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: no known allergies / adverse drug reactions attending: chief complaint: "colostomy bag explosion." major surgical or invasive procedure: endoscopy with biopsy history of present illness: mr. is a very pleasant 87 y/o gentleman with cad s/p cabg, rheumatoid arthritis on methotrexate, and chronic renal insufficiency who presented to the ed today with a complaint of explosion of his colostomy bag. of note, he ha sigmoid colectomy with end colostomy for perforated diverticulitis . patient was discharged to rehab on and has been doing very well since.he has not had much abdominal pain and has been doing exercises at his rehab. no nausea or vomiting, poor appetite consistent with his appetite over the past year. today he presented with 1 episode of large volume melena that exploded his colostomy bad. dark stool, no red blood. he normally walks independently and feels a bit weak. today he is otherwise feeling fine and has no complaints. surgery evaluated him, thinking that this is related to his anastamosis - he had a low hartmann - so likely not bleeding from there. gi evaluated patient in ed as well - and asked to admit to icu. vitals from ed were bp 126/87, hr 106 ( he's in afib, not new), rr 27, sp02 100%ra, afebrile. without complaints. colostomy bag was just changed and he has minimal dark stool in it, wich was guaiac positive. pt was lavaged in ed, and that was negative. patient received 1 units in ed, and one on arrival to the micu. on the floor, patient was free of complaints, temp 97.7, hr 102, bp 138/74 o2sat 100%ra. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits past medical history: rheumatoid arthritis on methotrexate cad b/l carotid stenosis, s/p cea and stent on r, 60-70% on l prostate ca s/p radiation microcytic anemia cri (bl 1.5-1.6) past surgical history: cabgx4 15-20 yrs ago @ r cea r carotid stent back surgery yrs ago social history: smoked 1ppd x 20 yrs but quit 20 yrs ago. no etoh or rda. retired, lives with wife. family history: noncontributory physical exam: micu admission physical: gen: alert, awake, oriented x3, not in acute distress. heent: perrla, mmm. oropharynx clear. poor dentition. neck: no jvd, no lymphadenopathy, supple. chest: ctab. no wheezes, no crackles. cabg scar. cvs: s1 and s2 were irregular. abdomen: nd,nt, soft, good bowel sounds presente. no organomegaly, no ascites. colostomy bag in place with minimal dark stool. large midline scar, well healed, with multiple strips of tape. extremities: no pitting edema. good pulses peripherally. skin: dry skin with seborrheic keratotic lesions, no jaundice. neurologic: cranial nerves intact grossly. good strength throughout. pertinent results: admission labs: 09:30am wbc-4.4# rbc-2.11* hgb-6.4* hct-20.3* mcv-96 mch-30.2 mchc-31.4 rdw-16.5* 09:30am neuts-61.6 lymphs-32.1 monos-5.0 eos-0.8 basos-0.5 09:30am plt count-391 09:30am pt-13.8* ptt-28.9 inr(pt)-1.3* 09:30am glucose-120* urea n-30* creat-1.1 sodium-137 potassium-4.7 chloride-101 total co2-30 anion gap-11 09:44am lactate-1.1 03:52pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 03:52pm urine color-straw appear-clear sp -1.017 hematocrit trend: 09:30am hct-20.3* 11:52pm hct-23.2* 05:00am hct-25.1* 12:13pm hct-25.1* 09:25pm hct-23.7* 07:51am hct-24.8* discharge labs: 07:51am blood wbc-6.7 rbc-2.80* hgb-8.4* hct-24.8* mcv-89 mch-30.1 mchc-33.9 rdw-17.1* plt ct-426 07:51am blood glucose-108* urean-24* creat-1.0 na-134 k-4.1 cl-102 hco3-27 angap-9 imaging: egd: normal esophagus. stomach: lumen: a medium size hiatal hernia was seen. excavated lesions a single linear non-bleeding 1.5 cm ulcer was found in the antrum. the ulcer was clean based without stigmata of recent bleeding. duodenum: excavated lesions two ulcers were found in the duodenal bulb. the first was 1.5 x 0.5cm with a clean yellow base. no visble vessels or clots were seen. the other ulcer was noted on the opposite duodenal wall and was 0.7cm in diameter. it had a clean white base without visible vessels or clots. no blood was seen. other procedures: cold forceps biopsies were performed to assess for h. pylori at the stomach. impression: medium hiatal hernia ulcer in the antrum; ulcers in the duodenal bulb(biopsy). otherwise normal egd to third part of the duodenum recommendations: await biopsy results. treat for h. pylori if positive. avoid nsaids, prilosec 20mg . the ulcers were the likely cause of the melena. all the ulcers are currently at a low risk for re-bleeding. given gastric ulceration would recommend repeat egd in 8 weeks time. f/u with inpatient gi team gastric biopsy pending brief hospital course: 87 y/o gentleman s/p hartmann's procedure for perforated sigmoid diveriticulitis in who was admitted with acute gastrointestinal hemorrhage likely secondary to gastric ulceration. active issues: 1. acute gastrointestinal hemorrhage: presented with large volume melena accompanied by acute drop in hematoctit from prior baseline of 26-29 to 20.3. patient was initially admitted to the icu on protonix gtt for close monitoring of hemodyanmics and serial hematocrits. he was transfused 2u prbc with hct stabilizing at 23-25. subsequent egd showed multiple nonbleeding ulcers in the stomach which were felt to be the cause of initial hemorrhage. etiology of ulcerations were likely multifactorial from recent stress reaction (following colectomy), nsaid use (on high dose aspirin), possible contribution from methotrexate, +/- h pylori (biopsy pending). patient was placed on ppi , reduced to 81mg, and methotrexate was held indefinitely. he will need repeat endoscopy in 8 weeks to ensure resolution of ulcerations. 2. atrial fibrillation: ekg on admission showed asymptomatic atrial fibrillation. heart rate remained well controlled on metoprolol 25mg . despite chads score of , patient did not start on anticoagulation given recent gi bleed. he should follow up with primary care physician to further discuss the risks of anticoagulation and to complete diagnostic evaluation with possible echo. medical problems: 3. s/ for perforated diverticulitis: patient healing well with no evident complications. patient will follow up in - to discuss the possibility of ostomy reversal to regain intestinal continuity. 4. rheumatoid arthritis: stable with no signs of active joint inflammation. discontinued methotrexate, given possible contribution to mucosal ulceration. 5. cad: stable, with no signs of ischemia, patient continued on metoprolol with aspirin dose reduced to 81mg as above. transitions of care: # gi bleed: - continue ppi - dose reduce to 81mg - hold methotrexate - f/u gastric biopsy - repeat scope in 8 weeks # afib: new onset - continue rate control - pcp follow up regarding longterm management medications on admission: folic acid 1 heparin 5000 mtx 15 weekly metoprolol 25 oxycodone 5 tramadol 50 325 discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 4. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain: do not exceed 4gms daily. discharge disposition: extended care facility: at discharge diagnosis: primary diagnosis: acute gastrointestinal hemorrhage gastric ulcers atrial fibrillation secondary diagnosis: rheumatoid arthritis perforated diverticulitis s/p colectomy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr. , you were admitted to the hospital with a gastrointestinal bleed. you had an endoscopy which showed ulcers in your stomach, which were likely the cause of the bleeding. you received 2 units of red blood cells and your blood counts stabilized. you will need to take a acid suppressing medication twice daily and have a repeat endoscopy in 8 weeks to ensure that these ulcerations have resolved. please make the following changes to your medication regimen: - hold methotrexate until your doctor tells you that you can restart - start omeprazole 40mg twice daily - change your aspirin to 81mg daily it was a pleasure taking care of you during this hospitalization followup instructions: department: endo suites when: friday at 12:30 pm department: digestive disease center when: friday at 12:30 pm with: , md building: building (/ complex) campus: east best parking: main garage procedure: esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: atrial fibrillation personal history of malignant neoplasm of prostate coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status personal history of tobacco use chronic kidney disease, unspecified occlusion and stenosis of carotid artery without mention of cerebral infarction long-term (current) use of other medications rheumatoid arthritis chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction precipitous drop in hematocrit colostomy status acquired absence of intestine (large) (small) 

Answer: The patient is high likely exposed to