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: gi bleeding, respiratory distress major surgical or invasive procedure: s/p central line placement history of present illness: 68-year-old male with a history of hypertension and gout who is being treated on the biologics service with il-2 for metastatic melanoma. he began the protocol on monday and had been tollerating the tid il-2 infusions, but had a decline in his plts from 200 to 56 as well as a 11# weight gain attributed to capillary leak. he also had significant electrolyte imbalances, tachycardia, and tachypnea expected from this protocol. on the day of transfer, patient had some mild epigastric discomfort and complained to his daughter of heartburn. of note, he was on daily indocin while on il-2 therapy. at 10pm, he developed some diarrhea and then had an episode of nausea and vomiting. the covering md noted 2 very large blood clotts in the emesis. noted increased rr of 40s, was 84% on ra and then improved to 100% on 4l nc. biologics attending was not concerned about other parameters, but was worried abt bleeding as patient may be at risk for bleeding given his plts have dropped in the past few days. brought to , gi team asks for ffp, plts. pt has guiac positive brown stools, but complains of hemorrhoids and some rectal irritation that may be contributing. holding on ng lavage unless patient becomes unstable. first two hcts are stable. past medical history: onc hx per omed notes: pt was diagnosed with melanoma in when he was found to have a mole on his left abdomen. he underwent wide local excision and sentinel lymph node biopsy at that time which revealed no residual melanoma and the 3 sentinel nodes were negative. two years later in , he developed a red raised nodule under the scar of the local excision. this was reexcised and he subsequently did well until when he had another satellite recurrence and reexcision. he then had a third satellite recurrence and reexcision in and was then started on interferon therapy that was stopped side effects. recent pet/ct done revealed a left axillary lymphadenopathy as well as 2 liver lesions. .. .. pmhx: melanoma, gout, htn. reports recent normal egd and colonoscopy social history: married, 4 kids, quit smoking 35 years ago (prior 7pk yr hx), rare etoh use, retired engineer . family history: father with lung cancer physical exam: pe: 98.2 133-152/72-75 hr 132 rr 28 100% 4l nc gen: obese, breathing rapidly, no acute distress, comfortable, alert heent: mm dry, op clear, neck supple with tripple lumen in place, eomi cv: distant hs, tachy s1s2 no m/r/g lungs: crackles noted bilat, l>r, otherwise clear abd: obsese, multiple metastatic nodules palpable on l side of abdomen, soft, nt/nd, active bs ext: 1+ edema bilat rectal: brown guiac positive stools pertinent results: cxr portable impression: minimal patchy basilar opacities likely due to atelectasis. no evidence of pulmonary edema. . cxr portable impression: new diffuse bilateral parenchymal opacities compatible with pulmonary edema. . chest xr: a single ap supine view is compared to previous examination earlier from the same day. again seen extensive bilateral parenchymal opacities suggesting pulmonary edema. there is more dense consolidation in left lower lobe with air bronchogram, compatible with pneumonia. there is a new endotracheal tube with the tip overlying t3. . bilateral le doppler impression: no evidence of lower extremity dvt. . echo : ef>60% conclusions: 1. the left atrium is mildly dilated. 2. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. 3. the right ventricular cavity is moderately dilated. right ventricular systolic function appears depressed. 4. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. 5. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. 6. there is a trivial pericardial effusion. . renal us impression: 1. multiple left kidney stones, the largest measuring 2.1 cm in the mid pole. no evidence of hydronephrosis. multiple parapelvic cysts. 2. right kidney stone. no evidence of hydronephrosis. . liver/gb ultrasound impression: 1. no evidence of intra- or extrahepatic biliary ductal dilation. no evidence of cholecystitis. 1.3 cm shadowing gallstone. 2. two hypoechoic liver lesions likely corresponding to the lesions seen on ct. metastatic disease to the liver is within the differential. . cxr impression: ap chest compared to and 24: left lower lobe consolidation is clearing, probably resolving atelectasis. pulmonary vascular congestion is present but edema has not returned. azygous distention indicates volume overload. heart size is top normal. no pleural effusion or pneumothorax. et tube and right subclavian line are in standard placements and a nasogastric tube passes through the mid stomach and out of view. . *** culture data *** urine cx neg blood cx x 6 pending sputum cx: 2+ gpc in pairs, sparse growth oropharyngeal flora stool: o&p pending blood cultures neg worm macroscopic pending cmv vl not detected crytococcus negative rapid resp viral negative bal: oropharyngeal flora, no pmn, no microorg, neg fungal, afb brief hospital course: hospital course: on the day of transfer, , patient had some mild epigastric discomfort and complained to his daughter of