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: bactrim / augmentin attending: chief complaint: dyspnea, anemia major surgical or invasive procedure: egd colonscopy capsule endoscopy history of present illness: mrs is a pleasant 66f with history of copd, afib, mitral valve replacement presenting from group home with worsening dyspnea on exertion x 3 days. she denies chest pain, cough, shortness of breath, lower extremity swelling, headache, nausea, vomiting, or fever. she has orthopnea at rest and sleeps with 2 pillows at baseline, this has not worsened recently. . in the ed, she was noted to be hypotensive to the 70s, however manual bp was 100/70 and pt was mentating well. physical exam was notable for loud murmur not previously documented. ekg was done and notable for hypertrophy and st depressions, unchanged from prior. labs were notable for mildly elevated lactate of 2.4, hyponatremia to 132, elevated creatinine to 2.4 (baseline 2.0), mildly elevated bnp, and crit of 21.5, down from a baseline of 30. pt was guiac negative on exam. cxr showed retrocardiac opacity, possibly pleural effussion. . on the floor, pt is comfortable without any complaints. she states that she feels improved since she arrived in the hospital, with improvement in her weakness. . review of systems: (+) per hpi. pt states she has 1 bm daily, no blood recently however did have blood in stools 1 wk prior which she attributed to her hemorrhoids. + lightheadedness. (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: -rheumatic heart disease s/p mitral & aortic valve replacement -copd -asthma -hypothyroid -cri, baseline creatinine 2.0 -urinary incontinence -anxiety -depression -afib -psychoaffective disorder -hx ascending aortic anuerysm 5.4x 4.9 cm , appropriate for resection social history: lives in group home. no tobacco/no etoh, very unstable family life according to pcp family history: mother and father with cad, dad died of mi physical exam: admission physical exam vitals: t:98.2 bp:100/46 p:63 r:17 o2:98% general: alert, oriented, no acute distress heent: sclera anicteric, mm dry, oropharynx clear, conjunctiva pale neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irregular rate, 2/6 sem, mechanical s1, s2 abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: aaox3, cns intact, strength and sensation grossly nl. . discharge physical exam vs: 97.3, 77, 103/52, 16, 96% on ra gen: a&ox3 heent: mm dry, oropharynx clear, anicteric conjunctiva neck: supple, jvp not elevated, no lad heart: irregularly irregular rhythm, high pitched s1, s2, systolic murmur best heart at lusb lung: cta bl abd: soft, nt/nd, positive bs, no rebound/guarding ext: warm, no pitting edema, nontender over left mtp pertinent results: admission labs 02:50pm wbc-9.5 rbc-2.34*# hgb-6.9*# hct-21.5*# mcv-92# mch-29.6 mchc-32.2 rdw-20.5* 02:50pm neuts-84.1* bands-0 lymphs-9.8* monos-5.3 eos-0.7 basos-0.1 02:50pm hypochrom-3+ anisocyt-2+ poikilocy-occasional macrocyt-2+ microcyt-normal polychrom-1+ ovalocyt-occasional stippled-occasional teardrop-occasional 02:50pm plt smr-normal plt count-273 02:50pm pt-33.2* ptt-77.7* inr(pt)-3.3* 02:50pm probnp-2838* 02:50pm glucose-100 urea n-69* creat-2.4* sodium-132* potassium-3.5 chloride-91* total co2-28 anion gap-17 02:50pm ctropnt-0.02* 03:00pm lactate-2.4* k+-3.5 05:35pm urine color-straw appear-clear sp -1.006 05:35pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.0 leuk-neg 11:34pm hct-23.3* 11:34pm ck-mb-2 ctropnt-0.01 11:34pm ck(cpk)-24* . discharge labs 07:05am blood wbc-2.9* rbc-3.06* hgb-8.8* hct-27.1* mcv-89 mch-28.9 mchc-32.6 rdw-17.0* plt ct-146* 07:05am blood pt-28.0* inr(pt)-2.7* 07:05am blood glucose-96 urean-13 creat-1.4* na-141 k-4.2 cl-105 hco3-28 angap-12 07:05am blood alt-31 ast-24 alkphos-21* totbili-0.4 07:05am blood calcium-8.9 phos-3.6 mg-2.1 . pertinent labs 02:50pm blood probnp-2838* 04:52am blood caltibc-369 hapto-33 ferritn-23 trf-284 07:25am blood vitb12-455 folate-19.4 . beta-2-glycoprotein 1 antibodies igg test result reference range/units b2 glycoprotein i (igg)ab <9 <=20 sgu . 07:30am blood ttg-iga 1 07:00am blood inh screening pos 07:00am blood lupus anti-coagulant pos 07:05am blood aca igg-2.2 aca igm-7.2 anticardiolipin antibody igg 2.2 0 - 15 gpl 0-15 gpl: negative;15-20 gpl: indeterminate; >20 gpl: positive anticardiolipin antibody igm 7.2 0 - 12.5 mpl . pertinent studies ct chest/abd/pelvis impression: 1. stable appearance of thoracic aortic aneurysm without evidence of hematoma in the chest, abdomen, or pelvis, as questioned. 2. splenomegaly and prominence of the left hepatic lobe, findings that suggest the possibility of background liver disease. correlation with lfts is recommended. 3. biapical and left lower lobe nodular pulmonary densities, for which followup with chest ct is recommended in one year if there are risk factors for lung cancer. 4. aortic and mitral valve replacement with biatrial enlargement and findings again consistent with pulmonary artery hypertension. 