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: bright red blood per rectum major surgical or invasive procedure: intubation upper endoscopy sigmoidoscopy x2 history of present illness: mr. is a 50 y.o. m with antiphospholipid syndrome c/b portal vein thrombosis and superior mesenteric vein thrombosis with prior partial hepatic vein inclusion on lovenox, grade iii esophageal varices, portal gastropathy, who presents with 4 episodes of brbpr that started the day prior to admission around 5 pm. this continued through the night, and then the day of admission, he had 4 more brbpr episodes. around 4:30 pm, on his way to bathroom, he experienced dizziness, lightheadedness, syncopized and hit his right jaw. + loc. he denied chest pain, shortness of breath, palpitations prior to this syncopal event. his last brbpr was at 4 pm on day of admission. last dose of lovenox this am. he has had some brbpr but just "drops" secondary to hemorrhoids. this bleeding is "heavy duty." as he was getting out of the car to come to the ed, he also felt lightheaded and needed a chair. in the ed, initial vs: t 97.5 hr 72 bp 102/53 rr 20 o2 99% on ra. ed physical exam noted gross blood in the rectal vault with internal and external hemorrhoids. labs were drawn, significant for hct 30.1 (baseline 37-38), leukocytosis 12.9, thrombocytosis 700k, inr 1.7, bili 2.8, and k 5.7 (hemolyzed). repeat hct 1 hour later was 28.7. the patient vagaled while an iv was being placed with bradcardia to 30s and hypotension with sbp in upper 80s. after 2 l ns, bp was in 90s and hr in 50s. 3rd l ns hanging. head ct, ekg and cxr performed. hepatology was consulted. the patient was started on octreotide gtt. active t&s with 2 units crossmatched and 1 prbc transfused prior to arrival in icu. 2 18 gauge pivs. ed signout vs: t 97.5 101/40 48 18 100% nrb currently, the patient denies pain. denies lightheadedness and dizziness. past medical history: - antiphospholipid antibody syndrome - jak2 mutation indicative of myeloproliferative syndrome - cbd stones and cholangitis s/p ercp in - portal vein thrombosis in , thought to be secondary to antiphospholipid antibody syndrome, recently switched to lovenox after recurrent thrombosis while on therapeutic coumadin therapy - status post cholecystectomy - grade 3 esophageal varices seen on ercp - portal gastropathy in the stomach - periampullary varix - hemorrhoids social history: school administrator and headmaster, is married with 2 children. denies smoking, has occasional alcohol, one glass of wine at night. no drugs of abuse. family history: there is no family history of hypercoagulable disorders, no history of coronary disease or early mis. father with history of hypertension. there is no history of diabetes. there is no history of prostate or colon cancer. physical exam: on admission to micu: vital signs: t 96.6 hr 62 bp 97/52 rr 13 100% 2 l nc gen: pleaseant, malaised appearing male lying in bed heent: eomi, slight icterus, op - no exudate, no erythema, mmm, no cervical lad, 2 cm linear cut on r chin without overt bleeding chest: ctab, no w/r/r cv: bradycardia, no m/r/g abd: ndnt, soft, decreased bs ext: no c/c/e neuro: a&o x 3 derm: no rashes noted rectal: deferred - but reportedly gross, bloody stool in rectal vault per ed, gi fellow noted scant red blood in vault on admission to floor: general: alert, oriented, no acute distress heent: sclera with minial icterus, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, mildly distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley currently placed. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: ekg : brady at 60s with frequent pvcs, nl interval, nl intervals. no acute st changes or twi. no change compared to prior. ct head w/o contrast: there is no evidence of hemorrhage, edema, masses, mass effect, or acute infarction. the ventricles and sulci are normal in caliber and configuration. no acute fracture. there is mild mucosal thickening predominantly involving the sphenoid sinus. the mastoid air cells are well aerated. : cxr: in comparison with the study of , there is again increased opacification at both bases, more prominent on the right, worrisome for developing pneumonia. endotracheal tube and right central catheter remain in place. cxr: in comparison with study of , there has been placement of a right ij catheter that extends to the lower portion of the svc. lower lung volumes may account for much of the apparent increase in the transverse diameter of the heart. mild atelectatic changes are seen at both bases, though there is no evidence of acute focal pneumonia, vascular congestion, or pleural effusion. egd/sigmoidoscopy: grade iii varices with high risk features at the mid and lower esophagus (ligation)varices at the fundus. there was no blood in the esophagus, stomach, or duodenum.banding was successfully performed without complication. otherwise normal egd to second part of the duodenum. a single, deep rectal varix was found. cyanoacrylate injection was applied at two points along the variceal cord, for hemostasis and sclerotherapy with success. : blood wbc-6.7# rbc-4.04* hgb-11.1* hct-33.9* mcv-84 mch-27.5 mchc-32.8 rdw-15.2 plt ct-250 : blood wbc-3.8* rbc-3.22* hgb-9.4* hct-26.4* mcv-82 mch-29.1 mchc-35.4* rdw-15.2 plt ct-152 : blood wbc-12.9*# rbc-3.70*# hgb-10.3*# hct-30.1*# mcv-81* mch-27.9 mchc-34.3 rdw-15.2 plt ct-700*# 10:46pm blood neuts-80.3* lymphs-15.0* monos-2.4 eos-1.9 baso-0.4 07:15pm blood neuts-74.7* lymphs-17.0* monos-4.1 eos-3.6 baso-0.6 04:45am blood plt ct-152 