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: latex attending: chief complaint: weakness major surgical or invasive procedure: evacuation of a postoperative wound hematoma. history of present illness: 66 yo female who presents with a deterioration of function since a recent discharge from . patient was admitted from to for new onset numbness from breast level to feet, urinary retention, and fecal incontinence. patient has a longstanding history of metastatic melanoma and imaging showed a lesion at t4-t5. palliative surgery was conducted to decompress these lesions. postop course included some improvement of function. on discharge, the patient continued to have left lower extremity paralysis but had sensation and her right leg was 4 to 4/5 strength. since that time, she was able to bend her right leg at the knee, and to wiggle her left foot on her bed. about a week ago, she experienced some changes in pain in her middle back. in rehab, it was determined that the patient had a elevated wbc to the 42, and a positive ua. she was started on po vancomycin, and levoquin. she was transferred to . past medical history: 1. spina bifida 2. melanoma (left forearm) - with metastatic involvement in - refused treatment initially 3. chronic tinnitis social history: lives with husband, retired translator. non smoker. family history: non-contributory physical exam: o: t: 97.2 bp: 141/64/ hr: 94 r 16 o2sats 99% gen: wd/wn, comfortable, nad. heent: pupils: 4-2mm eoms intact extrem: warm and well-perfused. neuro: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, and date. motor: d b t fe ff ip q at g r 5 5 5 wiggles foot l 5 5 5 uable to move foot sensation: not intact to light touch on legs, no propioception of bilateral great toes, vibration bilaterally. reflexes: b t br pa ac right 2+ - left 2+ - toes upgoing bilaterally ct/mri: pertinent results: 05:45am blood wbc-13.5* rbc-3.96* hgb-11.8* hct-35.1* mcv-89 mch-29.7 mchc-33.5 rdw-14.8 plt ct-223 05:20pm blood neuts-92* bands-1 lymphs-3* monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-0 05:20pm blood hypochr-3+ anisocy-1+ poiklo-1+ macrocy-normal microcy-normal polychr-normal ovalocy-1+ 05:45am blood plt ct-223 01:34pm blood fibrino-281 07:47pm blood facviii-214* 07:47pm blood vwf ag-185* vwf cof-276* 05:45am blood urean-18 creat-0.6 na-130* k-3.8 cl-97 hco3-26 angap-11 05:45am blood calcium-8.3* phos-2.7 mg-2.0 brief hospital course: mrs is a 66 yo woman with a h/o cutaneous melanoma on forearm (excised ) and spina bifida who initially presented 3 weeks ago () with a complaint of 4 days of increasing lower extremity weakness and numbness and fecal and urinary incontinence. she initially presented to an osh and mri was performed, showing an intermedullary cord lesion. she was transferred to the , and ct demonstrated diffuse metastatic disease from malignant melanoma including lungs, mediastinum, gallbladder, liver, left ureter with moderate hydronephrosis,cervix with uterine obstruction and ischiorectal fossa. a thoracic mri done at demonstrated 2 enhancing spinal masses most likely metastasis with leptomeningeal involvement- 1 intramedullary mass posterior to the t3-t4 disc space measuring 2 cm, and a second small possible intradural metastasis just posterior to l2. there was associated spinal cord edema. on whe underwent laminectomy at t3-t4 and resection of an intradural intramedullary tumor to improve her neurological symptoms. she was discharged to rehabilation . in rehab, on , she began to feel a very painful 'a lump' in her upper back at the site of her surgical excision. the pain was diffuse throughout her upper back, but did not radiate elsewhere. it was significantly worse with pressure, almost unbearable. it continued to worsen, and on she states that she was 'in and out of consciousness'. labs from the rehab facililty indicated that she had an elevated wbc to 42, and a positive ua. she was started on po vancomycin 125 mg q6h and levoquin 500 mg qday. she was transferred to . on admission, her hct was 18.9 and ct chest showed a large hematoma the right posterior back measuring 18 cm x 4.9 cm x 25 cm, and a new r pleural effusion. she was transfused five units prbc and two units ffp, and hct increased to 29%. she was taken to the or on and the hematoma was evacuated and washed out, using the old incision. she remained in the icu for 2 days she had some slow improvement of her right leg and no change (plegic in left leg)a hematology consult was obtained for cause of her hematoma and bleeding during surgery they felt it would be unlikely for her to have a primary factor deficiency or disease and not to have had prior bleeding problems. disease and more rarely fxiii deficiciency, however, can occur in the setting of normal coagulation studies. she may have acquired platelet dysfunction, and vancomycin is known to cause platelet dysfuction. regarding her systemic disease they felt her malignant melanoma was so advanced that she unfornately she did not qualify for any type of treatment. from an id perspective she was only treated for 7 days with cipro other antibiotic were dc'd. she developed anal ulcers from diahrrea. the left aspect has a full thickness ulcer approx. 