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: no known allergies / adverse drug reactions attending: chief complaint: nausea/vomiting, headache major surgical or invasive procedure: none history of present illness: 33f with metastatic melanoma with leptomeningeal disease, most recently recieved xrt four days prior to current admission to t11-l2 for ble weakness and loss of sensation now presents with frontal headache and nausea/vomiting. of note, she was recently admitted with new onset ble weakness and urinary retention, and t11-l2 and conus mets on mri at osh. her dexamethasone was increased during last hospitalization to 8mg tid but decreased over the weekend because of insomnia. this morning, patient woke up with left sided frontal/temporal headache not releived by tylenol she felt nauseaous and had several episodes of vomitting, no blood. she vomited the steroids and was only able to keep down a few peaches and fluids. the ble weakness/loss of sensation has not progressed, she is unable to stand. she doesn not have any new focal weakness. urinary retention has worsened. she is able to void with straining but not able to fully evacuate her bladder. she has required stool softeners for the last few days which is new for her. she denies fevers/chills, sob, chest pain, abdominal pain, no change in mental status. fatigue has worsened over the past 5-6 days. referred in for admission to omed and brain mr w/ contrast. . in the ed, initial vs were: t 98.8 hr 88 bp 139/87 rr 16 o2 100% patient was given morphine for pain and zofran for nausea, which were effective. ct head showed hemorrhagic transformation of known brain metastases with no midline shift or hydrocephalus. she was seen by neurosurgery who stated that no intervention is needed at this time and recommended q1 hour neur checks. neuro onc saw her and recommended decadron iv q6hr. rad/onc fellow was called who said that no further imaging is needed urgently and that she will be seen tomorrow morning for probable whole brain radiation. past medical history: melanoma stage iv - excisional biopsy revealed a 3.75 mm thick, level iv melanoma on her lower back. she underwent wide local excision and bilateral inguinal node sentinel lymph node biopsy which revealed no melanoma. - adjuvant peptide vaccine clinical trial at the nci for 1 year. - resection of soft tissue recurrence in apparent lymph node beneath right twelfth rib. -. enrolled in a vaccine trial at the , but reoccurred in right back soft tissue and an additional supraclavicular nodule. restaging pet scan showed retroperitoneal disease which was biopsied on and proven to be melanoma. - hd il-2 with 13/14 doses week 1 and doses week 2 with disease progression noted . -enrolled in clinical trial plx/ro5185426 on . she underwent pre treatment biopsy on on the left breast taillesion. treatment began on . -on , she had restaging ct of head for routine follow up as well as torso ct. her torso ct revealed to be stable with further reduction of her disease however, on head ct two suspicious lesion 1.0 cm in l frontal lobe and in the periventricular white matter on the left note is made of a small hyperdense focus which also enhances on post-contrast imaging, measuring in total 4 x 3 mm. she underwent head mri for confirmation and was found to have at least small lesions and well as the l frontal lesion. she was seen by dr. , our radiation oncologist who felt she also had leptomeningeal involvement given the location of the lesions are in the suface of the cns. also she has one lesion on the brainstem. she began ipilimumab off protocol on . social history: denies tob. endorses a few beers/night. denies recreational/illicit drug use. family history: noncontributory physical exam: admission physical exam: vitals: t:98.1 bp:134/83 p:53 r:11 o2: 97 ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, 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: foley ext: warm, well perfused, 2+ pulses, no cyanosis or edema neuro: cn ii-xii intact, ue: b/l in proximal/distal/hands, le: 1+/5 with proximal flexion b/l, 0/5 in distal extremities, sensation intact in ues, no sensation in /l from upper patella and below . discharge physical exam: vitals: t:97.6 bp:124/86 p:67 r:14 o2: 100 ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, 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: foley ext: warm, well perfused, 2+ pulses, no cyanosis or edema neuro: cn ii-xii intact, ue: b/l in proximal/distal/hands, le: 1+/5 with proximal flexion b/l, 0/5 in distal extremities, sensation intact in ues, no sensation in /l from upper patella and below pertinent results: admission labs: 02:35pm wbc-11.7* rbc-4.70 hgb-14.5 hct-41.0 mcv-87 mch-30.7 mchc-35.3* rdw-12.7 02:35pm neuts-93.1* lymphs-3.3* monos-3.3 eos-0.3 basos-0 02:35pm plt count-366 02:35pm glucose-113* urea n-15 creat-0.6 sodium-137 potassium-4.1 chloride-99 total co2-26 anion gap-16 08:03pm pt-12.1 ptt-22.3 inr(pt)-1.0 02:42pm lactate-1.0 02:35pm urine ucg-negative 02:35pm urine color-yellow appear-cloudy sp -1.013 02:35pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg . discharge labs: . 08:15am blood wbc-8.6 rbc-4.08* hgb-12.9 hct-36.0 mcv-88 mch-31.6 mchc-35.8* rdw-12.4 plt ct-316 08:15am blood pt-11.6 ptt-21.0* inr(pt)-1.0 08:15am blood plt ct-316 08:15am blood glucose-97 urean-12 creat-0.6 na-134 k-4.2 cl-97 hco3-28 angap-13 08:15am blood calcium-8.6 phos-4.0 mg-2.3 . microbiology: urine culture (): negative . imaging: ct head without contrast (): impression: 1. interval hemorrhage into two known metastatic lesions in the left anterior frontal lobe and left periventricular white matter with surrounding vasogenic edema. 2. local mass effect upon the left lateral ventricle and sulcal effacement. no shift of the midline structures or evidence of transtenorial herniation. 3. incompletely characterized additional known metastatic lesions. if there is clinical concern for new metastasis, mri of the brain is recommended. . ct torso with contrast (): impression: hypodensity/melanoma lesion in the caudate lobe appears slightly increased in size on the current study compared to the prior examination. otherhypodensities in the liver too small to characterize but unchanged since . . mr head with contrast (): impression: 1. hemorrhage within the lesions in left frontal and left frontoparietal periventricular white matter with increase in the size of these lesions and increased mass effect. 