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: this is a 56-year-old female with a history of rheumatoid arthritis, asthma, anemia, and status post nissen fundoplication in for severe gastroesophageal reflux disease, transferred from an outside hospital for possible embolization of a gi bleed. the patient first developed black tarry stools two weeks ago prior to admission and an egd at the time showed a small ulcer at the gastroesophageal junction. she received 1 unit of packed red blood cells and was discharged in stable condition at that time. on , three days prior to admission, she again developed black tarry stools. she was scheduled to see dr. , her gastroenterologist, who performed an egd on , one day prior to admission. this egd showed a normal upper gi tract. she was admitted to hospital the following day for a colonoscopy which only showed old blood in the cecum. a repeat upper gi was done and showed two clots in the fundus with fresh blood. she was transferred to the intensive care unit at hospital, and then transferred to the for possible angiography and embolization. at time of admission, she denied chest pain. she had some mild shortness of breath especially when standing. she did have dizziness when standing. she also had five stools on the day of admission with her bowel prep. she had one bowel movement prior to transfer. she denied fever, cough, or hematemesis. past medical history: 1. nissen fundoplication in for severe gastroesophageal reflux disease. 2. asthma. 3. rheumatoid arthritis on arava, methotrexate, and enbrel. 4. bilateral knee replacements in . 5. l5-s1 laminectomies. 6. iron deficiency anemia. 7. depression. 8. status post splenectomy. medications at home: 1. arava 20 mg q day. 2. methotrexate 25 mg q week. 3. enbrel 25 mg 2x/week. 4. prednisone 10 q day, which was discontinued in . 5. prozac 20 q day. 6. doxepin 100 q day. 7. folate 2 q day. 8. premarin 0.3 q day. 9. medroxyprogesterone 2.75 q day. 10. protonix 40 . allergies: 1. penicillin which lead to wheezing and shortness of breath, and itching rash. 2. sulfa which causes hives. family history: her maternal grandfather had a history of stomach cancer, and sister with severe gastroesophageal reflux disease. her father had gastroesophageal reflux disease. social history: she denies tobacco, alcohol, or iv drug use. she is a retired finance worker. she is married with four children. review of systems: as noted above. physical examination: on admission, she was afebrile with a temperature of 98.7, blood pressure was 103/54, with a heart rate of 100, and oxygen saturation of 97% on room air. in general, she was in no acute distress and pale appearing woman, who is obese. her head and neck examination: pupils are equal, round, and reactive to light and accommodation. extraocular motions were intact. her neck was supple with no lymphadenopathy. her heart was regular, rate, and rhythm with a systolic ejection murmur loudest at the left upper sternal border. her lungs are clear to auscultation bilaterally. abdomen was soft with no active bowel sounds, nontender, nondistended, and no hepatosplenomegaly. her extremities were warm and well perfused with no clubbing, cyanosis, or edema. laboratories on admission: from outside hospital included a white count of 5.9, hematocrit of 27.7, platelets of 309,000. her electrolytes were a sodium of 141, potassium of 4.6, chloride of 104, bicarbonate of 30, bun 12, creatinine 0.6, glucose 121, calcium 8.4, phosphorus 2.6, magnesium 1.9. her coagulation panel included a pt of 12, inr of 1.1, ptt of 25.4. hospital course by problem: 1. upper gi bleed: the patient was transferred to the medical intensive care unit upon admission, and was managed expectantly for any potential bleeding. she was transfused 2 units of packed red blood cells, and evaluated by the gastroenterology service. they felt that she would benefit from another esophagogastroduodenoscopy prior to angiography to further evaluate the possible sources of bleeding. she continued with stable vitals, and her egd showed no active bleeding source or abnormality in the esophagus, stomach, or duodenum. she was continued on observation in the medical intensive care unit until her third hospital day, where it was felt that she was stable to return to the medical floor. in the following morning, however, she had a further episode of black stool as well as dizziness upon standing and tachycardia on standing. she was thus, taken to the angiography vascular interventional suite, where a left gastric artery embolization was performed with gelfoam. please see full report for details of the procedure. the patient tolerated the procedure well with some residual nausea and vomiting, for which she was returned to the medical intensive care unit postoperatively for expectant management. the patient also had one episode of chest pain during the procedure that was evaluated with an electrocardiogram and one