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: prevpac / penicillins attending: chief complaint: chest transfer from for pericardial tamponade, s/p pericardial drain placement major surgical or invasive procedure: pericardial drain placement history of present illness: ms. is a 61 year old woman with hx of ulcerative colitis/crohns, recent dvt, who presented with chest discomfort initially, found to have pericardial effusion increasing in size, who was transferred from cardiology service to ccu for overnight monitoring s/p placement of pericardial drain for pericardial effusion/ tamponade. patient was recently discharged from with pneumonia, for which she was treated with vancomycin and ciprofloxacin. patient was noted to have small pericardial effusion at that time with a pulsus paradoxus of <10mmhg, felt to be stable. she was also diuresed for volume overload, and her tpn volume was decreased. she was discharged on . patient returned to hospital on this admission because of temperature to 100.1f and was found to have pericardial effusion markedly incrased in size. on presentation to floor, patient did complain of tugging sensation in her chest, muscle aches and dry cough and reported having had these symptoms on discharge from previous hospitalization. she does report diarrhea but unchanged from her normal diarrhea associated with her ibd. she was ruled out for influenza on the floor. she denied chills, sore throat, runny nose, headache, abdominal pain or sob. she denied hematochezia or melena. she admitted to intermittent swelling of her legs for past two years, which she attributed to her gout initially. echocardiogram this morning was similar to previous echo yesterday, showing large free-flowing pericardial effusion with rv invagination and diastolic collaps, evidence of cardiac tamponade. patient was taken to cath lab for placement of pericardial drain. right heart cath showed equalization of pressures in ra, pcwp, and pericardial pressure at 20mmhg, suggesting tamponade physiology. 450cc serosanguinous fluid drained from pericardiocentesis, fluid sent for studies, drain left in place, and patient transferred to ccu for further monitoring. on transfer to ccu, she appears to be comfortable and stable. no complaints of chest discomfort, just has mild lower back pain from positioning in bed. past medical history: 1. crohn disease diagnosed in , in the past she had surgery due to bowel obstruction requiring a 40-day stay including icu management. colonoscopy last done in . currently, on remicade infusions every 8 weeks and started on tpn 2. gout. present in left toes and ankles. 3. pseudogout. 4. tubal ligation in the past. 5. osteoporosis. recent bone scan shows severe osteoporosis, not taking bisphosphonate currently. 6. several abscesses in teeth requiring teeth extraction, likely secondary to remicade infusion. 7. hammertoes. 8. elbow pain requiring surgery. 9. asymptomatic kidney stones. 10. fracture of ribs from coughing. 11. depression 12. hypothyroidism cardiac risk factors: diabetes, dyslipidemia, hypertension social history: retired, worked for election department. currently lives with son and son's father (ex-husband). needs help with almost all adls. states she would probably not be alive without other's assistance. diet: eats what is tolerated. tobacco, quit last month. smoked about pack/day for about 40 years. alcohol, denies. family history: positive for diabetes, gout. negative for inflammatory bowel disease or gi cancer. father had heart disease, mother had and htn. physical exam: vs: t=98.6 bp=112/58 hr=92 rr=18 o2 sat= 100% 2l nc general: very thin woman, appears older than stated age, in nad. oriented x3. mildly anxious appearing. heent: ncat. sclera anicteric. eomi. conjunctiva were pink, moist mucus membranes. neck: jvp not elevated cardiac: rr, normal s1, s2. rate 90s. no m/r/g. no thrills, lifts. no s3 or s4. lungs: respirations unlabored, no accessory muscle use. lung fields clear anteriorly and laterally; limited posterior lung exam while lying supine post-procedure; no crackles, wheezes or rhonchi. abdomen: soft, nontender, nondistended. extremities: trace lower extremity edema, but has significant sacral edema. right groin site clean, dry, no hematomas or ecchymosis. skin: lower extremities w blanching erythema; nonblanchable sacral erythema pertinent results: admission labs (): 134 97 26 ------------- 71 4.6 31 1.1 ck: 21 mb: notdone trop-t: 0.01 . tsh:2.0 . ......8.8 13.6 ----- 336 .....27.7 n:87.8 l:8.3 m:3.5 e:0.3 bas:0.1 . lactate:1.2 serial echos x 7 echo pericardium: large pericardial effusion. effusion circumferential. stranding is visualized within the pericardial space c/w organization. rv diastolic collapse, c/w impaired fillling/tamponade physiology. conclusions: the estimated right atrial pressure is 10-15mmhg. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50%). the right ventricular cavity is small with borderline normal free wall function. there is a large pericardial effusion. the effusion appears circumferential. stranding is visualized within the pericardial space c/w organization. there is right ventricular diastolic collapse, consistent with impaired fillling/tamponade physiology. compared with the findings of the prior study (images reviewed) of , the size of the pericardial effusion is markedly increased. echocardiographic evidence of cardiac tamponade is now present. . echo overall left ventricular systolic function is normal (lvef>55%). rv with normal free wall contractility. there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , the effusion appears slightly smaller. brief hospital course: 61yof with h/o crohn's disease, recent dvt on lovenox, bilateral pleural effusions, large pericardial effusion seen on echo with echo evidence of tamponade physiology; also with leukocytosis, low grade fever, paroxysms of afib seen on telemetry on presentation. . # pericardial effusion: the patient had a recent chest ct and previous echocardiograms showing evidence of a pericardial effusion. however, the effusion appeared larger on initial bedside tte in the ed (moderate to large in size). clinically the patient appeared well with stable bp's and pulses with pulsus paradoxus . however, given echocardiographic findings suggestive of early tamponade phsyiology, pt underwent placement of a pericardial drain. the patient was transferred to the ccu post-procedure for monitoring with continued significant drainage initially which tapered off. after the drain was pulled, she had two serial ttes which did not show reaccumulation of pericardial fluid. the pericardial fluid showed wbc 111 (polys 60, lymphs 30, monos 10), hct 12 with negative cytology and negative cultures to date (acid fast smear negative but acid fast and fungal cultures still pending). rheumatology was consulted for a high titer (1:1280), positive dsdna. given tha positive anti-histone antibody, the most likely cause of the pericardial effusion is believed to be drug-induced sle, likely secondary to infliximab. the patient's gi specialist, dr. , was notified that the patient should have her infliximab discontinued indefinitely. her pulsus paradoxus was 6 for two days following transfer from the ccu to the floor. the patient had a tte on ~1 week following her pericardial drain, which showed continued resolution of the pericardial effusion. she will need another tte around to follow up and ensure the continued resolution of the pericardial effusion, and was notified of this prior to discharge. . # deep venous thrombosis: on a past admission, pt was found to have r lower superficial femoral vein and popliteal vein dvt in with plan for 6 month anticoagulation. initially started on coumadin but quickly switched to enoxaparin because inr was consistently very supratherapeutic secondary to poor nutritional status. most recently on 40mg enoxaparin , which was switched to heparin gtt in anticipation of procedure on admission. this was briefly held in the setting of bloody pericardial effusion in the ccu, but was re-started on the floor after resolution of pericardial drainage. le us showed near-resolution of dvt. . # atrial fibrillation: patient with h/o afib was intermittently in afib throughout her hospital stay. she was given iv metoprolol, as well as adenosine in the ccu with conversion back to nsr. the patient was briefly on admiodarone for anti-arrhythmic effects, but this was discontinued following pericardial drain when the patient converted back to nsr. the patient was also briefly on phenylephrine for maps in 40s, sbp in 70 in the ccu, not responsive to fluids, and was also transfused 1 unit prbc for hct 21. the patient was anticoagulated as above with heparin and then lovenox. . # crohns disease: patient with chronic diarrhea crohn's disease, guaiac negative. during these most recent admissions she had a colonoscopy which was grossly normal up to the ileo-colonic anastamosis, biopsies also normal at that time, and then had a follow up mr enterography showing wall thickening and hyperemia in the cecum and neoterminal ileum, consistent with crohn's disease, which was new from previous