2. increase in the size of the lesions in right temporal, left temporal, left frontal lobes, and in right periaqueductal region. 3. no new lesion. brief hospital course: 33f with metastatic melanoma with leptomeningeal disease, ble weakness and loss of sensation now presents with frontal headache, nausea, and vomiting, found to have likely hemorrhagic transformation of 2 known brain metastases on ct head. . active diagnoses: . #hemorrhagic transformatin of known brain mets: pt presented with severe headaches, nausea, and vomiting with findings on ct demonstrating hemmorrhagic conversion confirmed on mri brain. the patient was seen by neurosurgery in the ed, who recommended no immediate surgical intervention. her dexamethasone dose was increased to retard swelling and she was admitted to the icu for regular neuro checks and monitoring. she remained neurologically stable overnight and was transferred to the omed service. ct chest/abd was performed for staging and showed no new mets. radiation oncology recommended whole brain radiation to address the growth of brain mets in addition to the planned spinal radiation course. the patient refused wbr in favor of other therapeutic options. she was started on vamurefanib (study medication) and monitored for neurological changes over the next 2 days. she remained nearly completely paralyzed from the waist down with full neurological function above the waist. she tolerated the study medication well and required only occasional prn doses of morphine for headaches and ativan for steroid-induced anxiety and muscle tension. she was converted to po morphine liquid (as she preferred it to her home oxycodone) and was discharged on a regimen of oxycontin 10mg for basal pain control and morphine liquid 5mg po q4hrs prn for breakthrough (pt also continued on oxycodone by family request but warned against using both prn oxycodone and prn morphine for concern of increased risk of sedation and respiratory depression). . # cauda equina syndrome to leptomeningeal involvement of melanoma: she remained neurologically stable with known ble weakness with motor function limited to 1+/5 strength in proximal bles and with complete loss of sensation below her knees. since her prior admission she had developed worsening of her urinary and bowel retention. a foley was placed and she was continued on her bowel regimen of senna and colace with daily pr dulcolax (she had concerns about straining for urination and bowel movements as a cause of increased intracranial pressure). she continued a short course of radiation treatments to her spine which was discontinued on initiation of vamurefanib therapy. she was discharged home with services and a foley in place. . chronic diagnoses: none . transitional issues: her decadron dose was converted to po and continued at 4mg po qid. neuro-oncology recommended a taper down from 4mg qid to 4mg tid over a week and then to 4mg over another week. we held off on initiating a taper until she was followed by neuro-oncology in dr. clinic. . medications on admission: dexamethasone 8 mg po tid docusate sodium 100 mg po bid prn constipation senna 8.6 mg po bid ativan 1 mg po bid prn anxiety zofran odt 8 mg po q8h prn nausea oxycontin 10 mg po bid mvi 1 tab po qd gabapentin 100 mg po tid ibuprofen 800 mg po tid prn pain naproxen 500 mg po bid discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. zofran odt 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. 4. morphine 10 mg/5 ml solution sig: five (5) mg po q4h (every 4 hours) as needed for pain. disp:*30 doses* refills:*0* 5. dexamethasone 4 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*30 tablet(s)* refills:*0* 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* 7. vemurafenib sig: four (4) (2 times a day). 8. lorazepam 0.5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for anxiety. 9. oxycontin 10 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po twice a day. disp:*60 tablet extended release 12 hr(s)* refills:*0* 10. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. discharge disposition: home with service facility: , discharge diagnosis: primary: metastatic melanoma cauda equina syndrome secondary: none discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mrs. , . it was a pleasure taking care of you. you were admitted to for evaluation of severe headaches and found to have hemorrhagic conversion of known tumor metastasis in your brain. you were monitored in the icu but were found to be neurologically stable. you were started on vamurafenib and tolerated the medication well. you remained neurologically stable on the new treatment and are being discharged home. . the following changes have been made to your medications: -start vamurefanib 4 tabs by mouth twice daily per oncologist orders -start morphine oral solution 10mg/5ml, one-half of a dose every 4 hours as needed for pain -change dexamethasone to 4mg by mouth every six hours -stop ibuprofen and naproxen and gabapentin . it was a pleasure taking care of you. please be sure to follow-up with the appointments below. please continue on your current steroid dosage until you see dr in clinic (make an appointment for within 1 week if possible). followup instructions: please call to make a follow-up appointment with dr. in clinic () for management of your steroid taper within a week . department: bmt/oncology unit when: tuesday at 2:00 pm building: fd building (/ complex) campus: east best parking: main garage . department: bmt/oncology unit when: tuesday at 2:00 pm building: fd building (/ complex) campus: east best parking: main garage . department: dermatology when: wednesday at 9:30 am with: - , md, phd building: sc clinical ctr campus: east best parking: garage md procedure: insertion of indwelling urinary catheter other radiotherapeutic procedure diagnoses: intracerebral hemorrhage nausea with vomiting secondary malignant neoplasm of brain and spinal cord personal history of malignant melanoma of skin secondary malignant neoplasm of other parts of nervous system neoplasm related pain (acute) (chronic) secondary malignant neoplasm of retroperitoneum and peritoneum secondary and unspecified malignant neoplasm of lymph nodes of multiple sites secondary malignant neoplasm of breast cauda equina syndrome without mention of neurogenic bladder straining on urination 

Answer: The patient is high likely exposed to