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 57-year-old male with a past medical history significant for hypothyroidism, tobacco abuse, with no known gastrointestinal history who presents with a 6-day history of "blueberry-colored" stools. he was in his usual state of health until the morning of (six days prior to admission) when he developed dark-colored stools times one. no frank blood was noted. later that day, he developed an episode of lightheadedness with nausea and vomiting times one. no hematemesis or bilious vomitus at that time. he was seen in the emergency department at and reported blood pressure, electrocardiogram, chest x-ray, and blood tests were okay. therefore, he was given meclizine for lightheadedness and was discharged to home. the following day (on ), he had a similar dark-colored stool times one and developed fatigue, but he had no nausea or vomiting. he stayed from work the next three days and had several additional similarly colored stool and episode of nausea, vomiting, lightheaded, and diaphoresis. he has not had any syncope of chest pain. he had mild dyspnea on exertion on the day prior to admission (on ). he reports no diarrhea, abdominal pain, dysphagia, sick contacts, new food, rashes, or arthralgias. he saw his primary care physician on the day of admission who noted him to have orthostatic changes with a heart rate of 112 supine and 140 while standing. therefore, he was sent to the emergency department for further evaluation. while in the emergency department, he was found to be guaiac-positive and have a hematocrit of 15, white blood cell count was 17, and blood urea nitrogen to creatinine ratio was 34 to 0.7. a nasogastric lavage was performed which was negative for blood or coffee grounds. he was then admitted to the medical intensive care unit for monitoring and further evaluation. past medical history: 1. hypothyroidism. 2. tobacco abuse (one pack per day times 40 years). 3. rectal condyloma; status post partial excision (present for the last 20 years). 4. one episode of melena in which was incompletely evaluated as the patient declined an esophagogastroduodenoscopy at that time. no chronic nonsteroidal antiinflammatory drug use. medications on admission: 1. synthroid 0.125 mg p.o. once per day. 2. aspirin 81 mg p.o. once per day (stopped six days prior to admission). allergies: no known drug allergies. social history: he is a bakery owner. he lives with his wife and daughter. smokes one pack per day times 40 years. occasional alcohol use. no history of illicit drug use. no herbal medications. no human immunodeficiency virus risk factors; including no history of intravenous drug use, no history of blood transfusions, and no history of homosexual receptive anal intercourse. family history: no family history of inflammatory bowel disease or colon cancer. two cousins with a history of ulcers. physical examination on presentation: on physical examination vital signs revealed temperature was 98.8, blood pressure was 106/57, heart rate was 93, respiratory rate was 18, and oxygen saturation was 100% on room air. in general, the patient was a pleasant and well-appearing male in no apparent distress. on head, eyes, ears, nose, and throat examination his sclerae were anicteric. conjunctivae were pale. pupils were equal, round, and reactive. the oropharynx was clear. mucous membranes were moist. no petechiae were noted. the neck was supple. there was no lymphadenopathy and no thyromegaly. heart was regular in rate. normal first heart sounds and second heart sounds. no third heart sounds or fourth heart sounds. no murmurs. the lungs were clear to auscultation bilaterally. the abdomen revealed normal active bowel sounds. soft, nontender, and nondistended. possible round nontender rubbery mass at the xiphoid process base which was nonpulsatile. no hepatosplenomegaly. extremity examination revealed extremities were warm and well perfused without edema. the skin revealed no rash, jaundice, or petechiae. rectal examination revealed heme-positive melanotic stool (per emergency department report). multiple flat approximately 2-cm round papules in the gluteal folds and rectal area with stuck-on appearance. multiple additional small polypoid skin colored lesions perianally. some brown papules with pink centers. pertinent laboratory values on presentation: laboratory values on admission revealed white blood cell count was 17.7 (with 73% neutrophils, 21% lymphocytes, and 3% monocytes), hemoglobin was 5.2, hematocrit was 15.7, and platelets were 317. prothrombin time was 12, partial thromboplastin time was 21.8, and inr was 1. sodium was 139, potassium was 4.1, chloride was 105, bicarbonate was 22, blood urea nitrogen was 34, creatinine was 0.7, and blood glucose was 97. pertinent