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: penicillins / methadone attending: chief complaint: left sided neglect, right sided weakness, dysarthria major surgical or invasive procedure: l frontal craniotomy & tumor resection history of present illness: patient is a 47 year old woman with a history of metastatic melanoma with mets to the abdomen, brain, right tibia initially found via a shoulder lesion which was excised. she underwent craniotomies for resection of brain lesions with dr in and , as well as cyberknife 3 times in and following her resections and then again in . she was seen by dr in clinic on after an mri on showed worsening of her left frontal and left cerebellar lesions in the interval from her last mri which was done in . she reported 3 days of progressive left sided weakness prior to that visit. plan following that visit was for her to be discussed in brain clinic on with neuro-onc, rad-onc, and neurosurgery. on she developed what was described by osh reports as expressive aphasia and left facial droop which were not noted in dr note from . she was subsequently transferred to for further management given these findings. of note at the osh she was found to have a hematocrit of 15 a hemoglobin of 4.3, a wbc of 31.9, and a platelet count of 920. she was given decadron 10mg iv x 1, as well as 2 units of rbcs and transferred here. on arrival she was evaluated by the ed who found that she also had a guaiac positive rectal exam. past medical history: past oncologic history: (from omr) - 0.47-mm thick, level ii melanoma resected from right shoulder lesion during her second pregnancy, then observed - developed a forehead nodule and a biopsy in revealing melanoma. pet/ct scan revealed uptake in the right frontal bone, a 2 cm soft tissue mass near the ascending colon and in the right tibia - cyberknife radiosurgery to the skull lesion on , followed by high-dose il-2 therapy that was started on . a follow up pet/ct at week 11 revealed interval increase in size of the right tibial lesion, but no fdg avidity in the right frontal bone or ascending colon soft tissue mass. - xrt to the right tibia over 5 fractions completed on . follow up tibial mri showed increased enhancement while pet scan was stable in that area. - right tibial metastasis resected by , m.d. on . she took chinese herbal medication until . she then received ipilimumab treatment from to in a phase ii protocol. - , she developed forgetfulness and frontal headaches. outpatient head mri on showed a large right frontal heterogeneously enhancing mass suggestive of a metastasis. - resection by , m.d. on , and the pathology was metastatic melanoma. - cyberknife radiosurgery to the resection cavity from to to 2,400 cgy (800 cgy x 3 fractions). she later had more cyberknife radiosurgery procedure to a left parietal brain metastasis on to 2,000 cgy at 78% isodose line. she then had a left parietal craniotomy for resection of hemorrhagic tumor by dr. on , followed by more cyberknife radisurgery to a left cerebellar to 2200 cgy at 79% isodose line on , and another cyberknife radiosurgery to a left medial frontal metastasis on to 2,200 cgy at 75% isodose line. - one month f/u brain mri was stable. pet scan on revealed increased fdg avidity in the right tibia and in the posterior stomach felt c/w recurrent disease. - she began compassionate-use ipilimumab on with worsening right le pain noted. she received radiation, 10 fractions over two weeks, to the rle, completed on . - underwent resection of the right proximal tibia and reconstruction with an oncologic hinged proximal tibia replacement prosthesis on by dr. . - status post egd with biopsy on showing melanoma, and - received pd-1 antibody treatment from to . - left occipital craniotomy resection of brain mass social history: no tobacco, alcohol or drug use. lives with her husband who is her hcp. brother is very involved in care as well. on hospice family history: mother had pancreatic cancer and diabetes at 63. her grandmother's brother died of melanoma and her great grandmother died of colon cancer. physical exam: gen: cachetic, tired, comfortable, nad. heent: pupils: perrl eoms left gaze neglect but crosses midline with prompting neck: supple. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, flat affect. orientation: oriented to person, place, and date. language: some dysarthria, pt says her speech feels garbled, she has good comprehension and repetition. naming intact. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 4mm to 3mm bilaterally. visual fields are difficult to assess given patient cooperation iii, iv, vi: extraocular movements intact bilaterally without nystagmus when prompted, has a left gaze neglect. v, vii: left facial droop sensation intact and symmetric. viii: hearing intact to voice. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue deviates to left without fasciculations. motor: decreased bulk and tone bilaterally. no abnormal movements or tremors. lue 4+, rue grip 5-, and tri , lle 4+ throughout, rle ip 4, q/h/gas/at/ , no pronator drift. left sided exam likely secondary to neglect as patient verbalizes knowledge she is moving right when asked to move left. with much prompting and discussion moves left side well sensation: decreased on left upper and lower extremities likely secondary to neglect. on right side is intact to light touch toes downgoing bilaterally coordination: normal on finger-nose-finger with right upper extremity, does not complete on left side discharge exam: gen; pleasant and cooperative neuro: aox3 perrl, eom intact, face symmetric, motor except for lle secondary to known osteosarcoma, sensory intact to light tough, no clonus skin: incision intact, clean and dry with absorbable monocryl sutures in place. pertinent results: mri brain 1. marked interval increase in size of the left frontal contrast-enhancing lesion, with an even larger interval increase in surrounding vasogenic edema in the bilateral frontal lobes, which now causes subfalcine herniation with 9-mm rightward shift of midline structures, as well as further effacement of the frontal of the left lateral ventricle. 