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: bactrim / aspirin attending: chief complaint: dark stools major surgical or invasive procedure: egd and femoral line placement and discontinuation history of present illness: mr. is a 47yo gentleman with h/o esrd s/p kidney transplant in , hiv (cd 4 77 and vl undetectable ), svc syndrome s/p stent on asa and plavix who was admitted earlier today () with a 3 day history of melena. he originally presented to kidney transplant clinic, where he noted that he had been having black bowel movements. exam revealed hr 122 with bp 125/91 and grossly guaiac positive stools. he was directly admitted to the hospital for further management. upon admission to the hospital, he denied dizziness or lightheadedness. his orthostatics were positive and he continued to be tachycardic at 100 with sbp in 120s. hct at noon was 26 (baseline is 30-35) and coags were normal. gi was consulted and recommended iv ppi , monitoring serial hct, and planned on egd in am. his asa was held but plavix was given. in the late afternoon, he became increasingly tachycardic but did not complain of any symptoms. his 7pm labs revealed a hct drop from 26 to 16. he began to complain of dizziness and then had a large grossly melenotic bowel movement. micu was contact to evaluate the patient. he denies chest pain, shortness of breath, hematemesis, or hematochezia. past medical history: hiv/aids diagnosed , vl undetectable and cd4 77 in . esrd htn or hiv. s/p cadaveric kidney transplant . disseminated tuberculosis in with ruq, psoas, submandibular abscess, peritonitis, pyelonephritis h/o positive rpr anemia baseline hct 30-35 but has dipped into upper 20s htn neuropathy oa of right knee esophagitis/stomach ulcer s/p ? surgery early s/p gunshot wound to abdomen- in record but pt denies this depression bacteremia with mssa in , svc syndrome followed by heparin tx which was discontinued lgib complete occlusion of the left innominate vein stent. s/p angioplasty with recanalization allergies: bactrim (rash), asa (bleeding) pcp: renal: social history: lives alone in an apartment in jp. married, wife lives in area with 2 sons- aged 10 and 17-who are hiv negative. denies etoh, ivdu, or illicit drugs. smoked 3 cigarettes/day. disabled on ssdi since . came to the us in , first having lived in and since in . his wife also has hiv. family history: not contributory physical exam: vitals - 100.3 115 203/94->151/86 17 100% ra general: pale, tearful, no acute distress. heent: mmm cardiac: regular tachycardia without a murmur. lung: crackles at bases b/l with superimposed transmitted upper airway sounds. abdomen: +bs, soft, and not tender. palpable kidney transplant. ext: no clubbing, cyanosis, edema. 2+ dp bilat. lue av fistula with palpable thrill. neuro: aa+ox3. cn ii-xii intact. moving all extremities. skin: no rash pertinent results: ekg: sinus tachycardia with normal axis and intervals, poor r wave progression (which is present at baseline from 07/). upon arrival to micu, patient has mild t wave flattening in lateral leads. 05:00am blood wbc-5.3 rbc-3.19* hgb-10.2* hct-29.7* mcv-93 mch-32.0 mchc-34.4 rdw-20.6* plt ct-187 08:45am blood pt-11.8 ptt-23.5 inr(pt)-1.0 05:00am blood glucose-116* urean-29* creat-2.3* na-137 k-3.8 cl-111* hco3-22 angap-8 04:15am blood alt-31 ast-29 ld(ldh)-196 alkphos-193* totbili-0.2 05:00am blood calcium-8.2* phos-2.2* mg-1.9 05:00am blood tacrofk-9.1 . cxr there is no chf. cardiomegaly is stable. there is no pneumothorax or enlarging pleural effusions. minimal atelectasis in the left base is noted. multiple small calcifications are again noted in the spleen and left brachiocephalic stent is noted. . left ue venous us- no evidence of dvt in the left upper extremity. left internal jugular vein is also patent. . egd: grade 1 esophagitis in the lower third of the esophagus petechiae, erythema and erosion in the antrum compatible with erosive antritis. ulcer in the second part of the duodenum. otherwise normal egd to second part of the duodenum . egd: blood in the stomach body and antrum ulcer in the second part of the duodenum (injection, thermal therapy) (biopsy). friability and erythema in the first part of the duodenum and second part of the duodenum compatible with duodenitis otherwise normal egd to second part of the duodenum brief hospital course: 47yo gentleman with h/o hiv/aids, esrd s/p kidney transplant, and svc syndrome s/p stent on asa and plavix with upper