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: patient recorded as having no known allergies to drugs attending: chief complaint: hypoxia, tachypnea major surgical or invasive procedure: pericardiocentesis fine needle aspiration of axillary node history of present illness: she is a 58-year-old resident with mental retardation, copd, and no reported past cardiac history who presents for examination of distended belly, anemia and noted to have large pericardial effusion. given mental retardation, interview with patient is extremely limited, and pt. minimally able to report symptoms. pt. was admitted to after echo for workup of shortness of breath revealed moderate pericardial effusion without tamponade. repeat echo 24h later showed stable-to-improved effusion and was discharged with plans for f/u echo in 14d. . today, she presented to ed from nh with short episode hypoxia with recovered with albuterol and 02 and started on levofloxacin. also had kub given some abdominal distension which reportedly was concerning for ileus. she was transferred to for evaluation of a distended belly in setting of previous volvulus. in ed, she had a distended abd with minimal ttp, normal lfts, pancreatic enzymes, without leukocytosis. she was guaiac negative with vss and received abdominal ct shich showed large pericardial effusion and presacral, perihepatic fluid, but no acute abdominal process. given large pericardial effusion without previous comparisons, pt. was admitted for planned f/u echo in the am. . spoke with pt.'s brother and wife who report that 8 weeks ago, she started to become pale, have increased shallow breathinig, low grade temps to 100-101, with some abdominal distension that has been ongoing. concern for gerd, copd, uti, all diagnosed within this time period. uti tx. with levaquin. she has had no bloody or black stools per family until she starte fe so4. past medical history: - mental retardation of unknown etiology. - djd. - bilateral knock knees (talus valgus, pes planus). - neurodermatitis. - psoriasis. - history of obesity. - status post volvulus and colonic resection. - status post left oophorectomy. - fe deficiency anemia 28.5 at 1 week ago - gerd social history: social history is significant for the absence or etoh use. patient is a resident at center. family history: father died of prostate cancer, cabg, mis; he also had colon ca. maternal aunt with ovarian and breast cancer. mi and cad throughout family on both sides. physical exam: vs - t 99.8 137/65 hr 101, 95%ra, no pulsus gen: middle-aged woman, nad, repititious and perseverative, follows commands. oriented x 1. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pale, no with sublingual pallor, mmm neck: unable to assess jvp as pt. will not allow herself to be reclined. at 45 degrees, jvp flat. cv: pmi located in 5th intercostal space, midclavicular line. rr, borederline tachycardic, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no wheezes or rhonchi. mild, occ. crackles at right base. abd: mildly distended, obese, with difficult abodminal exam as pt. denies belly pain but seems to grimace on palpation of ruq>rlq. no organomegaly noted in context of bodyhabitus and difficulty participating in exam. no abdominial bruits. ext: 2+ pitting edema to knees (new per pa at bedside. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. + hirsutism pulses: right: carotid 2+ femoral 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ 2+ dp 2+ pt 2+ neuro: cn ii-xii grossly intact, moving all 4 ext. spontaneously, follows commands. pertinent results: echocardiogram left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. trivial mitral regurgitation is seen. there is a moderate to large sized circumferential pericardial effusion. stranding is visualized within the pericardial space c/w organization. there is substantial right atrial collapse and brief diastolic invagination of the right ventricular outflow tract (cine loops #15 and #28), consistent with low filling pressures or early tamponade. impression: moderate-to-large pericardial effusion with echocardiographic findings of early tamponade. . ct chest, abdomen & pelvis w/contrast impression: 1. diffuse lymphadenopathy in the axillary, supraclavicular and mediastinal regions. pulmonary nodules in the left lung apex is also noted. this is concerning for a neoplastic process. differential diagnosis includes primary lymphoma or lung neoplasm. 2. small pericardial effusion, decreased in size. 3. bilateral small pleural effusions. 4. splenic hypodensity. 5. multiple hepatic subcentimeter hypodensities which are too small to characterize. 6. cholelithiasis without evidence of cholecystitis. 