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: service: medicine history of present illness: miss is a 66-year-old woman with a past medical history of peptic ulcer disease in , negative h. pylori who initially presented to from an outside hospital due to hematemesis times two of bright red blood. at the outside hospital she was dizzy, tachycardic to 120's but with stable blood pressure of 120/80. she received iv fluids and was given iv protonix. she was transferred to for interventional gastroenterology services. at she was admitted to micu a, was vigorously hydrated with iv fluids and had an egd showing grade 1 esophageal varices in the mid and distal esophagus with gastric varices in the body and fundus. the gastric varices were ungraded. there was clotted blood in the distal of the esophagus as well as the fundus and body obscuring much of the view. the first endoscopy was done on . the patient also had an ultrasound on that showed a heterogenous liver, normal blood flow, evidence of patent vessels, edematous gallbladder wall which is often found in cirrhosis or in low protein states and heterogenous liver is consistent with fatty liver cirrhosis or fibrosis. past medical history: peptic ulcer disease in , lymphedema bilateral lower extremities secondary to surgery for vins, status post appendectomy, status post oophorectomy secondary to a ruptured ovary. allergies: percodan, change in mental status. erythromycin. medications: zantac 75 mg . family history: mother and father both have coronary artery disease. mother with diabetes mellitus. social history: the patient reports drinking alcoholic drinks on baseline, however, drinking more drinks per day recently over the past few months due to stress. the patient quit tobacco 12 years ago. she enjoys gardening as well as recently begun exercise tapes. the patient denies drug abuse. physical examination: vitals on transfer from the micu to medicine floor, temperature max 100.1, temperature current 98.4, heart rate 86-104, blood pressure 90-128/45-73, 80.9 kg, breathing at 14:20, 99% on room air. patient was not in acute distress and comfortable. extraocular movements intact, pupils are equal, round, and reactive to light and accommodation, anicteric eyes. moist, mucus membranes, no oral lesions, positive telangiectasias on her face as well as seborrheic dermatitis on her forehead and by her nose. lungs clear to auscultation bilaterally, no wheezes, rales, rhonchi, s1 and s2, regular rate and rhythm, 1/6 systolic murmur at the left upper sternal border. abdomen nondistended, tympanic, obese, soft, no rebound tenderness, no hepatosplenomegaly appreciated but her abdomen was distended. there was no pain on palpation whatsoever. patient alert and oriented times three, cranial nerves grossly intact, normal gait, no clubbing, cyanosis or edema but lower extremity stockings were in place. dorsalis pedis and posterior tibial pulses were palpable . review of systems: patient denies chest pain, fever, nausea, vomiting, abdominal pain, shortness of breath, positive for melena. laboratory data: on hemoglobin 9.6, hematocrit 29.8. patient's hematocrit was stable at approximately 30 to 31 for her whole admission, white count 5.6, platelet count 81,000. patient's hematocrit on admission was 34.7, decreased status post vigorous iv hydration and remained constant at approximately 30, inr 1.5. the patient received three doses of vitamin k with no significant change in the inr. sodium 141, potassium 4.2, chloride 111, co2 23, bun 11, creatinine .6, glucose 111. hepatitis surface antigen negative. hepatitis c negative. hepatitis b surface antibody negative. hepatitis b core antibody pending. alt 32, ast 92, ld 321, alkaline phosphatase 130, total bilirubin 1.7, direct bilirubin .4, magnesium 1.2, phosphorus 1.4, calcium 7.6, albumin 3, b12 420 and folate 6. mcv 109. hospital course: the patient is a 56-year-old woman with peptic ulcer disease and alcohol use who presents with gross bright red hematemesis times two with initial hematocrit drop from 39 to 34.7, 39 at the outside hospital and then 34.7 at admission here with ultrasound and chemistry data, i.e. ast, alt ratio suggesting alcohol liver disease as well as pulmonary hypertension due to varices on esophagogastroduodenoscopy. however, the varices were not bleeding at the initial esophagogastroduodenoscopy on . 