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 a 69-year-old male with a history of paroxysmal atrial fibrillation, status post failed cardioversion with procainamide, amiodarone and dc cardioversion, now on chronic anticoagulation, hypertension, probable coronary artery disease with prior admission for a rectus sheath hematoma, now presenting with 2-4 weeks of increased dyspnea on exertion, increased orthopnea and increased lower extremity edema. the patient reports he is typically able to walk 1?????? to 2 miles per day without dyspnea. for the past month he has had decreased exercise tolerance secondary to fatigue and dyspnea. he reports orthopnea times approximately one month. no history of paroxysmal nocturnal dyspnea. he does admit to a dry cough, no fevers, chills or sweats, no chest pain with the exception of some upper chest tightness associated with his dyspnea. symptoms on admission today are brought on by the slightest exertion including bending over to tie his shoes. he also describes one week of watery black diarrhea. no abdominal pain, no emesis, occasional nausea. the patient has had poor po intake earlier in the week secondary to nausea. no hematemesis, no bright red blood per rectum, no melena. he has a daughter with diarrheal symptoms approximately one week ago. the patient was seen in the clinic today and noted to have brown stool with bright red blood on rectal exam. his hematocrit was found to be 24.7 with inr of 7.7. he had no symptoms at rest. he was admitted one year ago for similar symptoms and found to be dyspneic on exertion with a low hematocrit attributed to demand ischemia. at that time the patient had an upper and lower endoscopy which were negative with exception of some diverticula noted in the large bowel. the patient had no prior history of bright red blood per rectum, melena or hematemesis. as noted above, ultrasound on that prior admission revealed a large rectus sheath hematoma. past medical history: 1) history of paroxysmal atrial fibrillation, hypertension, probable coronary artery disease with a mibi in which showed a mild reversible inferior defect. 2) history of chronic low back pain. 3) history of external hemorrhoids. 4) history of a rectus sheath hematoma in the setting of anemia requiring blood transfusion. 5) history of bright red blood per rectum in with a negative egd, negative colonoscopy and cardiac risk factors include hypertension and age. 6) history of iron deficiency anemia, previously on iron supplementation. medications: on admission, toprol 50 mg po bid, verapamil 180 mg po bid, coumadin 2.5 mg po q d, motrin 20 mg po q d, temazepam 15-45 mg q h.s. prn. allergies: no known drug allergies. family history: father with diabetes, no history of coronary artery disease or hypertension. social history: patient married with three children, no tobacco. he drinks approximately one drink per month. physical examination: temperature 97.2, pulse 80, blood pressure 132/82, respiratory rate 20, pulse 98% on room air. general appearance, patient awake, alert, oriented times three, no acute distress. heent: pupils are equal, round, and reactive to light and accommodation, extraocular movements intact, moist mucus membranes, sclera anicteric. neck, no jugulovenous distension at 45 degrees, supple. cardiovascular, irregularly irregular, normal rate, no murmurs. lungs with decreased breath sounds at the left base, trace crackles at the right base. abdomen soft with some mild periumbilical tenderness to palpation with active bowel sounds, no rebound or guarding, no palpable masses, no cva tenderness. rectal exam, brown stool with bright red blood per pcp. , 1+ pitting edema to the mid calf, 2+ pedal pulses. laboratory data: on admission, white blood count 11.7, hematocrit 24.7 from a baseline of 40 two weeks ago. differential, 87% neutrophils, 0% bands, 8% lymphocytes, 3% monocytes, sodium 139, potassium 4.1, chloride 104, co2 25, bun 28, creatinine 1.0, glucose 157, inr 7.7, esr 37, uric acid 3.7. cks were negative times three. alt was 69, alkaline phosphatase 72, which was ordered at outpatient office was positive with a titer of greater than 1:1280 with a diffuse pattern. as noted above, prior egd and colonoscopy had been negative with the exception of some diverticulosis of the sigmoid and descending colon as well as some grade 3 mixed thrombosed hemorrhoids. hospital course: 1. cardiovascular: patient with a history of coronary artery disease. in the setting of his anemia with likely congestive heart failure, the patient was noted to have some diffuse ischemic changes on ekg. he subsequently ruled out for myocardial infarction. he had no chest pain complaints during this admission. his blood pressure medications were initially held in the setting of his gi bleed and then reintroduced. the patient also with evidence of congestive heart failure, thought to be likely due to demand ischemia. the patient's dyspnea symptomatically improved after correction of his hematocrit. even after aggressive transfusion for gi bleeding, however, the patient remained dyspneic on exertion with mild desaturation with ambulation. he was noted to have persistent bilateral pleural effusions right greater than left. please see pulmonary section below. the patient's atrial fibrillation was rate controlled with usual dose of lopressor. the patient was started on a low dose of lasix at the time of discharge. 