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: blood from ileostomy major surgical or invasive procedure: pill enteroscopy (non-invasive) history of present illness: mr. is a 55 year old male with metastatic renal cell cancer diagnosed in early , currently on avastin therapy, crohn's disease s/p total colectomy with ileostomy formation in , who presents with brisk bright red blood from ileostomy this morning in oncology clinic. the patient states that he first noted bleeding from his ileostomy about 6 weeks ago, at which time he underwent a workup entailing an upper endoscopy and ileoscopy in . per report from the patient and notes (though we don't have the actual report), the upper endoscopy demonstrated significant portal hypertension with esophageal and gastric varices. a subsequent ileoscopy revealed a bleeding, ulcerated mass in the ileum, thought to be the source, with biopsies proven to be metastatic renal cell carcinoma. of note, he has been on avastin (bevacizumab), a chemotherapeutic for his renal cell cancer since , with the known risk of gi bleeding. there was discussion between the patient and his oncologist at the time of his gi bleeding regarding whether or not to discontinue this medication, however the patient decided to continue. his last avastin dose was on . his hematocrit was 28.9 at this time (slightly down from his recent baseline of approx 32). as mentioned above, mr. has had intermittent blood in his ileostomy bag for the last 6 weeks, noting bleeding again the day prior to admission. on the day of admission in oncology clinic the patient noted about 250 cc of bright red blood in the ileostomy bag and was sent to the ed. on arrival to the ed his vitals were 97.8, hr 77, bp 126/63, rr 18, 100% on ra. while in the ed he had another 250 cc of blood, and his hct was found to be 26.2, dropping to 22.8 within a couple of hours. he was given 1 l ns, however a transfusion was delayed secondary to difficulty with crossmatching (history of transfusions with resultant antibody formation). he was seen by gi and sent to the . past medical history: 1) oncologic history: diagnosed with renal cell cancer in early after hematuria noted by pcp. abdominal ultrasound showed a large left renal mass, two suspicious lesions in the liver and tumor thrombus in the ivc. in he underwent radical nephrectomy/partial small bowel resection/partial liver resection/cholecystectomy. pathology showed a 9cm renal cell carcinoma (granular), grade iv and invading the capsule, perirenal fat and vascular structures. three lymph nodes, the adrenal, small bowel and the margins were all were negative, although the margin was less than one millimeter at the anterior capsule. a liver nodule was positive. he has been on a number of medical regimens: low-dose interferon , but stopped due to evidence of progression on ct: opacities in the liver and new right middle lobe and left lung base nodules, both subcentimeter. mr. started the 43-9006 trial . drug stopped due to progression on ct. he has been on avastin with stable response since /. course complicated by intermittent sbo, thought secondary to adhesions. 2) crohn's disease: s/p total colectomy with ileostomy in . has had 2 episodes of bowel obstruction, treated with npo. 3) bph, on hytrin social history: from originally. married with 2 children. working with computers. used to smoke but quit 24 years ago; 10 py hx. drank socially in the past but not recently. no ivdu. family history: father with probable prostate ca. brothers and sisters are healthy. physical exam: vs: 98.4, hr 81, bp 133/64, 16, 100% ra. gen: pale appearing, slim male, resting comfortably in bed, conversant. heent: anicteric sclerae, moist mm. neck: no jvd. cor: rr, normal rate, no m/r/g. lungs: cta b/l, no w/r/r. abd: nabs, soft, nt/nd. large vertical midline scar, well healed. ileostomy site clean, brown stool in bag. (per ed, ostomy output guaiac positive, with bright red blood). extr: 1+ le edema to knees b/l (chronic), dp palpable b/l. pertinent results: ekg: nsr at 80 bpm, no st/t wave changes. 