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 an 83-year-old male with coronary artery disease, ischemic cardiomyopathy, recent onset atrial fibrillation with an icd biventricular pacemaker placement late . has been on coumadin since then. went to his primary care physician, . on for a follow-up routine visit and noted to have significant left upper extremity swelling which patient states had been present for one week associated with some pain. also complains of left lower extremity swelling and pain which patient attributes to gout. referred to the emergency department for ultrasound which showed left ij thrombosis. denies any chest pain, short of breath, nausea, vomiting, diarrhea, fever and chills. otherwise feeling well. past medical history: 1. coronary artery disease, status post coronary artery bypass graft in . re-do coronary artery bypass graft in . last cardiac catheterization in prior to re-do. last stress test in with egt mibi showing ef 27%, moderate partially reversible inferior defect, mild fixed apical defect, severe left ventricular enlargement. 2. ischemic cardiomyopathy, last echo in showing ef of 35%, elongated left atrium, mild global left ventricular hypokinesis, 1+ mr, 1 to 2+ tricuspid regurgitation. mild pulmonary hypertension. 3. chronic renal failure. 4. hypercholesterolemia. 5. hypertension. 6. ngus. 7. prostate carcinoma status post prostatectomy. 8. tophaceous gout. 9. cervical spondylolysis. 10. status post appendectomy. 11. atrial fibrillation onset in . 12. icd biventricular pacer placed in . medications on admission: 1. hydralazine 50 mg p.o. q.i.d. 2. digoxin 0.125 mg p.o. q day. 3. isordil 60 mg p.o. q day. 4. norvasc 10 mg p.o. q day. 5. prednisone taper. 6. tylenol #3 p.r.n. 7. aspirin 81 mg p.o. q day. 8. iron three times a day. 9. coumadin 5 mg p.o. q h.s. 10. calcium 11. protonix 40 mg p.o. q day. 12. epogen 8000 units q wednesday. 13. alphagan eyedrops one to each eye three times a day. 14. asopt eyedrops one to each eye three times a day. allergies: morphine. social history: lives alone, wife is in nursing home. has daughter. one child who is deceased. remote smoking history quit 40 years ago, no alcohol use. family history: no history of deep vein thrombosis or hypercoagulable state. physical examination: on admission blood pressure 134/54, pulse 89, respiratory rate 15, o2 sat 96% on room air. temperature 96.7. in general easily arouseable and no acute distress. head, eyes, ears, nose and throat exam irregular pupils. op clear. mucous membranes moist. neck: jugular venous pressure 8 cm. no lymphadenopathy or thyromegaly. lungs clear to auscultation bilaterally. cardiovascular exam: irregularly irregular. occasional systolic murmur at base and apex. abdomen soft, nontender, nondistended. normal active bowel sounds. no hepatosplenomegaly. extremities: left upper extremity markedly swollen especially distally, not warm or erythematous. strong radial pulse. left lower extremity swollen at foot, erythema, warmth and significant tenderness to palpation. labs: on admission white blood count 11.0 hematocrit 31.1, platelets 316. ptt 2.5, inr 2.9. calcium 9.7, phos 3.4, sodium 144, potassium 4.1, chloride 107, bicarbonate 24, bun 57, creatinine 2.9. glucose 96. ast 24, alt 18. alk phos 104. dig level 1.6, albumin 3.6. chest x-ray: no acute cardiopulmonary process. ultrasound: no lower extremity deep vein thrombosis. totally occluded left internal jugular, no left subclavian vein thrombosis. no axillary, brachial or cephalic thrombosis. electrocardiogram: atrial fibrillation, v-paced. impression: patient is an 83-year-old male with coronary artery disease, cardiomyopathy, atrial fibrillation, icd biventricular pacer, now with left ij thrombosis. hospital course: 1. heme. the patient has a left ij thrombosis unclear due to hypocoagulable state or due to sub-therapeutic coumadin and clot may be related to pacer wire. the patient was evaluated by ep department who felt that the clot was due to the pacer placement and not due to hypercoagulable state and recommended anti-coagulation. the patient was continued on coumadin and was started on lovenox and had a hypercoagulable workup which was unrevealing. in the setting of coumadin and lovenox with an inr of around 4, the patient evolved a massive gastrointestinal bleed with hematocrit drop to 15. the patient was started on peripheral fluids as well as a left femoral cortise insertion with transfusion of 6 units of blood, 4 units of ffp. the patient was transferred to the intensive care unit for management where he required several additional units of blood and ffp for reversal of the coumadin as well as keeping up with the iron blood loss