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: patient recorded as having no known allergies to drugs attending: chief complaint: melena and anemia major surgical or invasive procedure: egd history of present illness: hpi: mr. is a 75 year old man with history of atrail fibrillation on coumadin and transfusion-dependent mds (baseline hct 25-28) who presented to from his hematologist's office when he was discovered to have a history of days of melena and associated anemia. he describes having dark bowel movements once daily for the past 4-5 days; his last dark bm was on the day prior to admission. (at baseline he has one well-formed bm daily.) he describes feeling fatigued and very short of breath for two days prior to admission, with dyspnea with "any movement," relieved by lying still. he denies experiencing chest pain, palpitations, headache, lightheadedness, n/v, diaphoresis, abdominal pain or abdominal cramping, dyspepsia, or fever during this time period. he denies nsaid use. his appetite has been stable. he has no prior history of melena, brbpr, or hematemesis, but notes that he has 1-2 episodes per week of coughing blood related to his postnasal drip. on presentation to his hematologist's office on the day of admission, his hematocrit was found to be 18.7 and he was transfered to . in the ed he received 4 units prbc, 4 units ffp, and vit. k and transferred to the micu. on the following day () he underwent egd where he had multiple findings (see below) including a single linear ulcer at gastroesophageal junction with stigmata of recent bleeding but no active bleeding, as well as 2 avms in the stomach fundus. he has no previous history of pud or gastritis. he does report a past history of acid reflux at night, which he has not experienced since he stopped eating late-night meals 2 years ago. past medical history: 1. atrial fibrillaion on coumadin diagnosed 2. left atrium appendageal thrombus seen on tee 3. myelodysplastic syndrome - thrombocytosis and transfusion-dependent anemia with associated hepatosplenomegaly; diagnosed approx. 2 y.a. 4. pulmonary hypertension and rhf 5. cad s/p pci () 6. recent abrupt "muscle wasting" in extremities and trunk 6 months ago 7. lower extremity and scrotal edema, treated with lasix 8. hypertension 9. basal cell carcinoma 10. prostate ca . diverticular disease 12. hemorrhoids 13. eczema social history: no etoh, 40 pack-years tobacco (quit 's), no ivdu. lives with wife, performs own adls at baseline . family history: brother died of leukemia, s/p liver transplant physical exam: physical exam: . vs: ed-> t 96.5, hr 95, bp 75/45, rr 18 o2sat 95%ra vs upon transfer: t 99.5, hr 92, bp 106/68, rr 18 o2sat 96%ra gen: comfortable-appearing elderly man in nad heent: perrl, eomi, sclera anicteric, op clear and non-erythematous, moist mm, hearing intact to finger rub bilaterally neck: supple, no jvd, no lad, no thyromegaly cardio-irregular rr, sm best heard at apex pulm-decreased bs at l base, faint crackles in r base abd-soft, nt, nd, normal bs, liver easily palable at 10cm inferior to costal margin, 6cm diameter ventral hernia demarcated by 3cm well-healed scar ext-ble with 2+ pitting edema. no venous stasis changes, dp 2+ bilaterally. skin-wwp, multiple diffuse 2-3mm telangiectasias neuro-a&o to person/place/date, cns intact, strength and sensation to light touch intact in upper and lower extremities. marked muscle atrophy of limbs and shoulders. pertinent results: studies: . egd #1 : esophagus: excavated lesions- a single non-bleeding linear erosion was noted in the lower third of the esophagus with overlying mucus. a single nonbleeding linear ulcer was found in the gastroesophageal junction. there was stigmata of recent bleeding but no active bleeding. stomach: two small angioectasias non-bleeding were seen in the fundus. no thermal therapy was applied due to high inr. normal duodenum. impression: erosion in the lower third of the esophagus. ulcer in the gastroesophageal junction. angioectasia in the fundus . egd #2 : normal esophagus. the stomach was difficult to insuffulate due to what appeared to be an extrinsic compression. a few medium localized angioectasias that were not bleeding were seen in the fundus and stomach body. -cap electrocautery was applied for hemostasis successfully. normal duodenum. impression: extrinsic impression of the stomach angioectasias in the fundus and stomach body otherwise normal egd to second part of the duodenum recommendations: continue ppi follow hct ct scan abdomen to evaluate for extrinsic compression of the stomach. . ct abdomen/pelvis : ct abdomen findings: images of the lower thorax demonstrate a right pleural effusion. there is uniform hepatomegaly. there is no biliary dilatation. there is splenomegaly. there is compression of the stomach between these two organs. there is cholelithiasis. the right kidney is grossly normal except for the presence of a large upper pole simple cyst, which measures 6.5 x 9.0 cm in ap and transverse dimensions. the left kidney also demonstrates two large simple cysts in the upper pole. also, present in the left kidney are two nonobstructing calculi, one measures 1.2 cm in length and the other measures 0.8 cm in length, the width of each of these calculi is approximately 4-6 mm. between the tail of the pancreas and the spleen, there is a 2.0 x 3.3 cm cystic lesion. it is not clear if this arises from the pancreatic tail or the spleen. there is no pancreatic duct dilatation, however. there are no dilated bowel loops. contrast passes from the stomach into the small bowel and colon. the splenic vein is enlarged and tortuous. there is a small amount of ascites. ct pelvis findings: there are numerous diverticula involving the colon. there is a small to moderate amount of pelvic free fluid. there is no lymphadenopathy. bone windows demonstrate no lytic or blastic lesions. well-circumscribed lucencies are present in the right ilium which could be related to a bone marrow biopsy or osteopenia. degenerative changes are present throughout the spine. impression: 1. hepatosplenomegaly with compression of the stomach. this compression may be the cause of the mass effect seen in the recent egd. there is no bowel or gastric outlet obstruction, however. 