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: right sided clumsiness and heaviness major surgical or invasive procedure: none history of present illness: mr is a 50 yo rh m with a h/o melanoma with known mets to spine (s/p neck surgery 9 mos ago) enrolled in an experimental chemotherapy protocol, who presented to osh last night with weakness (r > l) and clumsiness. mr states that he was in his usual state of health last night at 9pm when going to bed, and awoke in the middle of the night and found himself unable to rise from bed. he noted weakness of his r limbs. he was taken by ambulance to , where head ct demonstrated a 6cm l parieto-occipital hematoma. he was transferred to for further evaluation, where he says he has felt "foggy." mr reports no changes in his health prior to the onset of weakness last night, denying ha, nvd, visual changes, hearing changes, vertigo, falls, trauma, difficulties with memory, speech, or language comprehension or production. per the pt's family, the pt has moderate clumsiness of his left hand at baseline, thought to be related to spinal metastases of his melanoma and the surgeries performed on his spine. per the pt and his family, he does not have the r sided weakness with which he presented at his baseline. past medical history: metastatic melanoma, mets to spine, liver, and kidneys (dx ) anxiety s/p laminectomy and cervical fusion s/p multiple resections past oncologic history: mr. was diagnosed with a 1.45 mm thick, level iv melanoma from his lower back in . he underwent wide local excision and bilateral inguinal negative sentinel lymph node biopsies. he developed left inguinal recurrence in , undergoing completion left inguinal lymph node dissection on with pathology revealing melanoma in four of nine nodes with extracapsular extension. he received radiation therapy to the left inguinal region completing in 05/. he began interferon off protocol in with therapy discontinued on due to radiation colitis. in , he underwent biopsy of a right clavicular lesion by dr. revealing a 0.45 mm thick, level iii melanoma. he underwent wide local excision in 04/. in , he had biopsy of a left mandible skin lesion revealing level iii, 0.51 mm thick melanoma with three mitoses per mm2. on , he underwent wide local excision and sentinel lymph node biopsy by dr. with no residual melanoma at the primary site, but one of three lymph nodes showed a microscopic deposit of melanoma. he underwent modified left neck dissection on with no melanoma noted in seven additional nodes. in , he underwent biopsy of a new right chest wall skin lesion by dr. revealing metastatic melanoma not seen at the margin without an epidermal component and two mitoses per mm2. it was unclear whether this represented an in-tranist metastasis from his right clavicle melanoma or an epidermatrophic metastasis. he underwent right chest wide local excision and right axillary sentinel lymph node biopsy by dr. on . there was no evidence of residual melanoma in the chest or in the sentinel lymph node. staging scans were negative and he began gm-csf off protocol on , completing 13 cycles in . torso ct in revealed new small bilateral pulmonary nodules and an abnormal right kidney. ct guided biopsy of the right kidney on confirmed metastatic melanoma. he began the phase i/ii raf 265 trial on . therapy was held on c1w4, , due to visual problems, fatigue and anorexia. social history: lives with wife, daughter, 10 and son, 8 in , nh. has a pet cat at home. no tobacco, no alcohol, no illicit drug use. his children have been at day camp this summer. family history: noncontributory, no melanoma physical exam: at admission: vitals: 98.4 87 135/82 20 100% ra physical exam: gen: -haired man lying flat in bed, appearing older than his stated age of 50 heent: no scleral icterus. no conjunctival injection. mmm. neck: supple, no lad in cervical chains. lungs: ctab cv: rrr, nl s1, s2, no m/r/g. abdomen: soft, nt, nd, nabs. extremities: le cool to touch, no cyanosis, clubbing, edema in le. neurologic examination: mental status: awake, alert, cooperative, affect appropriate orientation: oriented x 3 attention: performed dow forward, dow backward slow, unable to perform moyb, speech/language: speech fluent with intact comprehension, repetition, naming. can follow simple and 3-step commands. no dysarthria. no paraphasic errors. memory: registered , recalled 0/3 words at 5 minutes calculation: $1.75 = 7 quarters, $2.75 = 15 quarters