gi bleed admitted and transferred the same day to the icu in the setting of ongoing melena and 10 point hct drop. gi bleed: on admission, hct 26 but within 7 hrs of admission, hct dropped to 16 and pt became tachycardic to 140's on the floor. the pt also had several melanotic stools during that time. at the start of the patient's admission with the micu on , he had an initial hct of 16, tachycardia to 130's, dizziness, and continuing melena. the patient was type and crossed and began to receive transfusions of prbcs to keep his hct above 25. gi was consulted and performed an egd on which initially showed grade 1 esophagitis, erosive antritis, and a single superficial non-bleeding 5mm ulcer in the second part of the duodenum. on , the patient continued to have melena along with hematemesis, tachycardia, and a hct drop to 20; transfusions of prbcs were continued to keep his hct above 25; gi performed a second egd which showed a 1cm ulcer in the second part of the duodenum and was cauterized and injected with epi. during the admission, the patient was given multiple fluid boluses as needed for tachycardia. he was kept on an iv pantoprazole drip for the majority of course in the micu. line was placed on in the patient's left femoral vein in order to achieve access as his pivs had fallen out; this line was d/c'ed on prior to d/c and a piv was placed in his right arm. the patient continued to be transfused and his hct eventually stabilized to high 20's or low 30's. in total, the patient was transfused 10 units of prbcs and 1unit of platelets. upon transfer to the floor, his hct was 29.4, his tachycardia resolved to his baseline 90-100, and his hematemesis/melena had resolved. on the floor, hct was stable and 29.7 at the time of discharge. the pt was maintained on epo during this admission for his persistent anemia. hypertension: upon admission, the patient's sbp was at a max above 200 and would remain within the 140-160's. during his admission, renal was consulted with regards to the management of his hypertension. his anti-hypertensive medications were initially held during his acute bleed except for hydralazine iv which was given during extremely elevated episodes of htn (eg: sbp>200) which usually occured secondary to anxiety or after episodes of emesis. on , the patient was begun on his home anti-hypertensive medications including po amlodipine, metoprolol, and lisinopril which decreased his average sbp to the 110-120's. during the patient's admission he denied any neurologic or cardiac related complications including headache, chest pain, or vision changes. upon transfer to floors, the patient had a bp 122/74. on the floors, the pt remained normotensive on metoprolol, lisinopril and valsartan. he was discharged on the same. esrd s/p r kidney transplant- during the patient's admission, his bun/cr was monitored daily and was consistently found to be within his baseline range of 1.9-2.4. the patient maintained adequate urine output. he was continued on his home doses of mycophenolate mofetil and tacrolimus initially in the iv form before he was able to tolerate po medications; tacrolimus levels were checked daily and remained within therapeutic ranges. he was initiially provided with soumedrol before changing him to his home po daily dose of prednisone. the patient's transplant condition was followed by renal during his admission. svc syndrome s/p l brachiocephalic stent and h/o rue dvts: when the patient was admitted, his asa and plavix, which were used for stent stenosis prophylaxis, were held in order to not exacerbate his acute gi bleed. during his admission, he complained of left facial/jaw and left shoulder/proximal arm swelling; an u/s of his left upper extremity on showed patent central veins and no evidence of ue dvts; it was felt that this swelling was most likely dependent edema rather than stenosis of his stent. furthermore, the patient reported that he occassionally gets facial swelling when he lays on that side at night. through discussions with the patient's gi team, it was recommended to hold his asa and plavix for two weeks from the time of his egd on with a re-start date of his plavix on . the team did not feel restarting aspirin in the foreseeable future would be beneficial in light of pt's h/o ugib. the pt will follow up with gi to discuss restarting his plavix as above. hiv/aids: from previous records, it was seen that the patient had an undetectable viral load and a cd4 