due to the gastrointestinal bleed. the patient underwent nasogastric lavage which showed maroon returns and passed several melanotic stools. after reversal of the coumadin and with transfusion of blood, the patient began to have slowing of his gastrointestinal bleed and it was decided not to pursue further anti-coagulation as the deep vein thrombosis was in the upper extremities and was not likely to embolize the pulmonary embolus. also was not likely to extend along the pacer wire given its current position. at time of discharge the patient is not to be placed on anti-coagulation and this may be revisited in two to three weeks time. 2. gastrointestinal. as above. the patient was evaluated by esophagogastroduodenoscopy which showed initially clots in the stomach, was re-evaluate with esophagogastroduodenoscopy again which showed the patient had a gastric ulcer, this was evaluated again by h. pylori antibody which was negative so the patient was placed on protonix 40 mg p.o. b.i.d. and was not treated for infectious etiology for the ulcer. re-evaluation with esophagogastroduodenoscopy was done again as the patient's crit tended to drop slowly over the course of his hospital stay requiring transfusions about once a week and an esophagogastroduodenoscopy showed findings consistent with watermelon stomach or gave. treatment for which was initiated with argon coagulation. this will need to be repeated in three to four weeks time for re-coagulation. after the procedure the patient was transfused another unit of blood and his hematocrit has been stable since then. for now he is to continue on a proton pump inhibitor and is not to be started on any anti-coagulation or steroid. 3. gout. in the setting of diuretic use with multiple components of ffp transfused the patient had a significant amount of diuretics administered likely causing exacerbation of his gout in both knees, his feet as well as right wrist causing severe pain and it was felt by the rheumatology consult that helped to inject his joints with steroids, the left knee was injected for pain relief however, the patient declined any further injections of steroids. fluid analysis was consistent with urate crystals in the synovium of the left knee. will not be possible at this time to continue with steroids for the reasons mentioned above in systemic dosing. allopurinol will be continued at 100 mg p.o. q day for renal dosing. however, colchicine will not likely provide benefit at the small doses that would be given due to his renal failure. similarly nsaids would also be contraindicated due to the renal failure. 4. cardiovascular. the patient did have congestive heart failure exacerbation due to the significant amount of volume transfused and was diuresed with 80 mg intravenous b.i.d. with lasix with good effect and on discharge, is now sating significantly better on room air and not feeling significantly short of breath. will continue lasix at 80 mg p.o. b.i.d. for outpatient dosing for congestive heart failure and enalapril was discontinued due to renal failure, the patient will continue on hydralazine and long-acting nitrates. discharge diagnosis: 1. watermelon stomach. 2. gastric ulcer. 3. left ij thrombosis. 4. gout flare. 5. congestive heart failure systolic dysfunction. 6. status post massive gastrointestinal bleed. discharge condition: the patient was evaluated by physical therapy who noted that he was unable to walk on his own even with significant assistance. he is severely deconditioned and will require a stay in rehabilitation for improving his deconditioning and helping with ambulation. medications on discharge: 1. tylenol 650 mg p.o. q 6 p.r.n. 2. lasix 80 mg p.o. b.i.d. 3. colace 100 mg p.o. b.i.d. 4. dulcolax 10 mg p.o. q day p.r.n. 5. allopurinol 100 mg p.o. q day. 6. norvasc 10 mg p.o. q day. 7. iron sulfate 325 mg p.o. q day. 8. imdur 60 mg p.o. q day. 9. simethicone 80 mg p.o. q.i.d. p.r.n. 10. maalox 30 cc's p.o.q.i.d. p.r.n. 11. tylenol with codeine 1 to 2 tabs p.o. q 6 hours p.r.n. 12. protonix 40 mg p.o b.i.d. 13. folate 1 mg p.o. q day. 14. hydralazine 50 mg p.o. q.i.d. 15. digoxin 0.125 mg p.o.q day. 16. oxycontin 10 mg p.o. b.i.d. 17. alphagan eyedrops one to each eye three times a day. 18. asopt drops one to each eye three times a day. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine other endoscopy of small intestine endoscopic excision or destruction of lesion or tissue of stomach diagnoses: congestive heart failure, unspecified acute posthemorrhagic anemia atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction hyperosmolality and/or hypernatremia other specified gastritis, with hemorrhage 

Answer: The patient is high likely exposed to