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: cortisone / prednisone / adhesive tape attending: chief complaint: brbpr major surgical or invasive procedure: total colectomy history of present illness: 36 yo with uc pan colitis found recently to have rectosigmoid adenocarcinoma, with local extension planned for total colectomy has been undergoing neoadjuvant chemotherapy, on day 4 of 5fu and 3 days of xrt presents after significant brbpr and lightheadedness. . he states that he has had relatively poorly controlled uc over the past 10 years, complications of rash and perianal fistula in past but not currently, on salicylates (not tolerated), steroids (not effective and steroid psychosis) and remicaide in past- now on rifaximin as well as and cromolyn to control his gi symptoms. his uc has been relatively stable recently, a "few" painful bowel movements in the a.m. with some blood and mucous. baseline mild nausea. . this morning he awoke and began having llq and rlq abdominal pain in addition to profusely bloody bowel movements- initially slightly formed stool then progressing to stool consisting mainly of blood. he describes it as bright red, without clots, and roughly 1 liter in total. he felt very lightheaded with the bms and needed to lay on the ground to prevent passing out. by the time he was admitted he states he had about 50 bowel movements and the bleeding had significantly decreased and his rlq and llq abd pain was subsiding. mild nausea. pain was cramping and would fluctate in severity. . no chest pain, shortness of breath, fevers, chills, or other symptoms. currently feels very mildly lightheaded past medical history: rectosigmoid adenocarcinoma- t3 lesion on mri and enlarged lymph nodes (not clearly mets vs. ibd associated)- extensive local extension into mesorectal fat- planned for neoadjuvant chemo and concurrent chemoradiation. 5fu and xrt with plans for subsequent surgery- began 5fu on . ulcerative colitis- diagnosed 10 years ago- c/b perianal fistula colon cmv infection mitral valve prolapse migraines osteoporosis- secondary to steroids hyperparathyroidism social history: lives alone, has phd in biomedical engineering and molecular biology, post doc studies at bu. no tob, etoh or drug use. family history: father with ulcerative colitis. father w/ cad, stroke at 69. died at 69. mother alive, hypothyroidism and migraines. healthy brother. physical exam: tmax: 37.9 ??????c (100.2 ??????f) tcurrent: 37.9 ??????c (100.2 ??????f) hr: 97 (87 - 97) bpm bp: 147/66(88) {130/66(85) - 147/71(88)} mmhg rr: 16 (15 - 16) insp/min spo2: 100% physical examination general appearance: well nourished, thin eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic cardiovascular: (s1: normal), (s2: normal), no(t) s3, no(t) s4, (murmur: no(t) systolic, no(t) diastolic) peripheral vascular: (right radial pulse: not assessed), (left radial pulse: not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (breath sounds: clear : ) abdominal: soft, bowel sounds present, no(t) distended, tender: rlq tenderness without rebound, no masses or organomegaly extremities: right: absent, left: absent skin: not assessed neurologic: responds to: not assessed, movement: not assessed, tone: not assessed . at discharge: avss gen: nad, a/ox3 cv: rrr resp: ctab abd: +bs, soft, nd, appropriately ttp, rlq stoma beefy red, viable with liquid brown stool, +flatus incision: midline ota cdi extrem: no c/c/e pertinent results: 11:10am wbc-4.4 rbc-5.38 hgb-12.7* hct-41.6 mcv-77* mch-23.7* mchc-30.7* rdw-14.4 11:10am neuts-80.1* lymphs-18.0 monos-0.6* eos-1.1 basos-0.2 11:10am plt count-446* 11:10am pt-12.5 ptt-26.2 inr(pt)-1.1 11:10am lipase-22 11:10am alt(sgpt)-12 ast(sgot)-24 alk phos-115 tot bili-1.9* dir bili-0.2 indir bil-1.7 11:10am glucose-167* urea n-15 creat-1.1 sodium-137 potassium-4.7 chloride-102 total co2-20* anion gap-20. 04:39am blood wbc-5.3 rbc-4.00* hgb-10.3* hct-31.6* mcv-79* mch-25.7* mchc-32.5 rdw-17.1* plt ct-422 05:14am blood glucose-96 urean-6 creat-0.8 na-141 k-3.8 cl-105 hco3-26 angap-14 05:14am blood calcium-8.1* phos-3.8 mg-2.0 . cxr - single upright view of the chest at approximately 1:40 p.m.: impression: no free air under the diaphragm. no acute cardiopulmonary abnormalities. . pathology examination procedure date diagnosis: colon, abdominal colectomy: 1. well-differentiated colonic adenocarcinoma, see synoptic report. 