5. fat-containing umbilical and left inguinal hernias. . egd - tear blood in the body of stomach erythema in the stomach normal mucosa in the duodenum (biopsy) otherwise normal egd to third part of the duodenum . colonoscopy melanosis coli in the colon polyp in the colon . duodenal biopsy duodenum, biopsy (a): duodenal mucosa within normal limits. . cxr findings: in comparison with the study of , there is continued enlargement of the cardiac silhouette in a patient with aortic and mitral valve replacement and cabg procedure. opacification at the base posteriorly is consistent with pleural effusion, more prominent on the left. volume loss is again seen in the region of the left lower lobe. no evidence of acute focal pneumonia. . single ballon enteroscopy normal esophagus. normal stomach. normal duodenum. there was one small area with active bleeding seen in the proximal jejunum. the base of the bleeding was not able to be well visualized because of the active bleeding and clots. it is suspicious for avm or dieulafoy lesion. it was first treated with cauterization with a gold probe. then it was injected with 1:10,000 epinephrine. three hemoclips were placed successfully with good hemostasis. spot tattoo was applied on either side of the bleeding area for future localization . kub impression: single focally dilated loop of small bowel with wall thickening and two clips within the lumen, which likely represents a focal ileus in the area of the recent avm clipping. brief hospital course: 66 yo woman with h/o rheumatoid heart disease s/p mvr and avr, a-fib on coumadin, admitted for doe, found to have new anemia. . active issues: # jejunal avm: pt presented with 10 pt crit drop. there was no evidence of hemolysis or bm suppression. she was treated with ppi gtt. her egd revealed tear, but no active source of bleeding. her colonoscopy showed benign polyp and melanosis coli . however, capsule endoscopy showed jejunal avm. pt was treated medically with blood transfusion, while awaiting optimization of anticoagulation status. she received endoscopic cauterization on . she was hemodynamically stable afterwards. we discontinued her aspirin given she is already on warfarin. we continued her homedose omeprazole given there is no evidence gastric ulcer disease. . # coagulation abnormality: pt has chronically elevated ptt. current workup is notable for positive mixing test, inhibitor screening, and lupus anticoagulant. the test was done > 48 hrs after cessation of heparin, therefore unlikely false positive from presence of heparin. her anti-cardiolipin and beta2-glycoprotein were negative. the clinical suspicion for anti-phospholipid syndrome was high, however, pt does not formally meet the diagnostic criteria for antiphospholipid syndrome, and she is already on anti-coagulation treatment. a follow up appointment with hematology on with dr. has been made for further workup and management. . # ileus: pt complained of abdominal bloating and mild discomfort on the last few days of this admission. she tolerated food intake well with no nausea/vomiting. her abdominal exam was always reassuring. she did not have bowel movement for three days. kub showed evidence of ileus likely in the location of avm clipping. . # hx prosthetic valve: pt has documented h/o mvr and avr secondary to rheumatic heart disease. we kept her inr at goal of 2.5 - 3.5 with heparin gtt for procedure. no thromboembolic events were observed during this admission. she was discharged with inr 2.7. . # gout: pt developed left mtp pain. the location and nature of pain is concerning for gout. she was empirically treated with low dose colchicine once, and her symptoms improved significantly in the following days. . # : pt presented with acute kidney injury in the setting of significant gib. her creatinine improved after correcting her anemia. . # chf: pt has a documented history of diastolic chf. we held her diuretics temporarily in the setting of hypovolemia. an the time of discharge, pt tolerated half dose of her lasix well. we recommend restarting spiralactone and half dose of her potassium supplement, and titrating up as tolerated. . chronic issues # a-fib: pt has documented a-fib. she was in a-fib rhythm throughout this hospitalization. we started her diltiazem after the procedure, and she tolerated well. pt was anticoagulated throughout this hospitalization. . # psychoaffective disorder/depression: we continued her home medication. . # copd: pt has documented history of copd. she did well on her home medication spiriva and advair. . # hyperlipidemia: we continued her home dose statin. . transitional issues # code status: full code # communication: at group home (pt designated person of contact), daugher is official hcp, but not in . # pending studies at discharge: none # medication changes: - stopped aspirin in the setting of gib. will consider restarting after stabilization, as there are evidence that aspirin and coumadin is superior than coumadin monotherapy in mortality of patients with mechanical valves. - restarted furosemide at half dose. - stopped metolazone. - continued at home dose with alternating 5 mg and 4.5 