2 x 3 cm, right aspect has a full thickness ulcer approx. 1.5 x 1 cm-each site has yellow brown tissue with irregular wound edges. the periwound tissue is erythemic extending posteriorly along the intergluteal cleft where the epidermis is denuded. our wound care specialist recommended: keep perianal tissue clean and dry. check patient every 1-2 hours for fecal incontinence. cleanse perianal tissue with foam cleanser and disposable washcloths wet with warm water. pat the tissue dry (please no facecloths or towels and no rubbing of the tissue) apply a thin layer of critic aid clear moisture barrier ointment to the perianal tissue, covering the ulcers and extending posteriorly along the intergluteal tissue daily and prn or every 3rd cleansing. neurologically she has some antigravity movement on her right leg 3-4/5 strength. she has no movement of her left leg. she has normal strength in his arms. her incision is dry and clean. she is eating a regular diet. a foley is in place due to the anal ulcers. she will go to rehab and return to the brain tumor clinic for radiation planning on . medications on admission: bisacodyl 10 mg po/pr daily:prn senna 1 tab po bid:prn docusate sodium (liquid) 100 mg po bid pantoprazole 40 mg po q24h multivitamins 1 tab po daily oxycodone sr (oxycontin) 20 mg po q12h acetaminophen 500 mg po q6h:prn oxycodone (immediate release) 15 mg po q3h:prn lorazepam 1 mg po q4h:prn lactulose 15 ml po bid zolpidem tartrate 5 mg po hs insulin sc (per insulin flowsheet) hydromorphone (dilaudid) 0.5 mg iv q2h:prn postop pain dexamethasone 4 mg po q8h ciprofloxacin hcl 500 mg po q12h heparin 5000 unit sc tid discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. oxycodone 20 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 7. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 8. oxycodone 5 mg tablet sig: three (3) tablet po q3h (every 3 hours) as needed. 9. lorazepam 1 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 10. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po bid (2 times a day). 11. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 12. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 14. dexamethasone 4 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days. 15. dexamethasone 2 mg tablet sig: one (1) tablet po twice a day: start after 4mg dose-continue on this dose until follow up at brain tumor clinic. discharge disposition: extended care facility: discharge diagnosis: malignant melanoma wound hematoma discharge condition: neurologically stable with left leg paralysis and right leg weakness discharge instructions: ?????? do not smoke. ?????? keep your wound(s) clean and dry / no tub baths or pool swimming for two weeks from your date of surgery ?????? ?????? no pulling up, lifting more than 10 lbs., or excessive bending or twisting. ?????? limit your use of stairs to 2-3 times per day. ?????? have a friend or family member check your incision daily for signs of infection. ?????? take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. ?????? do not take any anti-inflammatory medications such as motrin, advil, aspirin, and ibuprofen etc. unless directed by your doctor. ?????? increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. we recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. call your surgeon immediately if you experience any of the following: ?????? pain that is continually increasing or not relieved by pain medicine. ?????? any weakness, numbness, tingling in your extremities. ?????? any signs of infection at the wound site: redness, swelling, tenderness, and drainage. ?????? fever greater than or equal to 101?????? f. ?????? any change in your bowel or bladder habits (such as loss of bowl or urine control). followup instructions: dr on at 9:30 am (this will be confirmed) 2. with dr (neuro-onc) and dr (rad-onc) on at 10:30 am 3. with dr on at 1 pm for the clinic 9 reception area a have your sutures removed next monday at your rehab facility procedure: transfusion of packed cells reopening of laminectomy site transfusion of platelets diagnoses: malignant neoplasm of liver, secondary urinary tract infection, site not specified hyposmolality and/or hyponatremia hematoma complicating a procedure secondary malignant neoplasm of brain and spinal cord other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation secondary malignant neoplasm of lung hydronephrosis personal history of malignant melanoma of skin spina bifida without mention of hydrocephalus, unspecified region ulcer of anus and rectum secondary malignant neoplasm of other urinary organs secondary malignant neoplasm of genital organs disseminated malignant neoplasm without specification of site 

Answer: The patient is high likely exposed to