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: heart palpitations major surgical or invasive procedure: bronchoscopy endotracheal intubation palliative radiation history of present illness: ms is a 51 year old woman with past medical history significant for melanoma (status post resection in from right chest) and newly developed asthma (minimally responsive to inhalers), presenting with acute dyspnea starting one day prior to admission, found to have large mediastinal mass and atrial flutter, who is now being transferred to the micu s/p intubation after bronchoscopy today. please see initial admit note for full details. as she is intubated, history obtained from current medical records. brielfy, patient reported difficulty swallowing and increasing shortness of breath in the past few months. her pcp initially diagnosed her with asthma, and started her on inhalers. she also reported unintentional 38 lb weight loss. was evaluted for dysphagia via egd which only showed gastritis. also reports progressive dyspnea with functional capacity limited to a single flight of stairs. on the day of admission, she felt worsening dyspnea and palpitations without chest pain, fevers, syncope, chills, nausea, vomitting. at osh, she was found to be in aflutter with rvr to 150 bpm. cta chest was negative for pe, but revealed large mediastinal mass and pulmonary nodules. she was initially on diltiazem drip which was transitioned to oral diltiazem on the floor, during which time she was in nsr today patietn underwent bronchoscopy which revealed near total collapse of the left mainstem bronchus and 50% collapse of the bronchus intermedius. trans bronchial biopsy was obtained with significant bleeding of at least 50 cc. she was electively intubated and sent to the micu. in the micu, patient appears comfortable on the ventilator. she is sedated but arousable. review of systems: limited due to patient on ventilator. appears comfortable. denies pain. past medical history: melanoma - shave biopsy in with 0.9-mm deep, level iv, ulcerated invasive melanoma with 2 mitoses per high-power field (t1b lesion), lateral margin with melanoma in situ - s/p wide excision of right chest melanoma with advancement flap closure and right axillary sentinel lymph node biopsy ? asthma social history: works cleaning homes, does not smoke, minimal etoh. married. family history: mother with lung cancer, 2 sibblings with skin cancer, father with skin cancer. no history of heart disease. physical exam: (micu admission exam) vitals: t: bp: 158/74 p: 106 r: 22 o2: 93% cmv 400 x14, 60%, peep 8 general: intubated, sedated but easily arousable and follows commands heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation anteriorly, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission: 12:34am pt-12.4 ptt-24.4 inr(pt)-1.0 12:34am plt count-421 12:34am neuts-87.3* lymphs-10.6* monos-1.2* eos-0.8 basos-0.1 12:34am wbc-9.1 rbc-5.19 hgb-13.3 hct-42.1 mcv-81* mch-25.6* mchc-31.6 rdw-13.2 12:34am calcium-8.8 phosphate-3.0 magnesium-1.9 uric acid-4.2 12:34am ck-mb-notdone 12:34am ctropnt-<0.01 12:34am ld(ldh)-156 ck(cpk)-60 12:34am estgfr-using this 12:34am glucose-130* urea n-9 creat-0.4 sodium-135 potassium-4.6 chloride-101 total co2-19* anion gap-20 12:50am urine rbc-0-2 wbc-0 bacteria-none yeast-none epi-<1 12:50am urine blood-mod nitrite-neg protein-neg glucose-neg ketone-150 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 12:50am urine color-straw appear-clear sp -1.026 01:45pm pt-12.2 ptt-23.6 inr(pt)-1.0 01:45pm plt count-419 01:45pm wbc-10.7 rbc-4.54 hgb-11.9* hct-36.9 mcv-81* mch-26.3* mchc-32.3 rdw-13.0 01:45pm albumin-3.9 calcium-8.8 phosphate-3.0 magnesium-2.1 01:45pm ck-mb-notdone ctropnt-<0.01 01:45pm alt(sgpt)-34 ast(sgot)-38 ld(ldh)-208 ck(cpk)-60 alk phos-54 tot bili-0.3 01:45pm alt(sgpt)-34 ast(sgot)-38 ld(ldh)-208 ck(cpk)-60 alk phos-54 tot bili-0.3 01:45pm glucose-93 urea n-10 creat-0.4 sodium-135 potassium-4.7 chloride-99 total co2-24 anion gap-17 08:28pm o2 sat-99 08:28pm type-art po2-345* pco2-42 ph-7.37 total co2-25 base xs-0 most recent labs: 04:19am blood wbc-7.2 hgb-10.6* hct-32.4* plt ct-294 03:59am blood pt-13.6* ptt-24.1 inr(pt)-1.2* 04:19am blood glucose-162* urean-16 creat-0.4 na-139 k-4.3 cl-103 hco3-28 angap-12 04:19am blood calcium-8.1* phos-3.4 mg-2.0 endobronchial biopsy on metastatic malignant melanoma. tumor cells stain positive for s-100, hmb45, mitf and focally for melana (mart-1). cells are negative for cytokeratin ae1/3 images/studies: ecg : atrial flutter with variable ventricular response or atrial fibrillation. consider left ventricular hypertrophy. st-t wave abnormalities. no previous tracing available for comparison. clinical correlation is suggested. tracing #1 ecg : atrial flutter or atrial fibrillation with a controlled response. since the previous tracing the rate has decreased. st-t wave abnormalities are less prominent. tracing #2 ecg : sinus rhythm. st-t wave abnormalities. since the previous tracing atrial tachy-arrhythmia is resolved. tracing #3 cxr : single portable upright view of the chest: the mediastinal contour is markedly abnormal, with right tracheal deviation and right paratracheal abnormal soft tissue density. there is left main stem bronchus narrowing and subcarinal soft tissue fullness. a 2 cm right upper lobe pulmonary nodule and smaller right middle lobe nodular opacity are consistent with the history of melanoma. there is no evidence of pleural effusion, congestive heart failure, or pneumonia. within the limits of chest radiography, no lytic or sclerotic osseous lesion is identified. impression: 1. pulmonary metastases, severe mediastinal lymphadenopathy due to melanoma. 