2. chronic active and inactive colitis, consistent with ulcerative colitis, with diffuse epithelial atypia, favor reactive. 3. focal active enteritis with villous atrophy. 4. multiple fissures of distal colon with focal perforation and peri-colic abscess formation. 5. appendix with fibrous obliteration and focal surface epithelium with atypia, favor reactive. colon and rectum: resection synopsis macroscopic specimen type: colonic resection. location: abdominal. specimen size greatest dimension: 70.5 cm. additional dimensions: 6 cm. tumor site: rectum. tumor configuration: infiltrative. tumor size greatest dimension: at least 5.2 cm. additional dimensions: 0.6 cm; see comment. microscopic histologic type: adenocarcinoma. histologic grade: low-grade (well or moderately differentiated). extent of invasion primary tumor: at least pt1: tumor invades submucosa; see comments. regional lymph nodes: pn2: metastasis in 4 or more lymph nodes. lymph nodes number examined: 27. number involved: 5. distant metastasis: pmx: cannot be assessed. margins proximal margin: uninvolved by invasive carcinoma: distance of tumor from closest margin: 700 mm. distal margin: involved by invasive carcinoma. circumferential (radial) margin: uninvolved by invasive carcinoma: distance of tumor from closest margin: 35 mm. lymphatic small vessel invasion: absent. venous (large vessel) invasion: absent. perineural invasion: absent. tumor border configuration: infiltrating. additional pathologic findings: two tumor nodules are found in peri-colic adipose tissue that lack residual nodal architecture or capsule. comments: the exact size and depth of invasion (t stage) cannot be determine as the tumor is present at the distal margin and the entire tumor is not examined. clinical: clinical diagnosis and data: lower gi bleed. patient with history of ulcerative colitis and rectal carcinoma. brief hospital course: 36 yom w/ a h/o ulcerative colitis and recent diagnosis of rectosigmoid adenocarcinoma on neoadjuvant chemo (5fu and xrt x 3-4 days) presents with profuse brbpr and lightheadedness. plan for colectomy but leaving tumor ?????? colectomy will allow for chemotherapy in setting of severe uc. . 1. gi bleed: s/p total colectomy- sparing rectum and colon ca for further neoadjuvand chemo. hartmanns pouch and ileostomy on with dr. . operative course uncomplicated. patient remained in for close monitoring of hct's, and associated hypotension. -+ ostomy output and rectal ouput post-op -hypoactive bowel sounds, no nausea -pain moderate, not very well controlled, per surgery switched to morphine pca for more long acting pain control with better control. pain control switched to oral agents once tolerating clear liquids. reported pain <. dishcarged home with pain medications. -diet advanced as bowel function resumed. tolerated regular diet without nausea/vomiting prior to discharge. -hct followed closely. treated accordingly with transfusions. hct's remained stable for many days prior to discharge. no further evidence of gi bleeding. . 2. ulcerative colitis: patient on a regimen of 360mg daily, rifaximin 800mg daily and cromolyn 400mg daily (when he eats), -gi and onc following: per gi recommendations, d/c'd rifaximin & restarted on home dose of & cromolyn for management of rectal bleeding. . 3. fever -no clinical evidence of dvt, high fever w/o leukocytosis however s/p chemo, not neutropenic, continue to follow anc -on cipro / flagyl, remained afebrile with normal wbc, discontinued prior to discharge home. -blood cultures all with no growth. urine cx from grew enterococcus which was treated with iv cipro. -medical & radiation oncology involved-recommended follow-up monday after discharge for re-assessment. plan to resumes chemo/xrt depending on physical exam, and labowrk data. . physical therapy: due to prolonged icu stay, and deconditioning, patient was evaluated by pt. pt worked with patient for a few sessions, and cleared him for discharge home without pt services. he continued to ambulate halls of 12 independently. . ostomy: patient followed by ostomy rn specialists during admission. competent with emptying pouch. visiting rn services set up for home to continue teaching, and assessment of stoma/surgical wound. in addition to follow-up with med/rad oncology, patient advised to follow-up with dr. in weeks. medications on admission: zinc vitamin d b complex codeine 7.5mg daily prn diarrhea cromolyn 400mg daily 360mg daily rifaximin 800mg daily vitamin d 6000 units qod mvi daily discharge medications: 1. cromolyn 100 mg/5 ml solution sig: one (1) 20ml po daily (): take with food. 2. 