praxis/neglect: used his hands as tools when simulating hammering a nail and combing his hair. pt appeared unaware that he was unable to move his rue and rle, believing that he had moved them when he had not. cranial nerves: i - not tested; ii, iii - perrl 4-->3 mm b/l. visual fields full to confrontation bilaterally iii, iv, vi - eomi, no nystagmus bilaterally, normal saccades v - sensation intact v1-v3 vii - facial movement symmetric, no obvious facial droop viii - hearing intact to finger rub bilaterally ix, x - voice normal, palate elevates symmetrically - sternocleidomastoid, trapezius 4/5 strength on r xii - tongue protrudes midline, movements intact motor: normal bulk and tone, lue bradykinesia, no pronator drift. tri bic we ff fe ip quad ham af ae tf te c5 c7 c6 c6 c7 c7 l2 l3 l4-s1 l4 s1 s2 l5 r - - - - - - - - - - - - - l 4- 4+ 5 5 5 5 5 5 5 5 5 5 5 coordination: dysdiadokinesia with lue (per wife at his baseline) reflexes: no clonus, toes downgoing bilatrally tri pat ach c5-6 c7-8 c5-6 l3-4 s1-2 right 1 1 1 1 1 left 1 1 2 1 1 sensation: intact to lt, pp and position on left. sensory level at ~c4 where pp is less below. extinction with ds on right. gait: not assessed pertinent results: brain mri with and without contrast: comparison was made with the brain, mri of . comparison was also made with the ct examination of . there is a large area of hyperacute and acute intra-axial hematoma identified in the left parietal lobe with surrounding edema and mass effect on the left lateral ventricle. small fluid level identified within the ventricle indicating intraventricular extension. there is no midline shift. no definite area of acute infarct identified. restricted diffusion visualized within the hematoma secondary to blood products. following gadolinium, there is no distinct enhancement identified within the region of hematoma in its lower portion, but there is subtle nodular enhancement seen in the superior portion, series 28, image 21. additionally, there is a 5-mm focus of enhancement identified in the left frontal lobe anterior to the hematoma. this is best visualized on series 28, image 22. no other foci of abnormal brain enhancement identified. there is no midline shift or hydrocephalus seen. note is made of a t1 hyperintense fluid within the pneumatized bilateral petrous apex air cells. impression: 1. large intra-axial hematoma in the left parietal lobe with blood products suggestive of hyperacute/acute hematoma. the hematoma measures approximately 6 x 4 cm. surrounding edema and mass effect is seen. small amount of blood within the ventricles indicate intraventricular extension. 2. small nodular enhancement at the superior aspect of the hematoma and an additional 5-mm focus anterior to the hematoma in the left frontal lobe are suggestive of underlying metastatic disease. mra head: head mra demonstrates normal flow signal in the arteries of anterior and posterior circulation without stenosis, occlusion, or an aneurysm greater than 3 mm in size. t1 hyperintense area adjacent to the carotid arteries on the source images are secondary to pneumatized petrous apex air cells with high protein content and t1 pre-gadolinium hyperintensities. impression: no significant abnormalities on mra of the head. mra neck: the neck mra demonstrates normal flow in the carotid and vertebral arteries. there is a 6-mm protuberance seen in the left subclavian artery proximal to the origin of left vertebral artery, which likely due to a small aneurysm. impression: no evidence of carotid stenosis or occlusion on neck mra. 7-mm protuberance in the left subclavian artery proximal to the vertebral artery origin could be a subclavian artery diverticulum or aneurysm. cta can help for further assessment if clinically indicated. non-contrast head ct: a 6.2 x 3.7 cm left parietal hemorrhage with peripheral zone of edema appears similar in configuration as compared to . there is extension of blood products into the left atrium and bilateral occipital horns, new since prior ct. there is no significant increase in the extent of sulcal effacement as compared to before. there is no new focus of hemorrhage. there is no shift of normally midline structures. ventricles are similar in size as before. suprasellar and basilar cisterns are patent. paranasal sinuses and mastoid air cells are well aerated. globes and soft tissues are unremarkable. impression: overall unchanged appearance of left parietal hemorrhage with mild peripheral zone of edema, without increased mass effect as compared to . no new focus of hemorrhage. see prior mr report for details reg. enhancement and metastatic disease. 