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: weakness, unsteady gait, and hemoptysis major surgical or invasive procedure: none history of present illness: 78 y/o m with pmhx significant for metastatic melanoma (currently at the end of a 10-week experimental regimen), who presented to the ed after 3 episodes of hemoptysis, 1 episode yesterday and 2 episodes this morning. reports that amount of hemoptysis was approximately 4 inches x 4 inches. per report, the patient also has had worsening confusion, unsteadiness of gait, and generalized weakness over the past few weeks. in the ed, the patient had a cta chest that showed no pe, increasing mets and new mets in the lungs, and no gross bleeding. ct head showed large mets everywhere (significantly worse from prior). there was no midline shift or mass effect, but there was some surrounding edema around one of the metastatic lesions. oncology was , who recommended transfer to the unit for observation overnight. ip was also , with plans for bronchoscopy in the morning. prior to transfer to the floor, the patient's vs were 97.8 124/71 79 18 97% on ra. he had not had any further episodes of hemoptysis. . on the floor, the patient's vs were t: 98.1 bp: 114/72 p: 81 r: 13 o2: 93% on ra. he complained of abdominal pain that has been occurring for some time. he reported that his shortness of breath has been occurring for some time and is currently resolved. he also reported recent unsteadiness of gait and weakness. he denied any headaches, visual changes, chest pain, or lightheadedness. he denied any current shortness of breath. per the patient's family, he has also had recent loss of appetite and confusion. . review of sytems: (+) per hpi (-) denies headache, sinus tenderness, rhinorrhea or congestion. denied shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. denied focal numbness or weakness. past medical history: past medical history: - metastatic melanoma (priamry melanoma resected from tip of nose in ) - varicose vein surgery in the - ear surgery in for what was felt to be a basal cell; additional basal cell on the left shin - ?hypertriglyceridemia . detailed oncologic history: - shave biopsy of a left midback lesion on , revealing an at least 2.4 mm thick level iv melanoma without ulceration, margins were positive - reexcision on , revealing residual invasive 1.8 mm thick melanoma with questionable regression - left shin lesion revealing a nodular basal cell carcinoma with positive margins; subsequent reexcision showed a dermal scar and no residual basal cell carcinoma - wide local excision of a left back melanoma and axillary sentinel lymph node biopsy on ; primary site revealed only a dermal scar without residual melanoma; no melanoma in 3 examined sentinel lymph nodes - - noted a firm mass in the right axilla; fna on revealed melanoma - ct chest showed right axillary nodule and multiple bilateral pulmonary nodules - - initiated dtic therapy with disease progression documented after 2 cycles - - mri head with small right posterior parietal and left cerebellar lesions c/w metastatic disease - - began compassionate use ipilimumab protocol (currently c1w10 of this therapy) social history: he lives alone. he has a history of alcohol abuse but has been sober for 18 years. used to smoke cigarettes, but quit ~30 years ago. family history: father with some form of cancer (does not recall primary). mother with breast cancer. ?brother with metastatic colon cancer. physical exam: admission exam: vitals: t: 98.1 bp: 114/72 p: 81 r: 13 o2: 93% on ra general: alert, oriented x 3 with some slight confusion, no acute distress heent: sclera anicteric, dry mm, op clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, spme ttp in the upper abdomen, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly noted gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: perrl, cn ii-xii grossly intact (aside from some slight anisocoria r>l), 5/5 strength throughout, sensation to lt intact throught, 2+ patellar, biceps, and brachioradialis reflexes, wide unsteady gait, mild dysmetria on the l on finger-to-nose pertinent results: cta : 1) progression of multiple bilateral pulmonary metastases. 2) no acute pe or hemothorax. 3) increased splenic, right adrenal, right posterior infradiaphrammatic lesions consistent with progression of metastatic disease. evidence of osseous metastatic disease again seen. ct head: multiple hyperdense intracranial lesions with surronding edema, significantly increased size and number from prior mri, consistent with progression of metastatic melanoma, some of which may contain internal hemorrhage. brief hospital course: 78 y/o m with known metastatic melanoma, presents with 3 episodes of hemoptysis and worsening confusion and gait disturbance, now with imaging showing worsening metastatic disease. . hemoptysis: given imaging findings, likely related to worsened pulmonary metastases with endobronchial involvement. metastases do appear close to right pa on