2. gi: the patient presented with one week of black diarrhea and noted to have bright red blood per rectum on digital rectal exam by pcp on the day of admission. he presented with an elevated inr and a low hematocrit. on the night of admission the patient had a large bloody bowel movement. he was transfused two units overnight but his hematocrit did not increase. he became progressively more tachycardic and uncomfortable. he was subsequently transferred to the medical intensive care unit where he was transfused an additional 4 units of packed red blood cells. he was also transfused three units of ffp and given three doses of vitamin k for elevated inr. a tagged red blood cell scan was negative. surgery was consulted. the patient was not scoped on this hospitalization as his bleeding had resolved and there was no obvious source on tagged rbc scan. it was thought that the likely source of his bleeding was colonic diverticula in the setting of an elevated inr. ct scan of the abdomen showed no retroperitoneal hematoma. 3. pulmonary: patient noted to have some congestive heart failure as well as bilateral pleural effusions, worse over baseline on admission. the patient did symptomatically improve after some diuresis but had a persistent left moderately sized pleural effusion. on the day prior to discharge the pleural effusion was tapped and 600 cc of yellow serous fluid removed. fluid analysis was as follows: gram stain with no polys, no organisms. pleural fluid analysis did reveal 9 white blood cells, 8,675 red blood cells, total protein 3.3, glucose 146, ldh 166, ph 7.47, cytology, and rheumatoid factor were pending at the time of discharge. pleural serum ldh ratio was noted to be 0.55 and pleural serum protein ratio was also noted to be 0.55, the latter consistent with an exudative effusion. the most likely explanation for this was her procainamide induced lupus causing pleuritis. the patient had also been noted to have evidence of a non hemodynamically significant pericardial effusion on echocardiogram and chest ct also supported this diagnosis. an antihistone antibody which is generally consistent with lupus in the setting of procainamide was also pending at the time of discharge. the patient was noted to spike several high fevers after returning to the floor following his micu course. his white blood cell also jumped from a normal range to approximately 25 in this setting. the concern initially was that his pleural effusion might represent infectious etiology or be parapneumonic in etiology. sputum gram stain and culture were sent. chest x-ray could not rule out an underlying pneumonia although patient had minimal respiratory symptoms. he had a dry cough with good o2 saturations on room air. the patient was noted to have a urinalysis consistent with a urinary tract infection and was treated with po levaquin. the day following initiation of antibiotics and tapping of the pleural effusion, the patient was afebrile with a resolving white blood count. 4. infectious disease: as noted above, the patient was treated for a urinary tract infection with levaquin. based on pleural analysis, it did not appear that the effusion was infectious in etiology. culture was still pending at the time of discharge, however. 5. gi: the patient was noted to have mild elevations in his transaminases. this was thought to perhaps be consistent with possible auto immune hepatitis given that the patient also had a positive . hepatitis panel was negative although hcv antibody was equivocal and should be followed up at the time of discharge. spep was also sent as this can be seen in the setting of auto immune hepatitis. as noted above, patient with a gi bleed significant enough to drop his hematocrit by approximately points. no obvious bleeding at the time of discharge. his hematocrit had been stable for several days at the time of discharge. the patient's hepatitis c serology should be reexamined at the time of discharge and his transaminases rechecked in several weeks. patient is scheduled for a follow-up appointment with dr. from gastroenterology. 6. gu: the patient had had a psa level drawn by his outpatient physician and this was noted to be elevated. this should be followed up as an outpatient as well. 7. hematological: the patient presented with an elevated inr on coumadin. he received several doses of vitamin k. his inr was corrected and he ultimately was restarted on his coumadin at prior dose. he should receive close follow-up for effective monitoring of his inr. discharge diagnosis: 1. hypertension. 2. coronary artery disease. 3. paroxysmal atrial fibrillation. 4. elevated inr. 5. gi bleeding. 6. left pleural effusion, possibly secondary to procainamide induced lupus. 7. elevated psa. 8. elevated transaminases. 9. equivocal hepatitis c virus antibody. discharge medications: verapamil 180 mg po bid, iron sulfate 325 mg po tid, lopressor 50 mg po bid, levaquin 500 mg po q d times five days, protonix 40 mg po q d, lasix 20 mg po q d, temazepam prn, coumadin 2.5 mg po q h.s., folate 1 mg po q d. the patient is told to avoid all aspirin and motrin products. follow-up: 1. the patient is to follow-up with his primary care physician, . . 2. patient to follow-up with gastroenterologist, dr. on at 1:20 p.m. in the bldg, . , r. m.d. dictated by: medquist36 procedure: thoracentesis diagnoses: systemic lupus erythematosus abnormal coagulation profile unspecified pleural effusion congestive heart failure, unspecified acute posthemorrhagic anemia atrial fibrillation hemorrhage of gastrointestinal tract, unspecified elevated prostate specific antigen [psa] 

Answer: The patient is high likely exposed to