04:23am blood pt-17.6* ptt-38.9* inr(pt)-1.6* 07:15pm blood pt-18.9* ptt-41.2* inr(pt)-1.7* 04:45am blood glucose-122* urean-11 creat-0.6 na-140 k-3.7 cl-103 hco3-28 angap-13 07:15pm blood glucose-117* urean-34* creat-0.7 na-138 k-5.7* cl-106 hco3-22 angap-16 04:23am blood alt-23 ast-23 alkphos-111 totbili-3.5* 07:15pm blood alt-30 ast-37 ck(cpk)-112 alkphos-138* totbili-2.8* dirbili-0.4* indbili-2.4 05:01am blood ck-mb-notdone ctropnt-<0.01 07:15pm blood ctropnt-<0.01 04:06am blood calcium-7.6* phos-2.9 mg-1.7 12:03pm blood calcium-6.8* phos-4.4 mg-1.9 05:01am blood calcium-6.6* phos-3.8 mg-1.8 10:46pm blood calcium-7.1* phos-3.6 mg-1.5* 07:15pm blood albumin-3.8 calcium-8.5 phos-3.3 mg-1.8 10:46pm blood hapto-22* 01:18pm blood type-art po2-220* pco2-35 ph-7.34* caltco2-20* base xs--5 08:47am blood type-central ve rates-/12 peep-5 fio2-50 po2-44* pco2-43 ph-7.40 caltco2-28 base xs-0 intubat-intubated vent-spontaneou 03:44am blood lactate-1.2 brief hospital course: 50 y.o. m with antiphospholipid syndrome c/b portal vein thrombosis and superior mesenteric vein thrombosis with prior partial hepatic vein inclusion on lovenox, grade iii esophageal varices, portal gastropathy, who presents with brbpr. in the micu: brbpr: egd in icu w/ grade iii varicies which possibly had bled, no active bleeding. 4 x banding. during procedure he desaturated likely due to pulmonary edema and was intubated. in the setting of intubation he likely aspirated and was started on antibiotics for aspiration (on ceftriaxone for infection ppx anyways) this will be continued for 8 day course. he then underwent a flex sig which revealed old blood. he was eventually reprepped and found to have a rectal varix which was banded and 3 polyps which will require repeat outpatient c scope. bleeding had stopped, hemodynamically stable, on octreotide drip x 5 days. heparin sc for dvt ppx restarted on and lovenox treatment dose restarted on s/p central line plcmt which was discontinued on . aspiration pna as well as pulmonary edema: pulm edema in setting of massive fluid / blood resuscitation. aspiration in setting of endoscopy which was < 24 hours from admission so treated w/ ceftriaxone alone. improved. antiphospholipid syndrome: c/b portal vein thrombosis. lovenox initially held given bleeding. restarted on . on the floor: brbpr: on transfer to the floor the patient was stable and continued his octreotide drip. hematocrit was checked over two days and was shown to be improving. on the floor nadolol was restarted and iv ppi was continued. on discharge plans were made for follow up for repeat banding and patient was placed on an oral ppi. aspiration pna: initially patient reguired 2l nasal canula. antibiotics were continued and incentive spirometry was encouraged. by day prior to dicharge patient was sating appropriately on room air. pt remained afebrile without a leukocytosis. antiphospholid syndrome: lovenox restarted on the floor. medications on admission: lovenox 160 mg sq daily nadolol 20 mg po daily ursodiol 300 mg po tid discharge medications: 1. ursodiol 300 mg capsule sig: one (1) capsule po tid (3 times a day). 2. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 3. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 4. enoxaparin 120 mg/0.8 ml syringe sig: one (1) subcutaneous once a day. discharge disposition: home discharge diagnosis: gastrointestinal bleed discharge condition: afebrile, hemodynamically stable and pain free discharge instructions: you were admitted with bleeding from your rectum. you had a endoscopy which showed esophageal varices and a rectal varice. because, of this bleeding you required a blood transfusion. during the endoscopy you had a difficult time breathing on your own an reguired intubation. the esophageal varices were banded and the rectal varice was injected with a thrombosing . please make sure to continue your medications as prescribed. the following changes were made to your regimen: - start taking omeprazole 40 mg daily. if you experience any increasing abdominal pain, nausea/vomiting, diarrhea, dark/tarry stools or bloody stools, fevers, chills, or any other concerning symptoms please call your doctor or return to the emergency room. followup instructions: phone: date/time: 9:30 cat scan phone: date/time: 10:45 , md phone: date/time: 9:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy fiber-optic bronchoscopy endoscopic excision or destruction of lesion or tissue of esophagus endoscopic polypectomy of large intestine closed [endoscopic] biopsy of large intestine flexible sigmoidoscopy endoscopic destruction of other lesion or tissue of large intestine diagnoses: acute posthemorrhagic anemia portal hypertension acute respiratory failure other specified cardiac dysrhythmias hypotension, unspecified pneumonitis due to inhalation of food or vomitus blood in stool long-term (current) use of anticoagulants primary hypercoagulable state injury to bladder and urethra, without mention of open wound into cavity urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure esophageal varices in diseases classified elsewhere, without mention of bleeding internal hemorrhoids with other complication external hemorrhoids with other complication acute vascular insufficiency of intestine acute vascular insufficiency of intestine benign neoplasm of colon syncope and collapse acute edema of lung, unspecified jaundice, unspecified, not of newborn portal vein thrombosis genetic susceptibility to other disease 

Answer: The patient is high likely exposed to