180 mg tablet sig: three (3) tablet po once a day: prevention of rectal bleeding. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever or pain: do not exceed 4000mg/24hrs. 4. zofran 8 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. 5. centrum 0.4-162-18 mg tablet sig: one (1) tablet po once a day. 6. vitamin d 1,000 unit tablet sig: six (6) tablet po every other day. 7. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po q12h (every 12 hours) as needed for pain for 2 weeks: take with food. disp:*35 tablet sustained release(s)* refills:*0* 8. morphine 15 mg tablet sig: one (1) tablet po q3-4h () as needed for breakthrough pain for 2 weeks: take with food. disp:*45 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: primary: flared ulcerative colitis with low abdominal peritonitis (perforation of the rectum) anemia . secondary: uc, rectosigmoid adenoca w/cea 1.9, sig w/nodular heaped up mucosa seen in the proximal rectum, patht well diff adenoca, mitral valve prolapse, migraines discharge condition: stable tolerating a regular diet adequate pain control with oral medication discharge instructions: please call your doctor or return to the er for any of the following: * you experience new chest pain, pressure, squeezing or tightness. * if you are vomiting and cannot keep in fluids or your medications. * you are getting dehydrated due to continued vomiting, diarrhea or other reasons. signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * you see blood or dark/black material when you vomit or have a bowel movement. * your skin, or the whites of your eyes become yellow. * your pain is not improving within 8-12 hours or becoming progressively worse, or inadequately controlled with the prescribed pain medication. * you have shaking chills, or a fever greater than 101.5 (f) degrees or 38(c) degrees. * any serious change in your symptoms, or any new symptoms that concern you. incision care: *you may shower. pat incision dry. *avoid swimming and baths until further instruction at your followup appointment. *leave the steri-strips on. they will fall off on their own, or be removed during your followup. *please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. monitoring ostomy output / prevention of dehydration: *keep well hydrated. *replace fluid loss from ostomy daily. *avoid only drinking plain water. include gatorade and/or other vitamin drinks to replace fluid. *try to maintain ostomy output between 500ml to 1000ml per day. *if ostomy output exceeds 1 liter, take 4mg of imodium, repeat 2mg with each episode of loose stool. do not exceed 16mg in 24 hours. followup instructions: please call the office of dr. to make a follow up appointment in weeks. . please make a follow-up appointment with your pcp, . in 1 week and as needed. . you have an appointment on monday with radiation oncology service ( at 8:30am located in basement. . provider: , md phone: date/time: 11:00 provider: , md phone: date/time: 11:00 procedure: parenteral infusion of concentrated nutritional substances temporary ileostomy diagnoses: acidosis mitral valve disorders adrenal cortical steroids causing adverse effects in therapeutic use blood in stool peritoneal abscess migraine, unspecified, without mention of intractable migraine without mention of status migrainosus personal history of irradiation, presenting hazards to health other specified disorders of rectum and anus other osteoporosis malignant neoplasm of other sites of rectum, rectosigmoid junction, and anus universal ulcerative (chronic) colitis other acute postoperative pain 

Answer: The patient is high likely exposed to