set of cardiac enzymes which were both negative for any evidence of ischemia. it was felt that this was likely secondary to her gastroesophageal reflux disease from a horizontal position. on hospital day seven, the patient was again returned to the medical floor after a stable time in the intensive care unit. she had received 1 unit of packed red blood cells prior to and during the angiography procedure. her hematocrit following this transfusion was 35.2. for the remainder of her hospital stay, the hematocrit drifted slightly down to 33 with several small episodes of melena. she was continually followed by the gastroenterology service with repeated hematocrits all remaining within the stable range. her dizziness and tachycardia upon standing resolved, and no further blood transfusions were necessary. her nausea and vomiting resolved after her first day following the procedure, and no further evidence of bleed was noted. her diet was advanced slowly from clear liquids 48 hours after her embolization procedure, and she was advanced to soft solids followed by a regular diet on the day prior to discharge. she remained pain free with stable vitals and no further evidence of bleed on hospital day 11, the day of her discharge. 2. shortness of breath and hypoxia: the patient reported shortness of breath and hypoxia, that was thought to be secondary to her anemia and deconditioning with decreased activity over the prior months. however, given the patient's changes in volume with transfusions as well as her lower extremity edema and presence of murmur, an echocardiogram was obtained which showed normal left ventricular function and ejection fraction as well as no evidence of diastolic dysfunction. please see full report for details of the study. in addition, given her hospitalizations and partial compliance with venodynes sequential compression device boots, it was felt that a pulmonary embolism was also a possible cause for her shortness of breath. a ct angiogram was obtained, and no evidence of pulmonary embolism was found. the patient remained on oxygen 2 liters nasal cannula during her early hospitalization, however, on the final three days of her hospitalization, she was oxygenating 94% on room air range. she was also able to ambulate without shortness of breath or desaturation. it was felt that her hypoxia was possibly secondary to her history of asthma/reactive airways disease. further workup as an outpatient is recommended as needed. 3. rheumatoid arthritis: the patient's rheumatoid arthritis medicines were held during this initial acute episode. she remained without pain or flare of her rheumatoid arthritis, however, on the final hospital day, she complained of some mild joint symptoms in her hands. it was recommended that she resume her rheumatoid arthritis medicines under consultation of her primary doctor. 4. depression and anxiety: the patient was maintained on her regimen of prozac and doxepin as well as receiving ativan prn and at hs. 5. fever: the patient had one episode of fever following her gi embolization. this was felt to be secondary to postoperative response to foreign material within the vasculature. her right groin sites where the interventional catheters were placed showed no signs of infection. in addition, her lungs were clear and no urinary symptoms were identified. she persisted with some mild low-grade fevers for two days following the procedure, however, the temperature came down to within her normal range subsequently. no sign of infection was noted, and blood cultures were not sent. on hospital day 11, the patient was deemed in stable condition to return home. condition on discharge: good and stable. discharge status: home with no services. discharge diagnoses: 1. gastrointestinal bleed. 2. rheumatoid arthritis. 3. anxiety/depression. 4. blood loss anemia. 5. hypovolemia. 6. hypoxia. discharge medications: 1. arava 20 mg q day. 2. methotrexate 25 mg q week. 3. enbrel 25 mg 2x/week. 4. prednisone 10 q day, which was discontinued in . 5. prozac 20 q day. 6. doxepin 100 q day. 7. folate 2 q day. 8. premarin 0.3 q day. 9. medroxyprogesterone 2.75 q day. 10. protonix 40 . 11. omeprazole 40 mg po bid. follow-up plans: the patient is instructed to followup with her gastroenterologist, dr. . is instructed to return to the emergency department or contact her physician if she develops any further bleeding per rectum, dark tarry stools, or fevers, nausea is uncontrolled, or vomiting. , m.d. dictated by: medquist36 procedure: endoscopic control of gastric or duodenal bleeding transcatheter embolization for gastric or duodenal bleeding diagnoses: esophageal reflux acute posthemorrhagic anemia asthma, unspecified type, unspecified dysthymic disorder rheumatoid arthritis gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction hemorrhage of gastrointestinal tract, unspecified aneurysm of other visceral artery 

Answer: The patient is high likely exposed to