heartburn. of note, he was on daily indocin while on il-2 therapy. at 10pm, he developed some diarrhea and then had an episode of nausea and vomiting. the covering md noted 2 very large blood clots in the emesis. noted increased rr of 40s, was 84% on ra and then improved to 100% on 4l nc. biologics attending was not concerned about other parameters, but was worried about bleeding as patient may be at risk for bleeding given his plts have dropped in the past few days. . brought to , gi team requested ffp, plts. pt has guiac positive brown stools, and complained of hemorrhoids and some rectal irritation that may be contributing. he was not scoped emergently that night, and his vitals were closely followed, along with hct. his hct was noted to be stable, with stable vs, and no episodes of melena. gi felt no emergent need for egd. he is receiving ppi . on , the pt was intubated for respiratory distress secondary to pulmonary edema thought to be secondary to capillary leak syndrome from hd il-2. he underwent diuresis and was started on levo/flagyl for ?lll pna, started . on , levo/flagyl d/c'd as all cx negative, pt afebrile. another reason abx d/c'd was b/c pt developed a rash thought to be a drug hypersensitivity reaction, which improved post d/c abx. id was consulted for continued fevers and recommended the initiation of broad spectrum abx incl. vancomycin, aztreonam, and flagyl (stopped ), ruq us to r/o cholangitis (b/c pt had elev lfts), and stated would not give steroids, and would do bronchoscopy/bal for most likely pulm source. chest ct demonstrated b/l lower lobe infiltrates c/w pulm edema vs. pna. pt underwent bronch , showing limited eval of right sided airways, lavage with rll post segment, result: no pmn, no microorg, grew op flora, pcp negative, afb negative. vancomycin was continued for ? line infection, and b/c the pt had difficult access, his line was continued for 19 days. he has been on vanco for 8 days. the pt's lft elevation was attributed to il-2 therapy, a known side effect. . also, he was noted to have renal insufficiency, with cr to 1.6, and eosinophilia, with presumed ain. his creatinine continued to rise to 2.6 (baseline 0.9). he was given prednisone, which was subsequently d/c'd. renal was consulted and recommended for pt to increase free water intake. they felt he had a number of reasons to have arf, including: capillary leak syndrome, nsaids, infection, contrast on , and drug reaction though no eos or wbc in urine. the pt's creatinine demonstrated slow improvement, was 1.4 , and on transfer from icu, his cr was 0.9 (baseline). . subjectively on transfer from to the medical floor, the pt felt well, is laughing and joking with family, and has no pain complaints. states his breathing if fine. no cough, fever, chills. no n/v. no abd pain. no diarrhea or constipation. no dysuria. no chest pain or shortness of breath. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ impression: a/p: 69 m with metastatic melanoma s/p il-2 therapy, last dose at 3 pm , now with fevers, resp failure non-cardiogenic pulm edema; now improving, extubated , and satting well on nc. resolved arf. s/p drug hypersensitivity reaction with discontinuation of all antibiotics and improvement. . #. pulmonary status s/p respiratory distress: mr. was intubated initially for resp distress, thought secondary to non-cardiogenic pulm edema from capillary leak syndrome from il-2, with possible contribution from pna. lll inbfiltrate on cxr, fevers, but sputum never grew anything, so unclear if pna vs atalectasis. he was intially started on levaquin and flagyl. chest ct showed lower lobe infiltrates c/w pulm edema vs pna. lenis were neg, but he did not have a cta because of renal failure. he has no h/o chf, copd or asthma. no echo on file. the pt was then taken off all abx on because all cx data was negative and fevers seemed likely due to acute interstitial nephritis given eosinophilia, arf, rash versus due to his melanoma and il'2 treatment. id was consulted, recommended bronchoscopy and labs, empiric sntibiotics for presumed hospital acquired pna vs. line infection, so he was started on vancomycin. bronchoscopy from was negative. he remained on vancomycin for 8 days until his central line was pulled. we then discontinued vancomycin iv. -now on room air, sats stable -nebs prn if needed -chest pt, mobilize secretions -is to bedside and encourage pt to use . # arf, resolved: this was thought to be acute interstitial nephritis given fever, rash and arf with peripheral eosinophilia. however, eos negative in urine. renal consulted felt to be pre-renal also question contrast induced nephropathy. this fully resolved with hydration, so finally appeared to be most likely pre-renal and contrast related. his creatinine continued to be at his baseline. we ended up restarting his outpatient acei. will see pcp 1 week. . # fever: unclear etiology still, all cultures negative. he has been hemodynamically stable. id was consulted in the setting of contemplating starting steroids. id recomended to r/o infection bal prior to starting empiric antibiotics, multiples serologies histoplasma antigen, ebv viral load, cmv viral load, cryptococal antigen, strongiloides serology. ruq u/s. all