7. diffuse colonic distention up to 12.2 cm. no evidence of obstruction. . pericardial fluid: three color gating is performed (light scatter vs. cd45) to optimize lymphocyte yield. cd45-bright, low-side scatter lymphoid cells comprise 23% of total analyzed events. of these, b cells comprise approximately 15% of lymphoid-gated events and do not express aberrant antigens. surface immunoglobulin expression is extremely dim-to-absent, precluding evaluation of clonality. t cells comprise approximately 80% of lymphoid gated events, express mature lineage antigens, and have a helper-cytotoxic ratio of 5.0. natural killer cells represent approximately 3% of lymphoid gated events. no expansion of cd34-immunoreactive events are identified in the "blast gate". monocytic cells comprise 6% of total analyzed events. . non-specific t cell dominant lymphoid profile; diagnostic immunophenotypic features of involvement by a lymphoproliferative disorder are not seen in specimen. correlation with clinical findings and morphology (see 08-) is recommended. flow cytometry immunophenotyping may not detect all lymphomas due to topography, sampling or artifacts of sample preparation. . l axillary lymph node fna three color gating is performed (light scatter vs. cd45) to optimize lymphocyte yield. b cells comprise approximately 9% of lymphoid-gated events, are polyclonal, and do not express aberrant antigens.t cells comprise approximately 89% of lymphoid gated events and express mature lineage antigens (cd2,3,5,7). . non-specific t cell dominant lymphoid profile; diagnostic immunophenotypic features of involvement by non-hodgkin b-cell lymphoma are not seen in specimen. review of cytospin slide (1096v-) shows predominantly blood with admixed lymphocytes and numerous degenerated cells precluding definitive morphologic assessment. correlation with clinical findings and morphology is recommended. flow cytometry immunophenotyping may not detect all lymphomas due to topography, sampling or artifacts of sample preparation. . complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 07:00am 9.4 3.38* 8.2* 28.6* 85 24.3* 28.7* 16.3* 389 07:00am 9.8 3.21* 7.8* 26.8* 83 24.3* 29.2* 16.5* 381 01:36am 9.6 3.73* 9.0* 29.9* 80* 24.2* 30.1* 15.5 410 06:00am 7.1 3.27* 8.2* 27.0* 83 25.0* 30.2* 15.8* 355 10:30am 10.5 3.40* 8.2* 27.5* 81* 24.2* 29.9* 15.7* 385 04:30pm 8.8 3.46* 8.5* 28.2* 82 24.5* 30.1* 15.7* 381 . differential neuts lymphs monos eos baso 04:20am 89.0* 5.5* 4.5 0.9 0.1 01:36am 89.3* 5.6* 4.8 0.2 0.1 04:30pm 89.1* 4.7* 4.6 1.5 0.2 . renal & glucose glucose urean creat na k cl hco3 07:00am 101 13 0.3* 144 3.8 109* 29 07:00am 103 12 0.3* 141 3.6 107 26 01:36am 155* 10 0.4 144 3.6 110* 26 03:50pm 109* 8 0.3* 143 3.9 109* 25 10:30am 126* 9 0.4 138 3.9 103 28 04:30pm 117* 13 0.4 140 4.1 105 29 . enzymes & bilirubin alt ast ld(ldh) alkphos amylase totbili 04:20am 27 19 292 129* 14 0.5 04:30pm 14 14 245 134* 0.5 . other enzymes & bilirubins lipase 04:20am 15 . brief hospital course: 58 yo f with mental retardation & h/o volvulus s/p colonic resection admitted with hypoxia & abdominal distention, also repeat echocardiogram given newly diagnosed pericardial effusion. . # pericardial effusion: s/p pericardiocentesis when early signs of tamponade seen on echocardiogram. bloody pericardial effusion ~510cc's removed, ?malignancy. however no evidence of malignancy cells seen on flow cytometry as well as cytology. w/u already started at and so far studies negative except for elevated esr, crp & ca 125. required overnight ccu stay after pericardial drain placed. developed afib with rvr during stay. no evidence of reaccumulation of fluid seen on repeat echocardiogram or vital signs including nml pulsus. . # atrial fibrillation with rvr: ?r/t pericardial effusion, worsened after pericardiocentesis during which time she stayed in the ccu given pericardial drain. she was treated with iv metoprolol, diltiazem then finally started on an emsolol drip for good control. this was weaned off with the onset of verapamil which was uptitrated during stay. metoprolol was also added for better rate control. the decision was made for no anticoagulation given bloody pericardial effusion, pt was continued on full strength aspirin. . # ct findings: diffuse lymphadenopathy in the axillary, supraclavicular and mediastinal regions with pulmonary nodules in the left lung apex which were concering for neoplastic process. pt underwent l axillary lymph node biopsy for concern of malignancy, ?lung ca, lymphoma vs. other other cancers. however, pathology was not diagnostic. pt with no prior colonoscopies or vaginal exams, however with nml mammograms & per report, last nml. guaiac negative stools during admission. pt will need outpt evaluation for excisional lymph node biopsy vs mediastinoscopy for tissue diagnosis, if desired by the family. . # abdominal distension: appeared to be chronic, however worsened acutely during