mg. - restarted half dose of potassium supplement # followup: - will need early follow-up with pcp/cardiology - recommend follow-up with hematology - recommend maintenance treatment for gout as outpatient. medications on admission: priloesec 20 mg qam diltiazem 240 mg q am spiriva 1 cap inh qhs aspirin 81 mg daily pramipexole 1 mg po qhs bupropion 150 mg po qam zocor 10 mg po qhs iron sulfate 325 po q am aldactone 25 mg po qam nephrocaps 1 cap po q day advair 5/500 puff inh senna 2 tabs po bid colace 100 mg po bid albuterol nebs 1 vial neb q 4hr prn sob tylenol 650 mg po q 6h procrit 40,000 un sc q month, hold for hgb 12 levothyroxine 125 mcg po qam zaroxolyn 1 tab 2.5 po mon/wed/fri 1/2 hr prior to lasix kcl 20 mcg po bid lasix 40 mg po bid coumadin 4.5 alternating with 5 mg mom 30 ml po prn constipation discharge medications: 1. pramipexole 1 mg tablet sig: one (1) tablet po qhs (). 2. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po daily (daily). 3. simvastatin 10 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 4. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 5. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 7. diltia xt 240 mg capsule,ext release degradable sig: one (1) capsule,ext release degradable po once a day. 8. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 9. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. albuterol sulfate 2.5 mg/0.5 ml solution for nebulization sig: one (1) neb treatment inhalation q4h prn as needed for shortness of breath or wheezing. 13. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 14. procrit 40,000 unit/ml solution sig: one (1) injection injection once a month: hold for hgb > 12. 15. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 16. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm: alternate 4.5mg and 5mg doses every other day. 17. ferrousul 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 18. milk of magnesia 400 mg/5 ml suspension sig: thirty (30) cc po once a day as needed for constipation. 19. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 20. spironolactone 25 mg tablet sig: one (1) tablet po once a day. 21. potassium chloride 20 meq packet sig: one (1) po once a day. discharge disposition: extended care facility: nursing and rehabilitation - discharge diagnosis: primary diagnosis - a-v malformation in jejunum secondary diagnosis - atrial fibrillation - asthma - anti-phospholipid syndrome (high suspicion) 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: dear ms. , you came to our hospital for shortness of breath, and was found to have a significant drop in blood count, concerning for bleeding from your gut. you were initially treated in the micu, and received multiple units of blood products. you underwent upper and lower endoscopy, as well as a capsule endoscopy. we found that you have a large malformed vessel in your small intestine. our gastroenterologist corrected that bleeding vessel through endoscopy. during this hospitalization, we also found that you have an unusual blood clotting pattern, that will require further followup. you had a small gout flare, that has largely resolved. . please note that the following medication has changed: - please stop taking aspirin, until further instruction by your pcp. please take a reduced dose of furosemide at 20 mg tablet, one tablet by mouth twice a day. please remind your doctor that this is half of your previous dose, and should be increased if needed. - please stop taking metolazone until further notice by your pcp. please continue to take warfarin 5 mg daily and have your inr checked regularly. - there is no further changes to your medication. inr monitoring will be extremely important moving forward due to the propensity of your blood to clot. we have arranged followup with your pcp/cardiologist dr. , and with our hematologist. please make sure that you make to these appointments. it has been a pleasure taking care of you here at . we wish you a speedy recovery. followup instructions: name: , : internal medicine/cardiology address: ,2nd fl, , phone: appointment: thursday at 2pm department: hematology/oncology when: friday at 11:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: control of hemorrhage, not otherwise specified colonoscopy esophagogastroduodenoscopy [egd] with closed biopsy other destruction of lesion of small intestine, except duodenum diagnoses: esophageal reflux congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism gout, unspecified atrial fibrillation depressive disorder, not elsewhere classified chronic kidney disease, unspecified heart valve replaced by other means anxiety state, unspecified hypotension, unspecified paralytic ileus angiodysplasia of intestine with hemorrhage chronic obstructive asthma, unspecified gastroesophageal laceration-hemorrhage syndrome chronic diastolic heart failure leukocytopenia, unspecified schizoaffective disorder, unspecified other specified disorders of intestine other and unspecified nonspecific immunological findings 

Answer: The patient is high likely exposed to