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: ace inhibitors / norvasc attending: chief complaint: gi bleeding major surgical or invasive procedure: upper endoscopy with biopsies pending history of present illness: 87 yo m with pmhx htn, afib, pvd, s/p pm for chb and duodenal avm who has had ongoing transfusion dependent gi bleeds transferred from osh for anemia and fatigue. his gi history dates back to where started having gi bleeds and underwent a workup in flordia. they had found mild gastric erosions on egd/ at that point. subsequently he was admitted to hospital for syncope for which a pm was placed for chb and found to be anemic again. he was scoped at that admission but there are is no documention but report of egd/ - gastric erosions - with ?avms in upper gi tract. also per report he had a capsule study which did not show evidence of bleeding. he was admitted in to for anemia found to to have duodenal avm on endoscopy. since then he has required 14 units of packed rbcs and has had ongoing dark stools. at osh today his hct was found to be 20. he was given 2 units at osh and a protonix gtt. ekg showed paced rhythm but no sttw. trop 0.28. . in ed, 80 150/60 20 98 %ra. per gi given history no need for ngl. hct 23.9. cr up. ordered for another unit of blood that he had not recieved. got 1/2-1l fluid. 3piv, 1 20 and 2 18g. protonix gtt. 98.8 68 135/55 16 98% on ra. gi consulted and will staff in am. . currently, patient reports some abdominal cramps that he has had after each meal. reported fatigue but no lightheadness or loc. he denied nausea but reported dark tarry diarrhea. denied cp, sob, cough, fever, chills. has chronic lower extremity swelling but denies orthopnea or pnd. no recent nsaid use. . ros: denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, constipation, brbpr, melena, hematochezia, dysuria, hematuria. past medical history: gi bleed anemia from gi bleed afib complete heart block s/p pacemaker bph htn pvd right cea djd social history: currently a resident of pavilion ( associated with hospital) - . tobacco: no etoh: heavy drinker scoth drinks per day, last drink was 6 wks back. family history: mother: had cancer (pt does not know the type) physical exam: tmax: 36.2 ??????c (97.2 ??????f) tcurrent: 36.2 ??????c (97.2 ??????f) hr: 65 (65 - 76) bpm bp: 135/51(70) {133/51(70) - 135/58(76)} mmhg rr: 9 (8 - 14) insp/min spo2: 96% heart rhythm: v paced height: 65 inch general appearance: well nourished eyes / conjunctiva: perrl heent: pale conjunctiva chest: regular hs, lungs ctab abd: soft, no tenderness elicited, no rebounding or guarding ext: + pitting edema b/l to knees skin: not assessed neurologic: oriented and appropriate. pertinent results: egd normal mucosa in the duodenum normal mucosa in the esophagus angioectasias in the stomach body ulcer in the stomach body (biopsy) otherwise normal egd to third part of the duodenum 03:55am blood wbc-4.8 rbc-2.73* hgb-7.8* hct-23.9* mcv-88 mch-28.8 mchc-32.8 rdw-16.7* plt ct-294 12:24pm blood hct-24.1* 05:36pm blood hct-31.0*# 11:34pm blood hct-27.3* 04:39am blood wbc-5.0 rbc-3.22* hgb-9.5* hct-28.5* mcv-89 mch-29.6 mchc-33.4 rdw-17.4* plt ct-268 05:01pm blood wbc-5.8 rbc-3.53* hgb-10.2* hct-31.3* mcv-89 mch-28.8 mchc-32.5 rdw-17.2* plt ct-296 01:15am blood hct-28.7* 05:10am blood wbc-5.5 rbc-3.35* hgb-10.1* hct-30.4* mcv-91 mch-30.1 mchc-33.2 rdw-17.0* plt ct-280 05:30pm blood hct-30.6* 03:55am blood neuts-71.6* lymphs-19.2 monos-7.0 eos-1.9 baso-0.4 03:55am blood pt-12.0 ptt-24.1 inr(pt)-1.0 05:10am blood pt-12.5 ptt-25.1 inr(pt)-1.1 05:10am blood plt ct-280 03:55am blood glucose-110* urean-85* creat-2.5*# na-139 k-4.2 cl-101 hco3-26 angap-16 05:36pm blood glucose-156* urean-67* creat-2.1* na-140 k-4.4 cl-104 hco3-24 angap-16 04:39am blood glucose-92 urean-56* creat-1.8* na-142 k-4.0 cl-107 hco3-27 angap-12 05:10am blood glucose-94 urean-37* creat-1.4* na-143 k-3.7 cl-108 hco3-29 angap-10 03:55am blood ck(cpk)-29* 12:24pm blood ck(cpk)-16* 03:55am blood ck-mb-notdone ctropnt-0.13* probnp-4085* 12:24pm blood ck-mb-notdone ctropnt-0.10* 04:39am blood calcium-8.5 phos-3.8 mg-1.9 05:10am blood calcium-8.3* phos-3.3 mg-2.0 chest x-ray ()- 1. small bilateral pleural effusion and pulmonary vascular congestion compatible with mild fluid overload. 2. asymmetrically enlarged and dense right hilus which could be due to vascular congestion, however oblique radiographs are recommended for further evaluation. 