10:24am blood wbc-3.2* rbc-3.15* hgb-8.3* hct-26.2* mcv-83 mch-26.3* mchc-31.6 rdw-19.2* plt ct-155 12:46pm blood wbc-3.3* rbc-2.78* hgb-7.5* hct-22.8* mcv-82 mch-26.9* mchc-32.7 rdw-19.3* plt ct-146* 07:48pm blood hct-25.1* 04:18am blood wbc-3.3* rbc-3.04* hgb-8.3* hct-24.5* mcv-81* mch-27.3 mchc-33.8 rdw-18.3* plt ct-146* 08:35am blood hct-29.9* 06:30am blood wbc-3.4* rbc-3.29* hgb-9.0* hct-27.4* mcv-83 mch-27.3 mchc-32.7 rdw-18.5* plt ct-134* 08:15am blood wbc-3.6* rbc-3.39* hgb-9.2* hct-28.4* mcv-84 mch-27.2 mchc-32.5 rdw-18.6* plt ct-148* 08:15am blood wbc-3.6* rbc-3.39* hgb-9.2* hct-28.4* mcv-84 mch-27.2 mchc-32.5 rdw-18.6* plt ct-148* 12:46pm blood pt-13.2 ptt-30.6 inr(pt)-1.2 10:24am blood gran ct-2420 08:15am blood glucose-77 urean-15 creat-1.8* na-139 k-4.5 cl-106 hco3-23 angap-15 04:18am blood alt-10 ast-25 ld(ldh)-128 alkphos-162* totbili-1.1 04:18am blood albumin-3.5 iron-68 04:18am blood caltibc-299 hapto-129 ferritn-42 trf-230 brief hospital course: 55 yo male with metastatic renal cell cancer diagnosed in early , currently on avastin therapy, crohn's disease s/p total colectomy with ileostomy formation in , who presents with brisk bright red blood from ileostomy this morning in oncology clinic. found to have hct drop from 29 on to 23 on day of admission. 1) gi bleed: patient with two known possible sources, given known varices, and also known mass in ileum. given that ng lavage negative (performed on arrival to ), patient denies hematemesis, and bleed seems to have slowed down, unlikely variceal. lastly, patient with crohn's disease, and has had bleeding in the past, but none for many years, and disease activity has decreased since colectomy - not on any medications. most likely source is known necrotic mass in ileum, which presents few therapeutic options, per gi. will need to consider embolectomy vs. endoscopic attempt at cauterization if bleeding persists. for now, no further blood in ileostomy bag. avastin possible diathesis. dr. from surgery was consulted who feels that tumor site 15cm from ileostomy is source of bleeding associated with evastin. gi arranged a capsule endoscopy, which showed a few prominent venous blebs in jejunum in ileum as well as a few discontinuous segements of friable mucosa in jejunum and ileum. they recommended a push enteroscopy and ileoscopy with biopsy. it was felt that the friable mucosa was not likely to be the source of bleeding. given the stabilization of bleeding, pt wanted to go home to , with plans to follow-up with dr. for a possible resection of the involved area of small bowel with intraoperative push enteroscopy to examine the rest of the small bowel. in addition, he will need to discuss at that time when to restart avastin. . 2) chronic renal insufficiency: creatinine at baseline of approximately 2.0, secondary to patient being s/p nephrectomy. . 3) crohn's disease: patient with improved disease since colectomy, on no medications. . 4) chronic anemia: normocytic. previous iron studies borderline - likely mixed picture of iron deficiency and chronic renal disease. repeat iron studies were unremarkable with normal iron, normal ferritin and normal tibc. . 5) fen: pt initially kept npo, given ivf. slowly started po diet, which he tolerated well. . 6) pain: patient with chronic low back pain for which he takes tylenol at home. will write for 325-650 mg q4-6, and check lfts. . 7) code: full. . 8) communication: with wife. . 9) access: 2 16 guage piv. medications on admission: hytrin qday tylenol prn avastin discharge disposition: home discharge diagnosis: primary: metastatic renal cell carcinoma gib due to metastatic renal cell ca(possibly also due to crohn's disease) secondary: crohn's disease bph discharge condition: stable discharge instructions: continue taking all your medications. if you develop worsening bleeding from your ostomy, lightheadedness, vomiting blood, severe abdominal pain contact your physician or return to the er. followup instructions: provider: , md where: hematology/oncology phone: date/time: 2:40 provider: , rn where: hematology/oncology phone: date/time: 3:00 provider: 5 date/time: 3:00 . contact dr. office, phone , to schedule an appointment if you decide to go to for resection of the tumor in . otherwise arrange for a surgical evaluation for resection of the tumor through your gastroenterologist or primary care physician. procedure: transfusion of packed cells other diagnostic procedures on small intestine diagnoses: malignant neoplasm of liver, secondary acute posthemorrhagic anemia portal hypertension secondary malignant neoplasm of other specified sites hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) regional enteritis of unspecified site hemorrhage of gastrointestinal tract, unspecified personal history of malignant neoplasm of kidney ileostomy status secondary malignant neoplasm of small intestine including duodenum 

Answer: The patient is high likely exposed to