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 / cephalosporins / iodine / codeine / adhesive tape attending: chief complaint: transfer from ip for management of metastatic melanoma major surgical or invasive procedure: thoracic pigtail tube placement for pleural effusion history of present illness: ms. is a 59 year old woman with history of melanoma who is transferred from the ip service for treatment of metastatic melanoma. she initially presented in with relatively acute onset wheezing and dyspnea. she was initially seen at nebh and treated with antibiotics and steroids for presumed lymphangitic spread of the melanoma. she was seen in consultation in melanoma clinic, where it was determined that she did not qualify for il-2 or any ongoing studies given her poor respiratory status. her breathing continued to deteriorate, and she developed orthopnea and small amount of hemoptysis. she was seen by the interventional pulmonologist for evaluation for possible stenting, but was unable to tolerate the procedure; she was admitted to the ip service for further management of her hypoxia and dyspnea. . in the sicu, her respiratory status improved after diuresis. she was found to have a left pleural effusion; a pigtail catheter was placed and drained 2000cc of exudative fluid, thought likely to be malignant. she had a chest ct which showed a large loculated pleural effusion (with pigtail catheter in place), extensive right hilar and mediastinal lymphadenopathy, and multiple pulmonary nodules. a v/q scan demonstrated low probability of pulmonary embolism. the pigtail catheter was pulled on . she was transferred to the for potential chemotherapy (taxol). . on arrival to the floor, her respiratory status is much improved, and she reports feeling much better. she also reports headaches (which she attributes to oxygen therapy) and periodic ruq pain. past medical history: oncology history: - diagnosed in with melanoma in with wide incision - developed right inguinal lymphadenopathy, s/p right radicular inguinal dissection with positive lymph nodes, complicated by post op skin infection requiring debridement - no further therapy of melanoma at that time - bronchial washings from were positive for malignant cells, consistent with metastatic melanoma; carinal lesion biopsy form demonstrated malignant melanoma . past medical history: - hypertension - steroid-induced diabetes mellitus - itp s/p splenectomy - right knee replacement social history: 40 pack year history, quit . lives in with her mother, who is independent. denies alcohol or medications. family history: stomach cancer paternal grandmother, breast cancer in paternal aunt, throat cancer in maternal uncle, and question stomach cancer in maternal uncle. physical exam: vitals: t97.6f, bp 100/72, hr 87, rr 22, o2sat 92%6l nc general: comfortable, no acute distress neck: no cervical lymphadenopathy card: regular rate & rhythm, 2/6 systolic murmur at lusb resp: no accessory muscle use. decreased breath sounds on left, with crackles ~1/3 up; right essentially clear abd: obese, + bowel sounds, non-tender, non-distended, no hsm appreciated back: no cva tenderness, no spinal tender ext: no clubbing, cyanosis, or edema; 2+ dp pulses bilaterally neuro: cn ii-xii intact, 5/5 strength in both upper and lower extremities bilaterally. no sensory deficits appreciated. psych: mood and affect appropriate. pertinent results: 07:35pm pt-13.4 ptt-24.8 inr(pt)-1.1 07:35pm plt count-537* 07:35pm neuts-69.4 lymphs-22.5 monos-5.0 eos-2.8 basos-0.3 07:35pm wbc-19.9* rbc-3.81* hgb-10.9* hct-33.0* mcv-87 mch-28.6 mchc-33.0 rdw-14.4 07:35pm calcium-9.5 07:35pm estgfr-using this 07:35pm glucose-158* urea n-16 creat-0.6 sodium-137 potassium-3.9 chloride-98 total co2-31 anion gap-12 . ecg : sinus rhythm. normal tracing. no previous tracing available for comparison . echo : normal biventricular cavity sizes with preserved global and regional biventricular systolic function. mild pulmonary artery systolic hypertension. . cxr : 1. large left pleural effusion, bibasilar atelectasis, and right basilar kerley b lines. this suggests lymphangitis carcinomatosa or direct, tumor-related pulmonary congestion. 2. hazy right upper lung opacity which may be bony confluence, though not excluded would be a right upper lobe nodule. 