1. gi: the patient was placed on octreotide drip for 72 hours to decrease the possibility of variceal bleeding. she had a repeat endoscopy on which showed grade 1 varices in the lower third of the esophagus. the varices were not bleeding. in the stomach there was diffuse erythema, congestion, friability of mucosa with contact bleeding in the fundus and antrum. these were compatible with gastritis. the duodenum was normal. impression was varices in the lower third of the esophagus, grade 1, erythema, congestion, friability in the fundus and antrum compatible with gastritis. otherwise normal esophagogastroduodenoscopy to the second part of the duodenum. the patient started on iv fluids, was advanced to a clear diet and then to pureed solid until the final esophagogastroduodenoscopy after which the patient was able to have a regular diet. the patient was placed on protonix 40 mg po q d. the patient was also placed on propranolol 20 mg as an outpatient for the grade 1 varices and prophylaxis of bleeding. the patient was also placed on ciprofloxacin 500 mg for two days status post the final esophagogastroduodenoscopy. she had it for the beginning of the first esophagogastroduodenoscopy through two days after the second esophagogastroduodenoscopy for sbe prophylaxis in the context of newly diagnosed cirrhotic with an upper gi bleed. the patient was placed on thiamine and folate. the patient was to follow-up at clinic here for continued follow-up of her varices as well as work-up for her liver disease. 2. heme: patient's hematocrit was stable at 30. cbc were followed throughout her stay at the hospital with no change in hematocrit. hemodynamically is stable for her stay. 3. id: patient, on the second day on the floor, spiked high grade temperatures to as high as 105.2. first the patient had spiked to 101.6, blood cultures were drawn on . they were repeated on . there were no growths from any of the blood cultures. stools were sent for c. diff which were also negative. the patient had no obvious source of infection. she had no neck stiffness, no headache. lungs were clear to auscultation bilaterally, no cough, no shortness of breath, no chest pain, no new murmur, no abdominal pain, no abdominal findings on exam, no ascites by ultrasound on the or no ascites on ct of the abdomen on . patient's only site seemed to be a septic superficial thrombophlebitis of her right arm which after insertion of an iv was hot, red and painful to the patient. she was started on cefazolin for the arm iv site infection and warm compresses were placed and warm packs were placed on the site. after two days the site became less erythematous, less warm, less painful and the patient's fevers broke. the patient received maximum dose of 2 gm of tylenol per day for treatment of the fever. she did not receive any nsaids to the risk of gi bleed. she also used a cooling blanket as an adjunct which did in fact work in reducing her temperature. the night that her temperature was 105.2 the cooling blanket dropped it to 102.5 at which point she was able to receive tylenol on that evening after the 24 hour period had passed. on the date of discharge the patient was afebrile for 24 hours, all cultures were negative, the infection in her arm was resolving and she is to complete 7 more days of po antibiotics and was switched to keflex for the infection in her right arm. 4. psychiatry: the patient was covered with ciwa scale and ativan for possible alcohol withdrawal, however, after receiving some ativan in the micu she did not need any on the floor and repeatedly denied feeling like she had any symptoms of withdrawal or any anxiety. 5. prophylaxis: the patient received sq heparin q 12 hours as well as the protonix. the patient was discharged on . discharge diagnosis: 1. gastritis, grade 1 non bleeding esophageal varices and alcohol liver disease. the patient was discharged home with follow-up with dr. , her primary care physician, to follow-up this week. she was also to follow-up with gastroenterology (dr. in the next coming weeks. discharge condition: good. discharge medications: keflex 500 mg times 7 days, ciprofloxacin 500 mg times two days, protonix 20 mg q d and propranolol 20 mg po bid. , m.d. dictated by: medquist36 procedure: other endoscopy of small intestine other endoscopy of small intestine diagnoses: alcoholic cirrhosis of liver cellulitis and abscess of upper arm and forearm unspecified gastritis and gastroduodenitis, with hemorrhage esophageal varices in diseases classified elsewhere, without mention of bleeding 

Answer: The patient is high likely exposed to