3.7 | 29 | 1.1 ca: 9.5 mg: 2.1 p: 2.8 13.4 7.7 >--< 166 38.4 n:89.8 l:7.4 m:2.2 e:0.3 bas:0.4 pt: 12.5 ptt: 27.3 inr: 1.1 brief hospital course: 50 yo rhm with h/o metastatic melanoma presents with left intraparenchymal hemorrhage. neuro: patient awoke in the middle of the night and found himself unable to rise from bed. he noted weakness of his r limbs. he was taken by ambulance to , where head ct demonstrated a 6cm l parieto-occipital hematoma. he was transferred to for further management. mri showed underlying contrast enhancing nodular areas that were highly concerning for underlying malignancy, especially given his metastatic melanoma. pt was started on dexamethasone, which was tapered and will continue to be tapered per oncology recommendations. patient was also started on keppra for seizure prophylaxis; there was no evidence of seizures. he was monitored in the neuro icu, where bleed remained stable, and he was transferred to the floor. neurosurgery was consulted, and no interventions were indicated. patient had stable dense right hemiparesis. pt/ot/speech swallow was consulted. patient was discharged to rehab. he will have repeat mri/mra in 6 weeks and follow up in stroke clinic. melanoma: patient was followed closely by his primary oncology team. radiation oncology saw patient and planned for whole brain radiation beginning on day of discharge. cv: patient was normotensive without any medications at discharge. pain: patient had severe headaches, started on morphine sr and ir prn with good effect. code status: confirmed full code with patient and family medications on admission: pt was on an experimental chemotherapy protocol, but has recently been off of chemotherapeutics, per protocol. pt states that he is not currently on any medications. discharge medications: 1. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 2. dexamethasone 4 mg tablet sig: one (1) tablet po q12h (every 12 hours). 3. lorazepam 1 mg tablet sig: one (1) tablet po hs (at bedtime). 4. morphine 15 mg tablet sustained release sig: one (1) tablet sustained release po q12h (every 12 hours). 5. morphine 15 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for breakthough pain. 6. baclofen 10 mg tablet sig: one (1) tablet po bid (2 times a day). 7. heparin (porcine) 5,000 unit/ml solution sig: one (1) 5000 injection tid (3 times a day). 8. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 9. senna 8.6 mg tablet sig: one (1) tablet po daily (daily). 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 11. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 12. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 14. acetaminophen 325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for fever, pain. 15. famotidine 20 mg tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: discharge diagnosis: melanoma with metastases to your left parietal cortex and left basal ganglia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). you have a right sided paresis. discharge instructions: you have a melanoma with metastases to your left parietal cortex and left basal ganglia. the latter bled. we have treated you medically (no surgical procedures were performed). you will undergo radiation therapy for these lesions. you were also started on anti-seizure medication for prophylaxis, which you will need to continue indefinitely. followup instructions: you will have a repeat brain mri and mra clinical center basement 2:00 pm nothing to eat or drink 4 hours prior you will follow up with dr. in the stroke clinic 1:30 pm clinical center you also have other appointments lined up: provider: scan phone: date/time: 11:30 provider: , rn phone: date/time: 9:00 provider: , dermatology gen- (nhb) phone: date/time: 11:30 procedure: other radiotherapeutic procedure diagnoses: malignant neoplasm of liver, secondary intracerebral hemorrhage anxiety state, unspecified secondary malignant neoplasm of brain and spinal cord cerebral edema secondary malignant neoplasm of lung personal history of malignant melanoma of skin secondary malignant neoplasm of bone and bone marrow personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health hemiplegia, unspecified, affecting unspecified side arthrodesis status secondary malignant neoplasm of kidney 

Answer: The patient is high likely exposed to