3. if clinically relevant to the patient's management, cross-sectional imaging of the chest would further characterize these findings. . cytology pleural fluid : negative for malignant cells. . ecg: sinus rhythm. normal tracing. compared to the previous tracing of the findings are similar. . ecg: slight sinus tachycardia. otherwise, within normal limits. compared to the previous tracing of the heart rate is faster. the other findings are similar. . cxr: in comparison with the study earlier in this date, there has been placement of a pigtail catheter with removal of substantial amount of fluid from the left chest. several lobulated opacifications suggest some loculated pleural fluid. specifically, no evidence of pneumothorax. relatively lower lung volumes with some opacification at the bases consistent with atelectatic change. there is also some increasing prominence of ill-defined pulmonary vessels that could reflect some developing increased pulmonary venous pressure. . v/q scan: low probability for pe. pe can not be excluded with certainty due to bilateral pleural effusion and airway disease affecting the interpretation of the lung scan. . cxr: moderate loculated left pleural effusion unchanged since , 2:51 p.m., previously much larger following placement of a left-sided pigtail drain unchanged in position since prior study. previous mild pulmonary edema has improved, bibasilar atelectasis, more pronounced on the right, has not cleared and small right pleural effusion has increased. heart size normal. . ct chest: several bilateral pulmonary nodules. extensive right hilar adenopathy with subsequent hypoventilation of the right lower lobe, combined with moderate mediastinal lymphadenopathy. no obvious bone destruction. no pericardial effusion. . cxr: several bilateral pulmonary nodules. extensive right hilar adenopathy with subsequent hypoventilation of the right lower lobe, combined with moderate mediastinal lymphadenopathy. no obvious bone destruction. no pericardial effusion. . cxr: 59-year-old woman with history of metastatic melanoma with pleural effusion. since yesterday, left pigtail was removed. there is no overall change. moderate loculated left pleural effusion, vascular congestion, bibasilar atelectasis and small right pleural effusion are unchanged. the study and the report were reviewed by the staff radiologist. . ecg: sinus rhythm. within normal limits. . cxr (pa/lat and lat decub): at the bases of the right lung, no evidence of pleural effusion is seen. newly occurred, however, is a parenchymal opacity in the right upper lobe with sparse air bronchograms that could be inflammatory in origin. the large loculated pleural fluid on the left is grossly unchanged as compared to the previous examination. also unchanged is a moderate related plate-like atelectasis. there is no evidence of pneumothorax. the size of the cardiac silhouette is unchanged. brief hospital course: 59yf with recent diagnosis of metastatic melanoma presenting with shortness of breath, found to have metastatic spread to lungs, pleura, and right hilar and mediastinal lymph nodes. she was initially admitted to the interventional pulmonary/thoracic service, where a workup for her shortness of breath (see below) was performed; a thoracentesis was performed with improvement, and she was transferred to the omed service for further management. . #) metastatic melanoma. known metastases to lungs/pleura, with extensive chest lymphadenopathy. patient also with headaches more recently, and vague ruq abdominal pain which raises concern for additional metastases. transferred to omed for administration of taxol which was given on without complications. she was continued on steroids (5mg and 10mg alternating days) and will receive her next dose of taxol per dr. (scheduled for follow up with him on ). . #) dyspnea. multiple reasons for her dyspnea, including known metastatic disease, pleural effusions (malignant in nature), lymphangitic spread of disease. ip did not believe talc pleurodesis would be successful (and might be detrimental in that she might not survive the procedure). dyspnea improved s/p thoracentesis. the last cxr on demonstrated loculated pleural effusions with nothing easily to take. she was continued on nebulizers and steroids, to be tapered per dr. as an outpatient. . #) elevated wbc. on steroids, which could account for some of the elevation. infection is possible given immunocompromised (splenectomy--which could also account for her elevated white count). blood and urine cultures were performed and were negative throughout the