examination revealed ulnar deviation of the bilateral digits. there was joint swelling. mildly tenderness to palpation. the patient had chronic superficial lower extremity ulcerations which did not appear erythematous or purulent. the patient did have tenderness around the ulcerations. rectal examination revealed the patient was guaiac-positive with brown/hard stool. neurologic examination revealed the patient was intact. alert and oriented times three. strength was throughout. no focal deficits. skin examination revealed no rashes. there were bilateral lower extremity ulcerations. pertinent laboratory values on presentation: laboratories upon admission revealed the patient's white blood cell count was 7.3, her hematocrit was 23.9, her mean cell volume was 76, rdw was 17.5, and her platelets were 433. the patient's coagulations were normal. chemistries were significant for a blood urea nitrogen of 38 and a creatinine of 0.9; otherwise, chemistry was normal. pertinent radiology/imaging: electrocardiogram revealed a sinus tachycardia at a rate of 104. a computerized axial tomography of the chest done in (per report) revealed a dilated pulmonary artery and small bilateral pleural effusions, with no metastases. concise summary of hospital course by issue/system: 1. upper gastrointestinal bleed issues: the patient was seen by gastroenterology in the emergency department and underwent an upper endoscopy upon arrival to the intensive care unit. the esophagogastroduodenoscopy report commented on blood in the fundus and in the bulb, deformity of the pylorus, and a small hiatal hernia. a follow-up esophagogastroduodenoscopy was planned for the following morning due to the inability to move the large blood clot in the stomach. the patient was transfused two units of packed red blood cells on the evening on admission and received one more unit on the following day; for a total of three units during this hospital admission. her hematocrit remained stable for several days at 30. the repeat upper endoscopy showed a mass in the fundus and antrum with no obvious bleeding site. there was blood in the fundus and old adherent blood found throughout the stomach. the hematemesis was thought likely due to an ulcerating mass. the patient's celebrex, aspirin, and iron were held during this admission. the patient was started on high-dose intravenous pantoprazole and was changed to a by mouth regimen of pantoprazole 40 mg by mouth twice per day upon discharge. the patient was kept nothing by mouth with sips during the first two days of her admission and was advanced to a clear liquid diet on day three with good tolerance. 2. gastric adenocarcinoma issues: the patient has known metastases in her liver. she did not wish for chemotherapy or surgical intervention. the poor prognosis was discussed with the patient's family in a family meeting, and it was thought that aggressive treatment for her blood loss would be pursued for now. the patient was aware of hospice services and will consider them in the near future. the patient also did not wish to discuss her prognosis and diagnosis; however, she was fully aware of her illness. 3. rheumatoid arthritis issues: the patient was continued on her chronic prednisone dose at 10 mg by mouth once per day even though this may add to her risk of bleeding. it was thought that an adrenal insufficiency state would be more harmful. 4. pain management issues: the patient was maintained on her fentanyl patch in addition to tylenol and vicodin. all nonsteroidal antiinflammatory medications were held do to worry of worsening gastrointestinal bleeding. 5. aortic stenosis issues: the patient's aortic stenosis was stable with a valve area of 0.9 cm2. she had no evidence of congestive heart failure during this admission. 6. depression issues: the patient was continued on her home dosing of citalopram and mirtazapine. 7. nutritional issues: the patient was encouraged to drink clears; however, she had a small appetite. it was thought that nutrition might become an issue in the near future for this patient; however, she wished to eat without any supplementation. 8. disposition issues: a family meeting was held with the patient's son on to discuss long-term plans and goals for this patient. it was decided that the patient would continue to be do not resuscitate/do not intubate. however, the patient wished to pursue aggressive treatment of further bleeding episodes for now. the patient's family was made aware of hospice and would be interested in this in the near future (as explained above). the patient was to be discharged to her rehabilitation facility on when a bed becomes available; likely on or . a physical therapy service consultation was obtained prior to discharge in addition to a palliative care service consultation. condition at discharge: condition on discharge was stable. discharge status: discharge status was to on rehabilitation/nursing facility. medications on discharge: 1. prednisone 10 mg by mouth once per day. 2. aspirin 81 mg by mouth once per day. 3. calcium carbonate and vitamin d. 4. celexa 20 mg by mouth once per day. 5. pantoprazole 40 mg by mouth twice per day. 6. colace 100 mg by mouth twice per day. 7. vitamin b12 by mouth every day. 8. iron sulfate 325-mg tablets one tablet by mouth twice per day. 9. glucosamine one tablet by mouth twice per day. 10. vicodin with dressing changes. 11. trazodone 25 mg by mouth at hour of sleep. 12. remeron 15 mg by mouth at hour of sleep. 13. duragesic patch 25-mg patch transdermally q.72h. please note that the patient's celebrex and aspirin should be held indefinitely; however, the patient should continue her daily prednisone dosing. the patient was also on a higher dose of pantoprazole than previous to admission. discharge diagnoses: 1. upper gastrointestinal bleed. 2. gastric adenocarcinoma. 3. aortic stenosis. 4. rheumatoid arthritis. 5. depression. 6. chronic lower extremity ulcerations. 7. diverticulosis. discharge instructions/followup: 1. the patient was instructed to follow up as indicated at the rehabilitation facility. 2. the patient was also instructed to follow up with her primary care physician as needed (dr. ). , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine other endoscopy of small intestine diagnoses: malignant neoplasm of liver, secondary long-term (current) use of steroids acute posthemorrhagic anemia aortic valve disorders rheumatoid arthritis hematemesis ulcer of calf malignant neoplasm of fundus of stomach 

Answer: The patient is high likely exposed to