2. no other finding to explain palpitations. cxr : impression: nasogastric tube in satisfactory position, some upper mediastinal shift. cxr : impression: improved right lung consolidation could have been due to aspiration. otherwise, stable appearances since yesterday's chest radiograph. staging ct torso 1. extremely large retrotracheal mediastinal adenopathy, obstructing the left main and lower lobe bronchi, resulting in left lower lobe collapse. 2. large pulmonary metastases in the right upper and middle lobes. 3. moderate bilateral pleural effusions. 4. no evidence of metastatic disease is noted within the abdomen and pelvis. 5. the large conglomerate of lymph nodes in the subcarinal location is compatible with metastatic disease. mr no significant abnormalities are seen on mri of the brain with and without gadolinium ct chest 1)interval development of patchy consolidation in the right upper and right middle lobe is most likely due to radiotherapy and a small right pleural effusion is now moderately large, the left pleural effusion has slightly increased and remains small. 2)slight improvement in the right main and left mainstem bronchial narrowing which remains severe. cxr () - as compared to the previous radiograph, there is no relevant change. unchanged extent of the left-sided pleural effusion with unchanged left atelectasis. unchanged right hilar mass and right upper enlargement of the mediastinum. the right costophrenic sinus is not completely included on the image. no evidence of newly occurred focal parenchymal opacities. brief hospital course: summary 51 year old woman with past medical history significant only for locally advanced melanoma s/p wide marginal excision in , presenting with dysphagia, worsening dyspnea, weight loss found to have large mediastinal mass that completely collapsed her left main-stem bronchus. she was admitted to the icu after she required intubation for hypoxia following a bronchoscopy. she remained intubated for the duration of her hospitalization, save for multiple self-extubations with subsequent respiratory failure on non-invaive ventillation. she received palliative chemotherapy and 10 doses of xrt to attempt to re-expanded her collapsed lung. this was unsuccessful. she was ultimately terminally extubated and placed on comfort measures. she expired on . by problem # mediastinal mass: she was admitted to icu following brochoscopy where she remained intubated given the findings of significant compression to the left mainstem bronchus with bleeding periprocedurally. pathology from the endobronchial ultrasound was consistent with malignant melanoma. the hematology oncology service was consulted and brain and abdominal imaging for staging were obtained. the interventional pulmonary service was consulted to evaluate for possible stent placemement but felt she was not a candidate. she was admitted to the icu after she required intubation for hypoxia following a bronchoscopy. she remained intubated for the duration of her hospitalization, except for several self-extubations with subsequent respiratory failure on non-invaive ventillation. she received palliative chemotherapy and 10 doses of xrt to attempt to re-expanded her collapsed lung. ultimately, this was unsuccessful and the patient was terminally extubated and placed on comfort measures. she expired less than 24 hours after extubation. # pneumonia: she developed fever of over 102, increased respiratory rate, and copious thick secretions on hospital day 2. there was evidence of left lower lobe infiltrate possibly due to post-obstructive pneumonia. she was started emperically on vancomycin and zosyn, which was later changed to vancomycin and unasyn after sputum culture grew moraxella. vancomycin was discontinued and she finished a 10 day course of unasyn without recurrence. # atrial flutter: on the floor, she had an episode of rapid ventricular rate post-procedurally and was started on po diltiazem. she spontaneously converted to sinus rhythm, which she maintained during her hospitalization. tte as well as chest imaging demonstrated compression of the left atrium from the mediastinal mass. her diltiazem was titrated according to blood-pressure and frequence of rvr over the course of her hospitalization. she spent most of the day in 3:1 block but occasionally required diltiazem boluses for 2:1 block. medications on admission: fluticasone albuterol discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy fiber-optic bronchoscopy closed [percutaneous] [needle] biopsy of mediastinum diagnoses: pneumonia, organism unspecified atrial fibrillation asthma, unspecified type, unspecified atrial flutter acute respiratory failure hypoxemia encounter for palliative care personal history of malignant melanoma of skin secondary malignant neoplasm of mediastinum 

Answer: The patient is high likely exposed to