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: bacitracin / percocet attending: chief complaint: hypotension major surgical or invasive procedure: ercp with stent removal and re-placement history of present illness: mr. is a 71 year-old man w/ metastatic melanoma recently completing 5 cycles of taxol was admitted yesterday with fever and shaking chills, ruq discomfort felt to possibly be septic from tumor burden biliary obstruction. he was placed on broad spectrum antibiotics and had ercp this am. blood pressures during this stay had been generally in the 90's on the floor prior to the procedure. endoscopists removed prior biliary stent and noted frank bleeding which appeared to emanate from tumor eroding into biiary vasculature. patient transferred to the for further management. as per admit notes, patient had been admitted from clinic earlier this month with fever and shaking chills. he was noted to have obstructive jaundice and underwent ercp which demonstrated common bile duct obstruction managed with stent placement. on discharge he did not complete his course of cipro and flagyl due to bad taste. at time of transfer mr. is without complaint including no abdominal pain, nausea, vomiting, chest pain, shortness of breath, light-headedness. he has not noted any hematochezia or melena. notes dark stools, on po iron for sometime. past medical history: past medical history: 1. metastatic melanoma--as per onc notes: "mr. was initially diagnosed w/ melanoma when he underwent left upper lobectomy in for a lung nodule discovered incidentally. pet scan showed uptake in the left neck but surgical exploration showed no evidence of melanoma, and no primary site was identified at that time. a ct scan in revealed a small nodule in the area of the left kidney, and resection in revealed a perirenal soft tissue mass consistent with melanoma. he was enrolled in ecog protocol 4697 on the hla-a2 negative arm and received nine cycles on that protocol. f/u ct scan documented a soft tissue density behind the left lobe of the thyroid gland which was resected on . pathology revealed evidence of metastatic melanoma. he began radiation therapy to the neck completed on . follow-up torso ct scans from late revealed several soft tissue masses within and around the head of the pancreas, consistent with metastatic disease. on , the patient began a phase ii trial involving treatment with dtic +/- sorafenib. the study was discontinued on when the patient's ct scan showed evidence of disease progression with significant growth in the pancreatic metastases. the patient was seen in the heme/onc clinic on . at that time, he was feeling well and remained active: he was walking daily and his ecog performance status was zero. in , he developed biliary obstruction requiring ercp and stenting complicated by pancreatitis. he completed a one year course of il-2 this past . he had initial disease regression, but scans after cycle 3 showed mild disease progression evidenced by enlarging porta hepatis mass. he started on weekly taxol on and has completed five cycles to date with evidence of stable disease. biliary stent removed 2/. need for new biliary stent on , placed along with sphincterotomy. 2. cad s/p mi 3. prostate ca s/p radical prostatectomy 4. s/p l pulmonary lobectomy 5. crohn's disease 6. gerd 7. biliary obstruction , stent placed, then removed , recurrent obstruction with placement of new stent 8. hypothyroidism social history: married with no children. he has an 80 pack year history of smoking but quit about 10 or 20 years ago. he is a social drinker. family history: he has no family history of melanoma. he has 10 siblings, of which one brother passed away secondary to leukemia at the age of 80. physical exam: vs: temp: 99.5tmax/98 hr 75 bp 85/53 rr 16 spo2 95% ra gen: comfortable at rest with no apparent distress, non-toxic skin: no rashes, mild jaundice heent: perrl, eomi, scleral mild icteric neck: supple, no jvd, no nodes lungs: ctab, good air movement heart: rr, no m/r/g abd: +bs, not distended. very mild tenderness in ruq, negative . liver span approx 3cm below costal margin with palpable mass noted. ext: trace edema neuro: a&o x3, cniii-xii grossly intact, no focal motor or sensory deficits. rectal: dark stool, guiaic negative pertinent results: laboratory results: 09:30pm blood wbc-12.5*# rbc-3.38* hgb-8.8* hct-27.5* mcv-81* mch-25.9* mchc-31.9 rdw-22.9* plt ct-306 01:00am blood wbc-6.9 rbc-3.67* hgb-10.5* hct-32.0* mcv-87 mch-28.5 mchc-32.7 rdw-24.9* plt ct-175 09:30pm blood pt-12.5 ptt-22.5 inr(pt)-1.1 09:30pm blood glucose-99 urean-13 creat-0.9 na-135 k-4.2 cl-101 hco3-24 angap-14 09:30pm blood alt-233* ast-354* alkphos-832* amylase-45 totbili-5.2* 01:00am blood alt-47* ast-27 ld(ldh)-595* alkphos-333* totbili-2.4* 09:30pm blood lipase-61* 09:30pm blood totprot-6.5 albumin-3.9 globuln-2.6 phos-2.8 mg-2.0 09:45pm blood lactate-1.3 relevant imaging: 1)cxray (): 1. no acute cardiopulmonary process. 2. unchanged appearance of elevated left hemidiaphragm, now with some prominent loops of colon seen in the left upper abdomen. 