hospitalization. . #) hypertension. held enalapril and carvedilol while in house; she was discharged with instructions not to take these medications. . #) chronic pain. patient on 300mg ms contin at home per nebh notes, transferred from thoracics service on 260mg tid. continued pain medications. . #) depression/anxiety. continue duloxetine. medications on admission: ms contin 300 mg po q12h ms ir 30mg q8h lyrica 150 mg daily cymbalta 60 mg po daily enalapril 10 mg po bid coreg 12.5 mg po bid lipitor 40 mg po daily prednisone 15 mg daily provigil 100 mg daily discharge medications: 1. oxygen therapy please provide continuous oxygen therapy, 6l. 2. duloxetine 30 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily) as needed for depression. 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily) as needed for hypercholestrolemia. 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). disp:*120 units* refills:*2* 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. disp:*120 units* refills:*0* 6. prednisone 5 mg tablet sig: 1-2 tablets po once a day for 14 days: please alternate between 10mg (two tablets) and 5mg (1 tablet)every other day for 14 days. disp:*21 tablet(s)* refills:*0* 7. morphine 30 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 8. clonazepam 1 mg tablet sig: one (1) tablet po bid prn as needed for anxiety. disp:*30 tablet(s)* refills:*0* 9. ms contin 60 mg tablet sustained release sig: one (1) tablet sustained release po three times a day: take with 200mg ms contin for a total dose of 260mg tid. disp:*90 tablet sustained release(s)* refills:*0* 10. ms contin 200 mg tablet sustained release sig: one (1) tablet sustained release po three times a day: please take with 1 (one) 60mg tablet for a total of 260mg every 8 hours. disp:*90 tablet sustained release(s)* refills:*0* 11. nebulizer & compressor for neb device sig: one (1) nebulizer unit miscellaneous as directed: please provide nebulizer for medication use. . discharge disposition: home with service facility: discharge diagnosis: metastatic melanoma pleural effusion anxiety discharge condition: the patient was hemodynamically stable, afebrile and without pain at the time of discharge. she was stating 94% on 6l and ambulatory stats ranged from 89-92%. discharge instructions: you were admitted for evaluation and treatment of shortness of breath. you symptoms were due to the accumulation of fluid on your lungs. this fluid was drained and your symptoms improved. you continue to require 6l of oxygen. . during this hospitalization, you received taxol, a chemotherapy for the treatment of your melanoma. you have tolerated this treatment well. you have been scheduled for a follow up appointment with dr. on monday, , at 11:00 am. please be sure to attend this appointment. . we have made several changes to your medications. first, you have held your provigil due to concerns for a high high heart rate. we have also dicontinued your blood pressure medications as your blood pressures have been low. please do not resume the use of these medications until you discuss these changes with dr. . . we have increased your pain medication to a new dose for better pain control. you will recieve a prescription for this at discharge. . to help with your breathing, we are sending you home with a prescription for albuterol and ipratroprium inhalers. you can take these medications every 6 hours as needed for wheezing/shortness of breath. you will need to complete a 2 week taper of prednisone. please take this and all medications as directed. . please call your doctor or seek medical attention if you develop a fever higher than 100.3, increased shortness of breath, chest pain, coughing up blood, nausea, vomiting, abdominal pain, diarrhea or any other symptom of concern. followup instructions: provider: . phone: ( date/time: monday, :00 am procedure: other incision of pleura injection or infusion of cancer chemotherapeutic substance diagnoses: unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use personal history of tobacco use acute respiratory failure long-term (current) use of insulin secondary malignant neoplasm of lung personal history of malignant melanoma of skin secondary and unspecified malignant neoplasm of intrathoracic lymph nodes leukocytosis, unspecified neoplasm related pain (acute) (chronic) secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified malignant pleural effusion 

Answer: The patient is high likely exposed to