3. severe atherosclerosis. chest x-ray (pa, lateral, obliques)- - small bilateral pleural effusions and generalized pulmonary vascular engorgement persists. heart is slightly larger. multiple views of both hila show that their enlargement is probably due to dilated pulmonary arteries. transvenous right atrial and right ventricular pacer leads are in place. thoracic aorta is extremely heavily calcified, but not dilated. no pneumonia ekg- - sinus rhythm with marked first degree a-v block and ventricular electronic pacing. compared to the previous tracing of the p-r interval has lengthened stomach biopsies- pending brief hospital course: micu course: the patient was transferred to for further management of his upper gi bleeding, and was admitted directly to the medical intensive care unit. he had a prior enteroscopy with dr. in in . egd in the micu revealed multiple linear 2-3cm ulcers were found along the gastric folds in the stomach body. blood clot suggested recent bleeding. the folds around the ulcer was induated and edematous. this appearance might be compatible with gastric lymphoma. cold forceps biopsies were performed for histology at the stomach body. he was transfused 2 units while at , but has remained hemodynamiclly stable. he was treated with intravenous ppi. he remained fully alert and oriented throughout his micu stay. floor course: patient transferred to the floor on the evening of . he was stable and did well while in the micu. upon transfer to the floor, the patient had two non-bloody bowel movements. his hct was closely monitored- trended from 31.3 to 28.7 overnight. up to 30.4 upon discharge (was ~20 on admission). he did not require any transfusions while on the floor and tolerated oral intake well. his blood pressure medications were held and his finesteride was restarted. bp returned to sbp of 130s-140s. patient instructed to resume home blood pressure medications now that bleed has resolved and he has no signs of hypovolemia on exam or on vital signs. upon discharge, the patient was stable and comfortable. medications on admission: cardura 4mg po qhs digoxin 0.125 mg daily lasix 40mg po daily fenestrate 5mg po daily colace 100mg po bid hydralazine 50mg po tid omeprazole 40mg po daily ferrous sulfate 325mg po daily toprol xl 75mg po daily discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 2. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 3. digoxin 125 mcg tablet sig: one (1) tablet po once a day. 4. cardura 4 mg tablet sig: one (1) tablet po at bedtime. 5. lasix 40 mg tablet sig: one (1) tablet po once a day. 6. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 7. hydralazine 50 mg tablet sig: one (1) tablet po three times a day. 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 9. toprol xl 25 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po once a day. 10. outpatient lab work please check cbc, chem-7 prior to and fax results to dr. at 11. potassium chloride 10 meq tablet sustained release sig: one (1) tablet sustained release po once a day. discharge disposition: home discharge diagnosis: primary: - acute gi bleed resolved - multiple 2-3cm ulcers in the stomach body - acute renal failure; resolved - non-thrombotic troponin elevation - dense right hilus secondary to enlarged pulmonary artery. secondary: - atrial fibrillation - heart block, s/p pacemaker - ckd stage iii - benign prostatic hypertrophy - hypertension - duodenal avms - peripheral vascular disease s/p iliac stent - s/p right carotid endarterectomy - s/p appendectomy - macular degeneration, blind in the right eye discharge condition: good. vital signs stable. no sign of active gi bleed. discharge instructions: you were transferred to for gi bleed management. when you arrived here, you were fatigued with a low hematocrit (a measure of your blood count). you were transfused 3 total units of blood and responded very well. the gi team saw you and performed an egd. they found stomach ulcer and believe that is the cause of your bleed. they took samples from the ulcer for analysis- those results are still pending. your bleed has now resolved and you have been hemodynamically stable. upon discharge, you had no signs of active gi bleed. your blood pressure medications were held while you were in the hospital. please resume all home medications at this time. please do not take any blood thinning medications (coumadin, lovenox) the following medication changes were made: 1. stop taking your omeprazole and start taking pantoprazole 40mg by mouth twice a day. if you experience another gi bleed, fevers, chest pain, shortness of breath, light-headedness, severe abdominal pain or any other medically concerning symptoms, please contact your primary care physician or go to the emergency department immediately. followup instructions: please follow-up with your primary care physician (, s ) next week. call dr. office on monday to make an appointment for next week. please get your blood drawn by so your primary care physician can have the results by the time you see her. the gi doctors here you at to schedule a follow-up appointment in the next week. procedure: esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: acute posthemorrhagic anemia acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, stage iii (moderate) chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction cardiac pacemaker in situ 

Answer: The patient is high likely exposed to