2. dilated splenic vein and ascites are suggestive of portal hypertension. 3. cystic structure in the region of the pancreatic tail and spleen. further characterization is not possible on this study. when the patient is over his acute illness, consider further evaluation with mri. 4. nonobstructing left renal calculi. 6. diffuse atherosclerosis. 6. small right pleural effusion. . cxr : findings: minor area of increased opacity above the mid portion of the left mid diaphragm likley to represent some left basilar atelectasis. no pneumothorax or effusion demonstrated. no gross pulmonary edema. heart size at the upper limits of normal. . cxr : findings: cardiac silhouette remains slightly enlarged. in addition to the left basilar atelectasis seen on the prior examination, there is slightly increasing opacity, consistent with effusion. superimposed infection cannot be excluded in this region. no other focal pulmonary opacities or evidence of pneumothorax. osseous structures appear unremarkable. impression: left basilar atelectasis with component of effusion. infection is not excluded. . labs: 11:20am wbc-22.5 rbc-1.76 hgb-5.6 hct-16.3 mcv-93 mch-31.8 mchc-34.2 rdw-20.0 pt-25.8 ptt-35.9 inr(pt)-4.9 glucose-153 urea n-78 creat-1.6 sodium-137 potassium-4.6 chloride-104 total co2-22 anion gap-16 calcium-8.0 phosphate-3.3 magnesium-2.6 brief hospital course: assessment: 75 year old man with history of atrail fibrillation and left sided thrombus on coumadin with 4-5 days of melena and associated anemia determined to be secondary to gastric avms successfully cauderized. . 1) gi bleed: after presenting to the ed with 4-5 days of melena and hct 16.3 in the setting of inr of 4.9, mr. anticoagulation was discontinued and he was given 4 units prbc, 4 units ffp, sc vit. k, and transferred to the micu. his hct stabilized and inr decreased to 1.9. diltiazem, losartan and furosemide were held for volume depletion. on , he underwent egd and was found to have ulcer at the ge junction with stigmata of recent bleeding but no active bleeding. egd also identifed a non-bleeding erosion in the lower esophagus and two small non-bleeding angioectasias in the fundus. after egd and stabilization of vital signs, mr. was transferred to the floor, where he was monitored for recurrent gi bleed with vital signs, serial hct checks, serial abdominal exams, and stool collection. his inr was followed and he was treated with protonix. coumadin was at first held due to risk of re-bleed, then restarted with a heparin bridge on in consulation with gi. after restarting coumadin and heparin it was noted that the patient's hct had not elevated appropriately after a transfusion of 1 unit prbc given for his mds. he was transfused a second unit overnight, and the following day, he was noted to have melena. nasogastric lavage was performed to assess whether the previously identified esophageal ulcer was bleeding; no blood was seen on ngl. given that he appeared to be having a repeat bleed in the setting of restarting his anticoagulation, the patient's coumadin, heparin, aspirin, and antihypertensives were held. he was transfused an additional 2 units of prbc and a repeat egd was performed on . on repeat egd there were no ulcers seen in the esophagus. two angioectasias seen in the fundus were cauterized. after the second egd, the patient remained stable with no signs of recurrent bleeding: hct and vital signs remained stable, and the patient's bowel movements were non-bloody and non-melenous. anticoagulation with coumadin and heparin was started again on , and for the duration of his hospitalization the patient remained hemodynamically stable and without signs of gi bleeding. diltiazem, losartan and furosemide were restarted prior to discharge. aspirin was held and the patient was instructed to restart as an outpatient in consultation with his pcp. . 2) atrial fibrillation and left atrium thrombus: the patient has a fib and a known left atrial thrombus normally treated with coumadin 5mg daily. the patient's gi bleed on admission occurred in the setting of a supratherapeutic inr of 4.9, so coumadin was held and anticoagulation was reversed in the ed with 4 units fresh frozen plasma and vitamin k. given his known left atrial thrombus and associated increased risk of stroke, it was recommended by cardiology that he restart coumadin as soon as the gi team considered his gi bleed stable. therefore, anticoagulation with coumadin and heparin bridge was started on . after the patient's recurrent gi bleed, anticoagulation was again stopped, then restarted on . he was kept on his digoxin throughout the hospitalization. diltiazem was initially held because his bp remained in the 90's and 100's systolic, but resumed once bp stabilized. the addition of a beta blocker to his medication regimen was considered, but it was decided that it would be best to start this as an outpatient, in consultation with his cardiologist. by the day of discharge, the patient's inr was therapeutic at 2.1 and he was discharged home on coumadin 5mg daily. . 