radiology/imaging: a chest x-ray showed no evidence of pneumonia or free air beneath the diaphragm. no evidence of congestive heart failure. degenerative changes in the thoracic spine. electrocardiogram on revealed a normal sinus rhythm. normal axis and intervals. no abnormalities. impression: this is a 57-year-old male with a past medical history significant for hypothyroidism and tobacco use presenting with symptoms of an upper gastrointestinal bleed. hospital course by issue/system: 1. gastrointestinal issues: on presentation, the patient had a 6-day history of dark-colored stools found to be guaiac-positive by emergency department examination. he was found to have orthostatic changes, and given his low hematocrit he was admitted to the medical intensive care unit for further observation. an esophagogastroduodenoscopy was performed on hospital day two which showed prepyloric erosions and a small ulcer in the duodenal bulb with a stigmata (red spot) of recent bleeding. there was no visible vesicles or active bleeding noted. therefore, no further interventional was performed during the procedure. of note, there were additional findings consistent with gastritis and duodenitis. additionally, a colonoscopy was performed and was found to have diverticulosis throughout the sigmoid colon without evidence of bleeding. otherwise, the colonoscopy was within normal limits. he was started initially on protonix 40 mg intravenously twice per day and transitioned to 40 mg p.o. twice per day once taking oral intake. although his smoking may have been contributing to ulcer formation, a helicobacter pylori antibody was sent and was pending at the time of this dictation. he will be treated appropriately, per his primary care physician, this become positive. 2. hematologic issues: on presentation to the emergency department, the patient's hematocrit was significantly decreased to 15 secondary to gastrointestinal bleeding. he was transfused 5 units of packed red blood cells with an appropriate response in his hematocrit. he was stable for the next 48 hours with his hematocrit ranging between 26 and 29. his coagulations were checked and found to be within normal limits. 3. dermatologic issues: the patient had the presence of rectal condyloma for at least the last 20 years with some of them status post excision. he has been resistant to have them further evaluated. the dermatology team was consulted while hospitalized and felt that the lesions were consistent with condyloma acuminata versus bowenoid papulosis which could increase his risk for potential squamous cell carcinoma. it was not clear the etiology of these lesions, as he does not have any risk factors for anal condyloma. he was to follow up with dr. in dermatology on for a biopsy and a definitive diagnosis. 4. infectious disease issues: elevated white blood cell count to 17 on admission which trended down after appropriate treatment. there were no signs of infection in either gastrointestinal, genitourinary, or pulmonary sources. it was likely that his increased white blood cell count without bandemia was secondary to stress from gastrointestinal bleed. 5. cardiovascular system: the patient's orthostatic changes resolved with a blood transfusion and intravenous fluids resuscitation. 6. fluids/electrolytes/nutrition issues: the patient's diet was advanced after colonoscopy and esophagogastroduodenoscopy to clears and then eventually to a soft mechanical diet just prior to discharge. condition at discharge: condition on discharge was stable and improved. discharge diagnoses: 1. upper gastrointestinal bleed secondary to peptic ulcer disease. 2. anemia secondary to acute blood loss; status post blood transfusion of 5 units of packed red blood cells. 3. hypothyroidism. 4. rectal condyloma acuminata. 5. diverticulosis. medications on discharge: 1. protonix 40 mg p.o. twice per day. 2. synthroid 0.125 mg p.o. once per day 3. aspirin 81 mg p.o. once per day (to be held until instructed to restart). discharge instructions/followup: 1. the patient was to follow up with his primary care physician (dr. within one week. 2. the patient was to schedule a follow-up appointment with dr. in gastroenterology within two weeks. 3. the patient was to follow up with dermatology (dr. , , on for a biopsy of suspicious lesions. , m.d. dictated by: medquist36 procedure: other endoscopy of small intestine colonoscopy diagnoses: tobacco use disorder acute posthemorrhagic anemia unspecified acquired hypothyroidism chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction unspecified gastritis and gastroduodenitis, without mention of hemorrhage diverticulosis of colon (without mention of hemorrhage) other specified disorders of skin viral warts, unspecified 

Answer: The patient is high likely exposed to