count of 77 in . he remained on his antivirals of combivir, efavirenz, and abacavir once he tolerated po medications. he was kept on dapsone and azithromycin as prophylaxis during his admission. depression: the patient maintained a flat affect during his admission; he continued to take his mirtazipine; and was followed by his transplant social worker who knows the patient well. medications on admission: abacavir-lamivudine- zidovudine (trizivir) 300-150-300 amlodipine 5mg qday azithromycin 600 2 tabs q saturday hs plavix 75 qday dapsone 100 qhs efavirenz 600 qhs epoetin alfa 20,000 u q week - mondays lasix 40mg 1-2 tabs qday prn lower extremity edema - not currently taking lansoprazole 30mg qhs lisinopril 40 qhs metoprolol xl 100mg 3 tabs qam mirtazapine 15 qhs myfortic 360mg 2 tabs nystatin 100,000 units/ml. 5 ml qid aftermeals and bedtime oxycodone 5mg 2-5 tabs q4-6h prn prednisonse 5 qday sodium polystyrene sulfonate 15 gm prn tacrolimus 7mg asa 325 qhs loperamide 2mg 1-4 tabs prn mvi sodium bicarb 650mg 2 tabs valsartan 40 qam discharge medications: 1. azithromycin 600 mg tablet : two (2) tablet po qsat (every saturday). 2. dapsone 100 mg tablet : one (1) tablet po qhs (once a day (at bedtime)). 3. efavirenz 600 mg tablet : one (1) tablet po qhs (once a day (at bedtime)). 4. mirtazapine 15 mg tablet : one (1) tablet po hs (at bedtime). 5. sodium bicarbonate 650 mg tablet : two (2) tablet po bid (2 times a day). 6. abacavir-lamivudine-zidovudine 300-150-300 mg tablet : one (1) tablet po twice a day. 7. prednisone 5 mg tablet : one (1) tablet po daily (daily). 8. mycophenolate sodium 180 mg tablet, delayed release (e.c.) : four (4) tablet, delayed release (e.c.) po bid (2 times a day). 9. tacrolimus 1 mg capsule : six (6) capsule po q12h (every 12 hours). disp:*360 capsule(s)* refills:*2* 10. metoprolol succinate 100 mg tablet sustained release 24 hr : three (3) tablet sustained release 24 hr po once a day. 11. epoetin alfa 4,000 unit/ml solution : five (5) ml injection every sunday. 12. lansoprazole 30 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 13. lisinopril 40 mg tablet : one (1) tablet po once a day. 14. nystatin 100,000 unit/ml suspension : five (5) ml po four times a day: after meals and bedtime. 15. nephrocaps 1 mg capsule : one (1) capsule po once a day. 16. ergocalciferol (vitamin d2) 50,000 unit capsule : one (1) capsule po once a week. 17. valsartan 80 mg tablet : one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis: ugib secondary diagnosis: s/p kidney transplant hiv/aids discharge condition: stable. ambulating. discharge instructions: you were admitted with bright red blood per rectum. you were transferred to the icu after your blood counts dropped quickly. you had two endoscopies to find the bleeding, which was due to a duodenal ulcer. the gastroenterologists stopped the bleeding from the ulcer. once you stabilized and your blood counts were stable, you were transferred to the floor. you continued to remain stable and are now being discharged. please continue to take your medications as prescribed. the following changes have been made: your tacrolimus was changed to 6mg twice daily. your plavix was stopped. dr. will tell you when you can restart it. do not restart until she tells you to (likely on ) you should never take aspirin again. your amlodipine was stopped. your valsartan was increased to 80 mg daily. your lansoprazole was increased to 30 mg twice daily. please keep all your medical appointments. if you have any of the following symptoms, please call your doctor or go to the nearest er: fever > 100.6, chest pain, shortness of breath, abdominal pain, bright red blood per rectum, black colored stools, red colored stools, black vomit, bloody vomit, or any other concerning symptoms. followup instructions: provider: , md phone: date/time: 1:00 provider: . phone: date/time: 3:15 provider: , md phone: date/time: 10:00 md procedure: other endoscopy of small intestine arterial catheterization endoscopic control of gastric or duodenal bleeding esophagogastroduodenoscopy [egd] with closed biopsy transfusion of packed cells diagnoses: unspecified essential hypertension acute posthemorrhagic anemia human immunodeficiency virus [hiv] disease esophagitis, unspecified kidney replaced by transplant other specified gastritis, without mention of hemorrhage acute duodenal ulcer with hemorrhage, without mention of obstruction 

Answer: The patient is high likely exposed to