work up unrevealing to date, and fevers tapered off. afebrile for 6 days prior to leaving icu. initial empiric a/b regimen with flagyl, aztreonam and vanco was d/c'd . he has remained afebrile on the medical floor and has been instructed to report to the ed for fever, chills. . #. hypernatremia, resolved: likely due to increase insensible lossess. free water boluses and d5w was given with normalization of sodium. . #. ?line infection: pt was continuing to spike fevers in the icu with a negative panculture workup and no infiltrate. other sources excluded, so iv vamco empirically given. his line was pulled, no drainage and erythema at site. his blood cx are negative to date. we stopped iv vancomycin on transfer to medical floor, no evidence to support its use. . #. metastatic melanoma: il-2 therapy on hold for now. plan per onc team, attending dr. and . his restaging lung ct, head ct showed only mediastinal nodes largest 1.7 cm, could not assess for pulm nodules given pulm edema. the pt has follow up with dr. . . #. gi bleed: the pt had emesis with large clots on . no further bleeding, hct has since remained stable stable. the pt can continue his ppi. his hct has remained stable, as well as his vital signs. . #. elevated lfts: stable. this is a known side effect of il-2 therapy. we held his il-2, and trended his lfts, which improved over time. . # confusion/icu psychosis: pt had vivid dreams as well as hallucinations while in the icu, and would often speak inappropriately at times or answer questions with responses unrelated. he was started on low dose haldol. on the medical floor, the pt was appropriate in conversation, but would occasionally state things that he was going to " to herd cattle." on questioning his family, they stated that he has no plans for a trip. he is otherwise appropriate. he has an appointment to follow up with his pcp 1 week. his haldol was not given while he was on the medical floor. . #. communication: with pt, wife and daughter . #. nutrition: the pt initially failed his speech and swallow study, however the study was done a few hours post extubation, when the pt still had copious secretions. at the time of transfer to the medical floor, the pt was swallowing and chewing fine. he did not experience any choking or coughing episodes with eating, and he is tolerating a po diet well. we did not repeat his swallow study. he does not appear to be an aspiration risk now. . #. access: rsc multi-lumen discontinued, now with piv . #. code: full . #. proph: ppi, pneumoboots, heparin sq tid . #. dispo: home with physical therapy services. follow up with pcp. has a cat scan scheduled for the last week in , followed by a heme/onc appt on . medications on admission: hctz, atenelol, lisinopril, allopurinol, mvi discharge medications: 1. albuterol 90 mcg/actuation aerosol sig: two (2) puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 mdi* refills:*2* 2. atrovent 18 mcg/actuation aerosol sig: two (2) puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 mdi* refills:*2* 3. allopurinol 300 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 4. lisinopril 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 5. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*2* 6. atenolol 100 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: primary diagnoses: 1. metastatic melanoma status post high dose il-2 therapy 2. capillary leak syndrome secondary to high dose il-2 3. acute renal failure 4. fever 5. hypernatremia 6. elevated liver function tests secondary to high dose il-2 secondary diagnoses: 1. hypertension 2. gout discharge condition: stable discharge instructions: notify dr. office for fever, chills, bleeding, shortness of breath, persistent swelling or inability to take oral fluids. please take all of your medications as directed. please follow up with your doctors (see information below). followup instructions: you have a follow up appointment with your primary care physician, . , for thursday, at 1:30pm. his office number is: if you have any questions. provider: scan phone: date/time: 10:15 provider: , md phone: date/time: 4:30 provider: , hematology/oncology-cc9 date/time: 4:30 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus transfusion of other serum transfusion of platelets high-dose infusion interleukin-2 [il-2] diagnoses: pneumonia, organism unspecified malignant neoplasm of liver, secondary unspecified essential hypertension acute kidney failure, unspecified gout, unspecified acute respiratory failure antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use acute glomerulonephritis with other specified pathological lesion in kidney dermatitis due to drugs and medicines taken internally infection and inflammatory reaction due to other vascular device, implant, and graft hematemesis hyperosmolality and/or hypernatremia other specified antibiotics causing adverse effects in therapeutic use delirium due to conditions classified elsewhere nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] malignant melanoma of skin of trunk, except scrotum secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb abnormal weight gain encounter for antineoplastic immunotherapy 

Answer: The patient is high likely exposed to