ct; however, if tumor had invaded pa, would expect more massive hemoptysis. pt only reports a small amount of hemoptysis (with the largest amount being approx 5cm x 5cm). of note, the patient's hematocrit is currently 34 (from 39 5 days prior). however, he is hemodynamically stable (normotensive and not tachycardic). ip was contact in the with plans for possible bronch in am. pt. did well during his hospitalization and the hemoptysis resolved. he was transfered from the micu to the oncology floor. the patient was hemodynamically stable during his stay on the oncology . . metastatic brain disease: pt. received an mri during his hospital stay that showed metastatic disease in the brain. he was seen by radiation oncology and he was started on dexamethasone. they completed two radiation treatments during his admission and he will continue these treatments for a full course of 5 treatments. . metastatic melanoma: pt with worsening pulmonary, intracranial, splenic, adrenal, osseous, and other metastatic disease. pt recently completed 10 weeks of experimental treatment with ipilimumab with progression of disease. onc is aware of admission and recommended icu admission for overnight observation. pt currently full code after discussion on admission; however, will need ongoing goals of care discussion in am (family wishes to involve primary oncologist in these discussions). patient recovered well during her admission and was tranferred to the oncology floor. . transaminitis: most likely related to metastatic disease vs. toxicity from chemo drugs. . goals of care: family discussion with son and daughter re planning for goals of care. we were awaiting dr input but prior to dr being able to see the patient, the family was anxious about discussing course, etc. relayed poor prognosis and unlikely helpful interventions. medications on admission: lorazepam - 0.5 mg tablet - 0.5 (one half) tablet(s) by mouth twice a day as needed for anxiety or insomnia megestrol - 400 mg/10 ml (40 mg/ml) suspension - 800mg/20ml by mouth daily for appetite stimulation ondansetron hcl - 8 mg tablet - 1 tablet(s) by mouth every 8 hrs as needed for nasuea/vomiting oxycodone - 5 mg tablet - tablet(s) by mouth every 4-6 hrs as needed for pain prochlorperazine maleate - 5 mg tablet - tablet(s) by mouth every 6 hrs as needed for nausea/vomiting valacyclovir - 500 mg tablet - 1 tablet(s) by mouth once a day . medications - otc aspirin - (prescribed by other provider; otc) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day multivitamin - (otc) - tablet - 1 tablet(s) by mouth once a day discharge medications: 1. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po bid (2 times a day) as needed for agitation for 2 weeks. disp:*28 tablet, rapid dissolve(s)* refills:*0* 2. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for pain. disp:*2 adhesive patch, medicated(s)* refills:*1* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. valacyclovir 500 mg tablet sig: one (1) tablet po bid (2 times a day). 5. dexamethasone 4 mg tablet sig: one (1) tablet po four times a day for 1 weeks. disp:*28 tablet(s)* refills:*0* 6. metoclopramide 5 mg tablet sig: one (1) tablet po every six (6) hours as needed for hiccups for 1 weeks. disp:*28 tablet(s)* refills:*1* discharge disposition: extended care facility: nursing & rehabilitation center - discharge diagnosis: primary diagnosis: hemoptysis secondary diagnosis: brain metastases discharge condition: activity status: ambulatory - independent. level of consciousness: alert and interactive. mental status: confused - sometimes. discharge instructions: it was a pleasure working with you during your hospitalization. you were admitting after coughing up blood. we believe that a lesion in your lung is related to your presenting symptom. we completed an mri on your admission that found two metastatic foci. radiation-oncology was consulted and recommended whole brain radiation therapy. we started your treatment as an inpatient and encourage you to keep your outpatient appointment with the radiation oncologist to complete your treatment course. please continue all your home medications in addition to several medications that we recently added. followup instructions: please follow up with radiation oncology to complete your 5 day course of radiation therapy. in addition to your appointment with radiation oncology, you should follow-up with the following physicians: provider: , md phone: date/time: 3:00 provider: , rn phone: date/time: 3:00 provider: , md phone: date/time: 3:00 procedure: other radiotherapeutic procedure diagnoses: secondary malignant neoplasm of brain and spinal cord cerebral edema secondary malignant neoplasm of lung personal history of malignant melanoma of skin delirium due to conditions classified elsewhere secondary malignant neoplasm of bone and bone marrow secondary malignant neoplasm of other digestive organs and spleen secondary malignant neoplasm of adrenal gland 

Answer: The patient is high likely exposed to