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: pericardial effusion. major surgical or invasive procedure: pericardiocentesis and pericardial drain placement. history of present illness: the patient is a 52-year old female with a history of metastatic breast cancer, s/p lt. mastectomy now enrolled in clinical trial "05-395" (lapatinib monotherapy 1500 mg), who noted lt. arm swelling . doppler neg for clot, but ct (routine, restaging) revealed pericardial effusion. echo revealed: small to moderate sized circumferential pericardial effusion, most prominently inferolateral to the left ventricle and around the right atrium, but ~1cm anterior to the right ventricle. there is mild right ventricular diastolic collapse consistent with increased pericardial pressure/early tamponade physiology. . : compared with the prior study (images reviewed) of , the pericardial effusion appears similar to slightly larger. there is right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. . : there is subtle rv diastolic compression without collapse (no overt tamponade). compared with the prior study (images reviewed) of , there is slightly less pericardial fluid anteriorly. otherwise no change. . a pericardial drain was placed with return of approximately 250 cc of serosanginous fluid and normalization of right heart pressures. she is admitted to the ccu for further monitoring. past medical history: oncology history: she was initially diagnosed in with a 3.5 cm infiltrating ductal carcinoma, lymph node positive, lvi positive, er positive. she is status post left mastectomy with reconstruction, caf followed by tamoxifen. she recurred in , with metastasis to her left supraclavicular node and lung. biopsy documented her-2/neu over expression by immunohistochemistry. er positive. she was treated with arimidex for six months, which was followed by taxol and herceptin. she was then treated with high-dose chemo and herceptin followed by transplant as part of the clinical trial. this chemo included thiotepa, , and taxol. in , she was treated with letrozole and herceptin and was then switched to aromasin and herceptin in 11/. upon progression was switched to the lapatinib phase ii trial in , and herceptin was discontinued. she has received 8 cycles of lapatinib. . past medical history: 1. metastatic breast cancer as above. 2. autologous bone marrow transplant in . 3. history of meningoceles. 4. hyperlipidemia. social history: a single parent. she lives with her 13-year-old daughter. tobacco, alcohol, or drugs. family history: father has lymphoma. physical exam: blood pressure was 116/66 mm hg while seated. pulse was 73 beats/min and regular, respiratory rate was 15 breaths/min. generally the patient was well developed, well nourished and well groomed. the patient was oriented to person, place and time. the patient's mood and affect were not inappropriate. . there was no xanthalesma and conjunctiva were pink with no pallor or cyanosis of the oral mucosa. the neck was supple with jvp of less than 6 cm. the carotid waveform was normal. there was no thyromegaly. the were no chest wall deformities, scoliosis or kyphosis. the respirations were not labored and there were no use of accessory muscles. the lungs were clear to ascultation bilaterally with normal breath sounds and no adventitial sounds or rubs. . palpation of the heart revealed the pmi to be located in the 5th intercostal space, mid clavicular line. there were no thrills, lifts or palpable s3 or s4. the heart sounds revealed a normal s1 and the s2 was normal. there were no rubs, clicks or gallops. there was a slight hsm. . there is a pericardial drain in place in the sub-xiphoid position. drainage bag connected, contains approx 10 cc of serosanguinous fluid. . the abdominal aorta was not enlarged by palpation. there was no hepatosplenomegaly or tenderness. the abdomen was soft nontender and nondistended. the extremities had no pallor, cyanosis, clubbing. there is slight (1+), diffuse, lt. ue edema. there were no abdominal, femoral or carotid bruits. inspection and/or palpation of skin and subcutaneous tissue showed no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: labwork on admission: 04:15pm wbc-4.2 rbc-3.40* hgb-10.8* hct-31.0* mcv-91 mch-31.9 mchc-35.0 rdw-14.8 04:15pm plt count-161 04:15pm glucose-99 urea n-12 creat-0.7 sodium-139 potassium-3.9 chloride-106 total co2-25 anion gap-12 . labwork on admission: c.cath study date of *** not signed out *** brief history: this 55 year old female with known diagnosis of metastatic breast cancer presented with pericardial effusion diagnosed on echocardiogram with significant respiratory mitral flow variation. patient was therefore referred for pericardiocentesis. indications for catheterization: pericardial effusion. procedure: right heart catheterization: was performed by percutaneous entry of the right femoral vein, using a 7 french pulmonary wedge pressure catheter, advanced to the pcw position through an 8 french introducing sheath. cardiac output was measured by the fick method. pericardiocentesis: was performed via the subxyphoid approach, using an 18 gauge thin-wall needle, a guide wire, and a drainage catheter. conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. hemodynamics results body surface area: m2 hemoglobin: gms % fick **pressures right atrium {a/v/m} 14/12/10 right ventricle {s/ed} 35/12 pulmonary artery {s/d/m} 35/15/21 pulmonary wedge {a/v/m} 16/16/12 aorta {s/d/m} 140/65/95 pericardium {m} 12 **cardiac output heart rate {beats/min} 70 rhythm sinus other hemodynamic data: the oxygen consumption was assumed. technical factors: total time (lidocaine to test complete) = 45 minutes. arterial time = 45 minutes. fluoro time = 2.3 minutes. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 20 ml, indications - renal anesthesia: 1% lidocaine subq. cardiac cath supplies used: - , pericardiosentisis set - allegiance, custom sterile pack comments: 1. resting hemodynamics were performed. the right sided filling pressures were mildly elevated (mean ra pressure was 12mmhg and rvedp was 12mmhg). the pulmonary artery pressures were mildly elevated measuring 35/15mmhg. the left sided filling pressures were equalized to the right (mean pcw pressure was 12mmhg). there was significant respiratory variation of systemic arterial pressure up to 20mmhg. there was equalization of ra and pericardial pressures. 2. pericardiocentesis was performed under fluoroscopy guidance. pericardial drain was subsequently placed with 240cc serosanguinous fluid removed. repeat measurement of pericardial pressure and ra pressure demonstrated clear seperation. final diagnosis: 1. elevated right sided filling pressures with equlization of ra/la/pericardial pressures. 2. successful placement of pericardial drain. . echo study date of conclusions: overall left ventricular systolic function is low normal (lvef 50-55%). there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , there is now minimal residual pericardial effusion. . ecg study date of 1:00:10 pm sinus rhythm normal ecg since previous tracing, no significant change . chest (portable ap) impression: ap chest, small right pleural effusion is present. right lower lobe atelectasis is new since . consolidation in the anterior segment of the right upper lobe and a right apical paramediastinal mass are unchanged. left lung is clear. several loops of pericardiocentesis catheter projecting over the subxiphoid midline, the base of the heart and superiorly to the level of the pulmonary outflow tract, are acutely coiled and should be evaluated clinically to see if they are draining properly. no pneumothorax. . echo study date of conclusions: left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a small circumferential pericardial effusion primarily inferolateral to the left ventricle with minimal effusion anterior to the right ventricle. no echocardiographic signs of tamponade physiology are seen. compared with the prior study (images reviewed) of , the inferolateral effusion is more prominent. . labwork on discharge: 09:25am blood wbc-5.6 rbc-3.67* hgb-11.9* hct-36.0 mcv-98# mch-32.3* mchc-32.9 rdw-14.2 plt ct-185 09:25am blood glucose-108* urean-8 creat-0.7 na-136 k-3.7 cl-104 hco3-21* angap-15 brief hospital course: 55 year-old female with metastatic breast cancer presenting with pericardial effusion. . 1. pericardial effusion. likely malignant. pericardiocentesis was performed with approximately 250 cc of serosanguinous fluid output and normalization of right heart pressures. a pericardial drain was placed with 320 cc of serosanguinous fluid output the first 12 hours, then 75 cc over 6 hours, then no output. a repeat echocardiogram showed a small pericardial effusion without evidence of tamponade as above. the pericardial drain was removed. an echocardiogram the next morning showed stable small pericardial effusion. cultures were negative at the time of discharge and cytology was pending. the patient will have a repeat echocardiogram five days after discharge and will follow-up with her oncologist. the patient may need a pericardial window or balloon pericardiotomy procedure if the effusion increases in size. . 2. infectious disease. the patient had a temperature to 100.8 the second day of admission. the patient's only localizing symptom was a nonproductive cough the patient has complained of for the past three weeks, overall improved since that time. chest x-ray showed atelectasis but no new consolidations. urinalysis negative for infection. urine, blood, and pericardial fluid cultures without growth at the time of discharge. the fever was likely secondary to atelectasis or the patient's underlying malignancy. . 3. breast cancer. the patient is now off the lapatinib study. the patient is followed by oncology. . 4. anemia. the patient's hematocrit remained stable at 31-36 during admission. the patient's iron studies showed an iron to tibc ratio of 5%, although ferritin was within normal limits. folate and b12 were within normal limits. further management deferred to the patient's primary physician. medications on admission: simvastatin 20 mg qd discharge medications: 1. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). discharge disposition: home discharge diagnosis: primary: pericardial effusion status post pericardiocentesis and pericardial drain placement/removal . secondary: 1. metastatic breast cancer 2. autologous bone marrow transplant in 3. history of meningoceles 4. hyperlipidemia discharge condition: afebrile, vital signs stable. discharge instructions: you were hospitalized after a procedure to remove fluid from your pericardial sac. you will need a repeat echocardiogram to assess for fluid reaccumulation. the office of your oncologist, dr. , contact you regarding scheduling of your repeat echocardiogram and follow-up with oncology. . you spiked a fever during admission without any localizing symptoms. your oncologist should follow-up the urine, blood, and pericardial fluid cultures drawn during this admission. . please contact a physician if you experience fevers, chills, chest pain, shortness of breath, palpitations, or any other concerning symptoms. . please take your medications as prescribed. there were no changes made to your medications. . please keep your follow-up appointments as below. followup instructions: the office of your oncologist, dr. , contact you regarding scheduling of your repeat echocardiogram and follow-up with oncology on monday, . please call the office at ( with any questions or concerns or if you do not hear from a representative by this friday. . previously scheduled appointments: provider: phone: date/time: 10:45 procedure: coronary arteriography using a single catheter pericardiocentesis right heart cardiac catheterization diagnoses: anemia, unspecified secondary malignant neoplasm of other specified sites personal history of malignant neoplasm of breast pulmonary collapse bone marrow replaced by transplant other and unspecified hyperlipidemia antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to