3) dyspnea: for two days prior to admission the patient experienced shortness of breath with minimal exertion, likely related to his severe anemia. he continued to experience intermittent milder dyspnea on hospital day 2, and o2 sat of 91% on ra was recorded. the patient was placed on 2l oxygen via nasal cannula, and ekg was obtained to rule-out cardiac ischemia ekg was unchanged from prior. cxr was obtained which showed a small opacity in the l lower lobe which was consistent with pneumonia. a 10-day course of levofloxacin was started. by discharge, the patient no longer had an oxygen requirement, and only noted mild dyspnea while in certain positions, which he attributed to his enlarged liver exerting pressure on his lungs. . 4) edema: the patient has a history of lower extremity edema and scrotal anasarca for which he takes furosemide 80mg daily. his furosemide was initally held because of low bp, then later re-started when he noted scrotal anasarca. his volume status was closely monitored while on furosemide. by discharge, there was moderate resolution of scrotal swelling, but the patient's lower extremitity edema had not resolved. . 5) myelodysplastic syndrome: heme was consulted and felt that there was no acute process at this time. given that the patient is known to have thrombocytosis and transfusion-dependent anemia, his blood counts were closely followed. he was continued on his anagrelide, but thalidomide was held due to hospital regulations. the patient was advised to follow-up with his outpatient hematologist upon discharge and continue medications as prescribed. . 6) cad s/p pci: the patient's cad remained stable throughout his hospitalization. he was monitored for signs of cardiac ischemia, especially in the setting of his gi bleed and low hct, and remained without signs of active ischemia. he was continued on statin therapy throughout his hospitalization. diltiazem and losartan were initially held, then resumed once the patient was stable and it appeared that his blood pressure could tolerate them. the addition of a beta blocker to his medication regimen was considered, but it was decided that this could be started as an outpatient. aspirin was held, and the patient should restart it as an outpatient, in consultation with his pcp or cardiologist. the patient was maintained on a cardiac diet while hospitalized. . 7) findings on ct scan: the patient had multiple significant findings on abdominal/pelvic ct obtained on : - dilated splenic vein and ascites, indicative of portal hypertension - 2.0 x 3.3 cm cystic lesion between the tail of the pancreas and the spleen; it is not clear if this arises from the pancreatic tail or the spleen. outpatient work-up of portal hypertension is recommended. it is also recommended that the patient undergo mri for follow-up of the cystic lesion in the area of the pancreatic tail. this can also be done as an outpatient. medications on admission: coumadin 5mg anagrelide 1mg thalidomide 50mg daily cyanocobalamin daily losartan 50mg daily digoxin 0.125mg daily asa 81mg daily diltiazem 240mg daily lovastatin 20mg daily lasix 80mg daily discharge medications: 1. anagrelide 0.5 mg capsule sig: two (2) capsule po bid (). 2. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 3. cyanocobalamin 100 mcg tablet sig: 0.5 tablet po daily (daily). 4. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 5. warfarin 5 mg tablet sig: one (1) tablet po hs (at bedtime). 6. losartan 50 mg tablet sig: one (1) tablet po daily (daily). 7. diltiazem hcl 240 mg capsule, sustained release sig: one (1) capsule, sustained release po once a day. 8. thalidomide 50 mg capsule sig: one (1) capsule po once a day. 9. lovastatin 20 mg tablet sig: one (1) tablet po once a day. 10. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. disp:*20 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: upper gi bleed in the setting of high inr, anemia discharge condition: mr. gi bleeding and shortness of breath have resolved. his coumadin has been restarted, inr is hematocrit is stable at >30. discharge instructions: 1) please call your doctor or return to the emergency department if you experience recurrence of blood in your bowel movements or dark bowel movements, or any of the following: chest pain, shortness of breath, dizzyness, fevers, chills, weakness, fatigue. 2) please keep your appointment on monday with your hematologist dr. . 3) please discuss with dr. or your pcp before restarting your daily aspirin 4) continue to take all other medications as prescribed followup instructions: 1) please follow-up this week with dr. 2) please have your inr checked every 2 weeks, or as recommended by dr. 3) please call this week to make an appointment to see your pcp procedure: other endoscopy of small intestine endoscopic control of gastric or duodenal bleeding transfusion of packed cells transfusion of other serum diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension portal hypertension atrial fibrillation personal history of malignant neoplasm of prostate other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status long-term (current) use of anticoagulants chronic diastolic heart failure volume depletion, unspecified angiodysplasia of stomach and duodenum with hemorrhage 

Answer: The patient is high likely exposed to