2)ruq ultrasound (): liver architecture is abnormal, distorted by a very large heterogeneous mass in the porta-hepatis that is consistent with known large metastases from metastatic melanoma. no definite intrahepatic biliary ductal dilatation is visualized. the common duct is not visualized, but the known cbd stent is seen traversing the large mass. there is a small right pleural effusion. there is no free fluid within the abdomen. gallbladder is not distended, but there is a small amount of layering sludge within dependent portions of the gallbladder. there is mild gallbladder wall thickening and mild gallbladder wall edema. the main portal vein is patent, with appropriate direction of flow. 3)ercp ():the common bile duct was cannulized and opacified. a plastic stent is identified. there is a filling defect in the cbd extending in to the intrahepatic biliary tree. as per gi report, the previous plastic stent was removed and replaced by a 7 cm 10 french cotton- biliary stent. blood and clots were found in the bile duct. 4)echo (): ef 40-45%. regional left ventricular dysfunction consistent with coronary disease or focal myocarditis. no obvious vegetations identified to suggest endocarditis. very small pericardial effusion located posterior to the atria. mild to moderate mitral regurgitation. brief hospital course: mr. is a 69yo male with metastatic melanoma s/p 5 cycles of taxol and recent biliary stent placement now p/w fever and elevated bilirubin concerning for blocked biliary stent and possible cholangitis. 1)cholangitis/bacteremia: patient's initial symptoms of fevers, chills and elevated lfts were thought to be due to blocked stent and possible cholangitis in the context of not completing his antibiotic regimen at home. he was initially started on zosyn, flagyl, and vancomycin since blood culture bottles were growing gpc's and gnr's. he underwent an ercp the following day which was complicated by bleeding as the stent was removed. the patient was transferred to the micu for closer monitoring. his hematocrit dropped to 24 and he was transfused with prbcs. cultures had been growing serratia and coag + staph aureus. upon transfer to the floor, his antibiotic regimen was changed to naficillin, cipro, and flagyl. flagyl was stopped as per ercp recommendations. patient remained afebrile during the rest of the hospital stay and his lfts slowly improved. he will be discharged on 2 week course of naficillin and cipro and last day will be . 2)anemia: secondary to blood loss during ercp. hematocrit dropped to 24.6 and he required multiple transfusions. upon transfer to the floor his hct slowly stabilized to the low 30's. his asa and beta-blocker had been stopped in the setting of bleeding but was restarted at time of discharge. 3)metastatic melanoma: s/p 5 cycles of taxol. no further treatment was given during this admission. he is scheduled to see his outpatient oncologist on for follow-up. 4)cad: patient remained asymptomatic during this hospital course. his asa and beta-blocker were held in setting of bleeding. statin was held in setting of elevated lfts. all 3 medications were successfully restarted at time of discharge. 5)thrombocytopenia: patient was noted to have drop in platelet count within 1 week after being admitted to the omed service. all heparin products were stopped and hit antibody was sent. hit antibody was negative. 6)crohn's disease: he was continued on asacol. 7)hypothyroidism: he was continued on levothyroxine. medications on admission: asa 81 mg po qd asacol 400mg 3 tab 3 times a day metoprolol 25 mg daily omeprazole 20 mg once a day zocor 20mg daily niferex 150 mg tid nitro quick 0.4mg take 1 tab daily prn angina pain levothyroxine 100mcg qd discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po daily (daily). 4. nafcillin 2 gm iv q4h 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 7. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 8. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 9. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours): last day will be . 10. mesalamine 400 mg tablet, delayed release (e.c.) sig: three (3) tablet, delayed release (e.c.) po tid (3 times a day). discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: 1)cholangitis 2)bacteremia 3)anemia seconady diagnoses: 1)melanoma 2)cardiovascular disease 3)hyperlipidemia 4)hypothyroidism discharge condition: stable discharge instructions: 1)please take all medications as listed in the discharge instructions. 2)you were found to have a blood infection. as a result, you are currently on two antibiotics which you must take for 2 weeks. your last day of antibiotics will be . 3)please check weekly cbc with differential, liver function tests, and bun/cr. results should be faxed to patient's oncologist at . 4)please attend all appointments as listed below. 5)if you experience any fevers, chills, dizziness, chest pain, sob, abdominal pain or any other concerning symptoms please return to the emergency room. followup instructions: 1)provider: felt, rn phone: date/time: 11:00 2)provider: , md phone: date/time: 1:00 3)provider: , md phone: date/time: 1:00 procedure: venous catheterization, not elsewhere classified arteriography of other intra-abdominal arteries endoscopic retrograde cholangiopancreatography [ercp] replacement of stent (tube) in biliary or pancreatic duct diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux acute posthemorrhagic anemia unspecified acquired hypothyroidism secondary malignant neoplasm of other specified sites hemorrhage complicating a procedure regional enteritis of unspecified site bacteremia 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 cholangitis obstruction of bile duct secondary malignant neoplasm of other digestive organs and spleen melanoma of skin, site unspecified 

Answer: The patient is high likely exposed to