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 / sulfa (sulfonamides) / tetracycline / darvon attending: chief complaint: melena major surgical or invasive procedure: egd history of present illness: this is a 55 y/o f with a pmhx of ms, cad s/p mi/lad stent in , fvl def and prot s deficiency on coumadin, presented to an osh with n/v/coffee ground emesis x1 week, and melena x 3 days. she states that she has been feeling progressively weaker over the past 2 weeks, and developed nausea with coffee ground emesis intermittantly over the past week. she also states that she had black, tarry stools for the past 3 days. she does not know how many bms she is having per day; last melenic stool was 9am this morning. she was taken to an osh for further w/u this am. . at the osh, her hr was in the 130s with bp in the 80s; initial hct 31 --> 24.6, intial inr 10. pt received 10mg im vit k, ppi, 2u ffp, and 1u prbc. an ng tube at the osh showed coffee ground emesis, and she was placed on protonix gtt and taken to their gi suite where an an egd performed that saw copious blood in stomach on egd, ? duodenal angioma, ? duodenal bleeding, although no definitive source found. at that time, due to her coagulopathy, no intervention was performed. pt was transferred to to post-egd where she received a 2nd unit of prbc en route. . in our ed, t98.1, hr 130s, bp130/70 - received 2l ns. hct here 26.6, inr 2.7. she was admitted to the for monitoring and transfused an additional prbc with goal hct >28 given h/o cad; no active ischemia at this time. pt had 2 large bore iv's in place at all times and was placed on iv ppi . her asa, plavix and coumadin were held. gi was consulted and on hd#2 due to ongoing melena, with an inr of 5.8, she was transfused 3u ffp prior to having an additional egd which was unremarkable for any ulcer or bleeding diathesis. her hct remained stable over the next day, with no further episodes of melena. her diet was advanced as tolerated. currently she is s/p 6uprbcs in total with a stable hct for >48 hours. past medical history: h/o gib likely from duodenal avms as seen on prior capsule endoscopy multiple sclerosis ibs with frequent constipation cad (mi in ), s/p lad stent +factor v leiden (requiring coumadin) protein s deficiency h/o dvt/pe ptsd l knee arthroscopy degenerative disc disease treated with steroid injections asthma chronic pelvic pain d/t post-herpetic neuralgia social history: lives alone, not currently working, on disability. ppd tobacco since age 17, past heavy etoh use, quit 15 years ago. family history: breast and lung ca physical exam: on admission: vs: t98.4 hr85 bp124/65 rr16 o2sat: 100% ra gen: thin woman, in nad. heent: anicteric sclera. perrl. neck: no elevated jvp. cv: regular, nml s1,s2. no murmurs. resp: ctab. no c/w/r. abd: soft, nd. +bs. mild epigastric pain ext: no edema bilat. neuro: aaox3. moves all ext rectal: no masses. melenic stool in the vault, grossly guiaic positive. transfer to floor: vs: pertinent results: ekg: nsr, 95. nml axis, nml intervals. laa. <1mm depression in v4-v6, no prior to compare. no q waves. brief hospital course: impression: 55 y/o f with a pmhx of ms, cad s/p mi/lad stent in , fvl def and prot s deficiency on coumadin, presented to an osh with melena and found to have an inr of 10. . plan: # melena/coffee ground emesis pt with melena and 14 point drop in hct in the context of an inr of 10. likely ugi source given melena and coagulopathy and previous h/o duodenal avms seen on prior capsule endoscopy at osh. pt is s/p ffp, vit k at osh, inr 2.7 at time of admission. she was admitted to the for monitoring and transfused an additional prbc with goal hct >28 given h/o cad; no active ischemia at this time. pt had 2 large bore iv's in place at all times and was placed on iv ppi . her asa, plavix and coumadin were held. gi was consulted and on hd#2 due to ongoing melena, with an inr of 5.8, she was transfused 3u ffp prior to having an additional egd which was unremarkable for any ulcer or bleeding diathesis. her hct remained stable over the next day, with no further episodes of melena. her diet was advanced as tolerated. hct remained stable and she had no episodes of melena or hemetemesis while inpatient. she was maintained on ppi . . # coagulopathy pt with a reported inr of 10 at osh, unclear etiology, but likely due to decreased po intake over the past 2 weeks with poor follow up of inr levels. she received vit k at the osh, and received 1mg vit k iv as well as 3u ffp as above. her inr decreased to 1.8. her osh hematologist was contact regarding to restarting her anticoagulation in the setting of her gib, given her hypercoagulable state of +factor v leiden and protein s deficiency. coumadin was resumed at 2mg/day, without lovenox bridge intitially. however, inr continued to fall from 1.8 and her coumadin was increased slowly to 5 mg po qd and lovenox bridge was started on . her inr will need to be followed closely as an outpatient, with goal . we would recommend holding the coumadin at 5mg and allowing the inr to increase slowly so as not to overshoot and precipitate a gi bleed. plan to continue lovenox until inr therapeutic. . # hx of cad s/p lad stent (last echo nromal w. ef 55%. ekg only showed <1mm of st depressions laterally; 2 sets