admission. no evidence of volvulus, cholecystitis or obstruction; imaging showed significant amounts of air with colonic distention, likely colonic ileus. surgery was consulted and recommended endoscopic decompression per gi. however, gi recommended rectal tube placement with was effective in decompressing her abdomen. pt initially made npo, however resumed regular diet gradually. had no episodes of nausea or vomiting, however it was difficult to access abdominal pain. per gi, pt will require intermittent decompression with rectal tube until ileus resolves. also given possibility of malignancy, it's recommended that pt under colonoscopy as part of further workup. . # microcytic anemia: c/w anemia of chronic disease; low retic count, however hematocrit stable. guaiac negative stool x 1 in the ed. we continued iron supplementation, ?other stools guaiac'ed. . # peripheral edema: unclear if new, no evidence of chronic venous stasis and no significant ascites seen on ct despite abdominal distention. no evidence of proteinuria, however sl.lower albumin. ?heart failure, however no other evidence on pe. liver function appears nml. . # neurodermatitis: continued topicals # djd: continued celecoxib & tylenol. . dnr/dni medications on admission: - multivitamin 1 tab - caco3 1250mg qdaily - celebrex 100 mg twice a day - artifical tears prn - eucerin cream topical every day, - vitamin e and vitamin d ointments - chlorhexidine topical - feso4 325 mg - started on levaquin 500mg at nh today given transient hypoxia . allergies: nkda discharge medications: 1. calcium carbonate 500 mg (1,250 mg) tablet, chewable sig: one (1) tablet, chewable po once a day. 2. hexavitamin tablet sig: one (1) cap po daily (daily). 3. celecoxib 100 mg capsule sig: one (1) capsule po bid (). 4. artificial tear with lanolin 0.1-0.1 % ointment sig: one (1) appl ophthalmic qid (4 times a day) as needed for dry eyes. 5. eucerin cream sig: one (1) application topical once a day. 6. glucosamine-chondroitin complx 500-400 mg capsule sig: two (2) capsule po twice a day. 7. ferrous sulfate 325 mg (65 mg iron) capsule, sustained release sig: one (1) capsule, sustained release po twice a day. 8. toprol xl 50 mg tablet sustained release 24 hr sig: 2.5 tablet sustained release 24 hrs po once a day. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) nebs inhalation q6h (every 6 hours) as needed for wheezing, sob. 11. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath, wheezing. 12. verapamil 120 mg tablet sig: 1.5 tablets po q8h (every 8 hours). 13. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: center discharge diagnosis: pericardial tamponade s/p pericardiocentesis atrial fibrillation with rvr colonic ileus with abdominal distension s/p rectal decompression mental retardation degenerative joint disease s/p volvulus with colonic resection discharge condition: stable discharge instructions: you were admitted with pericardial tamponade and you underwent draining of the fluid around your heart. laboratory analysis of the fluid did not reveal a cause. you were also found to have multiple enlarged lymph nodes in your chest. you had a biopsy of one of these nodes that was not diagnostic. you should speak with your doctor about having an excisional biopsy of one of your lymph nodes. during your hospitalization, you had abdominal distention from an ileus that resolved with rectal tube decompression which should be continued intermittently as needed. . medication changes: - start toprol xl 125mg po daily, verapamil 180mg po q8h - aspirin 325mg po daily continue to take your other medications as prescribed. . please call your pcp or come to the ed if you develop chestpain, shortness of breath or any other worrisome symptoms. followup instructions: please f/u with pcp at the residence within 1 week of discharge. you should discuss whether you should have a mediastinoscopy or excisional biopsy of one of your lymph nodes. procedure: pericardiocentesis angiocardiography of right heart structures biopsy of lymphatic structure right heart cardiac catheterization other diagnostic procedures on rectum, rectosigmoid and perirectal tissue diagnoses: chronic airway obstruction, not elsewhere classified atrial fibrillation unspecified disease of pericardium osteoarthrosis, unspecified whether generalized or localized, site unspecified paralytic ileus iron deficiency anemia, unspecified calculus of gallbladder without mention of cholecystitis, without mention of obstruction hypoxemia obesity, unspecified hyperosmolality and/or hypernatremia enlargement of lymph nodes other psoriasis unspecified intellectual disabilities lichenification and lichen simplex chronicus edema tachypnea congenital pes planus congenital deformity of knee (joint) 

Answer: The patient is high likely exposed to