2. minimal increase in size and comparatively larger interval increase in surrounding vasogenic edema seen at the left cerebellar enhancing lesion. 3. stable contrast enhancement adjacent to the right frontal lobe resection cavity. 4. no new lesions detected. mri brain no significant changes are identified since the most recent examination, unchanged left frontal heterogeneous enhancing lesion, similar pattern of enhancement surrounding the right frontal surgical cavity with ex vacuo dilatation of the ventricular frontal . fiducial markers are in place. stable left cerebellar enhancing lesion. no new lesions are identified since the most recent exam. ct head expected post craniotomy appearance. mri brain 1. small amount of residual circumferential nodular enhancement around the left frontal surgical bed. continued attention to this area should be paid on followup exams. 2. expected postoperative findings of pneumocephalus, a small amount of blood products, and cytotoxic edema is present. 3. stable appearance of prior resections in the left parietal and right frontal lobes. a stable pattern of enhancement is present adjacent to the right frontal lobe resection. 4. tiny regions of nodular dural thickening with mild enhancement. attention to these lesions should be paid in followup exams. brief hospital course: 47 y/o f with l frontal metastatic lesion with l neglect, r arm weakness and dysarthria presents for elective tumor resection. she was taken to the or on with no complications. she was transferred to the icu post surgery. on , the patient was started on iron for a hematocrit of 24. her dose of dexamethasone was weaned, and her foley was discontinued. (**concern for tongue deviation on exam??**) the following day, her hematocrit decreased to 23 and she was transfused 2 units of prbcs. he post transfusion hematocrit was 31%. she was evaluated by pt and was deemed stable for discharge with outpatient physical therapy. medications on admission: citalopram, dexamethasone, keppra, lidocaine patch, ativan, ritalin, omeprazole, oxycodone discharge medications: 1. acetaminophen 325-650 mg po q6h:prn pain/temp/ha max 4g/24hrs 2. citalopram 20 mg po daily 3. dexamethasone 2 mg po bid duration: 30 days rx *dexamethasone 2 mg twice a day disp #*60 tablet refills:*0 4. docusate sodium 100 mg po bid rx *colace 100 mg twice a day disp #*60 capsule refills:*0 5. ferrous sulfate 325 mg po daily 6. fluconazole 200 mg po q24h duration: 4 days rx *diflucan 200 mg daily disp #*4 tablet refills:*0 7. lorazepam 0.5 mg po q8h:prn nausea, anxiety 8. methylphenidate (ritalin) 5 mg po qam 9. omeprazole 40 mg po bid rx *omeprazole 40 mg twice a day disp #*60 capsule refills:*0 10. oxycodone (immediate release) 5 mg po q4h:prn pain rx *oxycodone 5 mg every four (4) hours disp #*60 tablet refills:*0 discharge disposition: home with service facility: hospice discharge diagnosis: l frontal metastatic lesion pterygium post operative anemia constipation oral candidiasis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ?????? have a friend/family member check your incision daily for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? dressing may be removed on day 2 after surgery. ?????? **you have dissolvable sutures you may wash your hair and get your incision wet day 3 after surgery. you may shower before this time using a shower cap to cover your head. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? you have been discharged on keppra (levetiracetam), you will not require blood work monitoring. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. call your surgeon immediately if you experience any of the following ?????? new onset of tremors or seizures. ?????? any confusion or change in mental status. ?????? any numbness, tingling, weakness in your extremities. ?????? pain or headache that is continually increasing, or not relieved by pain medication. ?????? any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ?????? fever greater than or equal to 101?????? f. followup instructions: follow-up appointment instructions ??????you will need an appointment in 2 weeks at the brain clinic and please call. their phone number is . the brain clinic is located on the of , in the building, . - please follow up with ophthomolgy in weeks for your pterygium for evaluation and treatment. procedure: other operations on extraocular muscles and tendons other excision or destruction of lesion or tissue of brain other repair of cerebral meninges diagnoses: anemia, unspecified other convulsions candidiasis of mouth constipation, unspecified anxiety state, unspecified secondary malignant neoplasm of brain and spinal cord personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits dysarthria personal history of malignant melanoma of skin family history of malignant neoplasm of gastrointestinal tract facial weakness other musculoskeletal symptoms referable to limbs neurologic neglect syndrome pterygium, unspecified 

Answer: The patient is high likely exposed to