of ce's were negative. pt remained completely asymptomatic. her hct was transfused as needed to maintain hct >28. her asa, plavix were held, and her cardiologist was contact due to the fact that patient had been on plavix >18 months post-stent placement. her cardiologist (dr. , formerly at ) agreed that plavix was no longer needed, and to continue asa once tolerating in regards to her gib. her bblocker was initially held and then restarted once her sbp was stable. asa restarted on discharge. . # factor v leiden & protein s deficiencies pt with a hypercoagulable state, currently on coumadin and plavix for anticoagulation. anticoagulation was initially held in the setting of active gi bleed. after discussion with her cardiologist, plavix was discontniued indefinitely. since she has a stent she does require a full dose aspirin which was re-started immediately before discharge, and after consultation with the hematology service, coumadin was restarted at a lower dose than previous. given the amount of vitamin k she recived at the osh, it is likely that it will be quite some time before patient is therapeutic and her inr should be watched very closely as an outpatient to allow for the appropriate dose adjustments. . # chronic pain: patient has very complex pain issues and attends an outpatient pain management clinic. continued topamax, ultram, lidoderm patch, vicodin prn. nortriptiline was stopped and trazadone was increased to 500mg po qhs and ambien continued at night. . # mild asthma - cont albuterol . # ativan prn - started on klonopin during this admission. she was on 0.5 tid, and dose was increased to 1mg . consider increasing this to 1mg tid as needed. . # ppx - on lovenox, ppi . medications on admission: protonix 40mg plavix 75mg qhs asa 325 toprol 25mg topamax 75 tid nortryptiline 100 qhs trazadone 300mg qhs valtrex 1gm qd ultram 100mg tid lipitor 80 vicodin soma 350 tid coumadin (5 smtwf, 6 thsa) miralax albuterol prn advair prn boniva lidoderm patch discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 2. aspirin ec 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 3. topiramate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 4. trazodone 100 mg tablet sig: five (5) tablet po hs (at bedtime). 5. tramadol 50 mg tablet sig: two (2) tablet po tid (3 times a day). 6. carisoprodol 350 mg tablet sig: one (1) tablet po tid (3 times a day). 7. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 8. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po twice a day. 9. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 10. artificial tear with lanolin 0.1-0.1 % ointment sig: one (1) appl ophthalmic prn (as needed). 11. nicotine 7 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). 12. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime). 13. erythromycin 5 mg/g ointment sig: one (1) ophthalmic qid (4 times a day). 14. lidocaine hcl 2 % gel sig: one (1) appl urethral (2 times a day) as needed. 15. docusate sodium 100 mg tablet sig: one (1) tablet po bid (2 times a day). 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 17. clonazepam 1 mg tablet sig: one (1) tablet po twice a day as needed. 18. warfarin 5 mg tablet sig: one (1) tablet po hs (at bedtime). 19. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed. 20. enoxaparin 40 mg/0.4 ml syringe sig: one (1) subcutaneous twice a day. 21. valtrex 1 g tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary: gastrointestinal bleed elevated inr . secondary h/o gib likely from duodenal avms as seen on prior capsule endoscopy multiple sclerosis ibs with frequent constipation cad (mi in ), s/p lad stent +factor v leiden (requiring coumadin) protein s deficiency h/o dvt/pe ptsd l knee arthroscopy degenerative disc disease treated with steroid injections asthma chronic pelvic pain d/t post-herpetic neuralgia discharge condition: good. patient able to sit in chair and ambulate. hct stable without evidence of ongoing bleeding. discharge instructions: please take all of your medications as prescribed. please call your pcp or return to the ed if you have shortness of breath, chest pain, fevers, chills, nausea, vomiting, bright red blood per rectum, melena, or other symptoms that are of concern to you. followup instructions: please call your pcp, . , at to schedule a follow up appointment 1-2 weeks after you are discharged from the rehabilitation facility. . please schedule a follow up appointment with your neurologist, dr. , at your earliest convenience. she has been e-mailed and is aware of your recent admission. procedure: other endoscopy of small intestine transfusion of packed cells transfusion of other serum other endoscopy of small intestine transfusion of packed cells transfusion of other serum diagnoses: tobacco use disorder iron deficiency anemia secondary to blood loss (chronic) percutaneous transluminal coronary angioplasty status blood in stool long-term (current) use of anticoagulants personal history of venous thrombosis and embolism primary hypercoagulable state hematemesis multiple sclerosis unspecified gastritis and gastroduodenitis, without mention of hemorrhage herpes zoster with other nervous system complications congenital deficiency of other clotting factors 

Answer: The patient is high likely exposed to