study. no evidence of fistula or abscess formation. she is currently being managed with daily mesalamine and remicade iv q 8wks. colonoscopy last done in did not show evidence of infection or crohn's flare. abdominal us during this hospitalization showed only trace ascites, large b/l pleural effusions, and b/l urolithiasis and renal cysts. gi was consulted and recommended holding mesalamine. additionally, the patient had been started on chronic tpn via r picc about 1 month ago for poor nutritional status, but tpn was held initially in the setting of pleural effusions and ?pericardial effusion from fluid overload. the patient was re-initiated on tpn slowly on the floor and was cautiously advanced to optimal rate. she should be diuresed with spironolactone as needed if she becomes volume overloaded on tpn. patient was also continued on mesalamine, b12, vitd, iron, ca carbonate . # lower extremity edema/pleural effusions/volume status: patient with a history of lower extremity edema for several years presented with significant sacral edema, likely poor nutritional status and low oncotic pressure low albumin. possibly worsened by acute rv backup secondary to impaired rv filling in setting of pericardial effusion and tamponade. however, patient continued to have le edema following drainage of pericardial effusion. she was also noted on cxr and echocardiograms to have b/l pleural effusions which persisted throughout her hospital stay, and likely also poor nutritional status. her oxygen and respiratory status were carefully monitored throughout her hospitalization, with a plan to diurese with spironolactone as needed for hypoxia or dyspnea, but the patient did not require diuresis. . # leukocytosis: patient with leukocytosis on presentation and was given a dose of azithromycin/ceftriaxone/vancomycin. pt had positive ua, but culture shows <10k organisms, and patient was briefly started on treatment with cipro/flagyl which were subsequently discontinued. cxr was negative for infiltrate. pt was ruled out for influenza. blood cultures were negative. patient remained afebrile during hospitalization, leukocytosis resolved, and recent ct abd is without evidence of colitis. . # acute renal insufficiency: cr elevated and stable at 1.1 from baseline of 0.7. improved with fluids back to baseline. . # hypothyroidism: recently diagnosed; pt was continued on levothyroxine. . # hx gout/pseudogout: continued allopurinol at renal dose, continued colchicine. . # depression: not currently on medication. was seen by social work in-house. medications on admission: budesonide 3 mg capsule sustained-release daily, cyanocobalamin 1000 mcg monthly injection indomethacin 50 mg twice a day infliximab 500 mg infusion every 8 weeks mesalamine 400 mg four tablets per mouth 3 times a day, triamterene/hydrochlorothiazide 50 mg/25 mg one capsule daily calcium carbonate 300 mg tablet daily ergocalciferol 400-unit tablet twice a day ferrous sulfate 325 mg tablet once a day magnesium oxide 400 mg tablet once a day multivitamin. levothyroxine 50mcg qd venlafaxine 37.5mg tablet qd discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 2. colchicine 0.6 mg tablet sig: one (1) tablet po daily (daily). 3. allopurinol 100 mg tablet sig: 1.5 tablets po daily (daily). 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever. 7. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po three times a day. 8. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 9. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po 1x/week (we). 10. enoxaparin 100 mg/ml syringe sig: ninety (90) mg subcutaneous daily (daily). 11. cyanocobalamin 1,000 mcg/ml solution sig: one (1) injection injection once a month. 12. tpn volume(ml/d) 1400 amino acid(g/d) 70 dextrose(g/d) 315 fat(g/d) 35 trace elements will be added daily standard adult multivitamins nacl 30 naac 0 napo4 40 kcl 10 kac 30 kpo4 0 mgs04 15 cagluc 9 cycle over 12 (hrs.) start at 1800 decrease rate to 0 (ml/h) at 600 stop 600 13. mesalamine 400 mg tablet, delayed release (e.c.) sig: three (3) tablet, delayed release (e.c.) po three times a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: pericardial effusion secondary to infliximab-induced systemic lupus erythematous secondary diagnosis: nutrition deficiency chronic diastolic heart failure discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - requires assistance or aid ( or cane) discharge instructions: you presented to the hospital with chest discomfort and you were found to have a fluid collection around your heart. this was drained and echocardiograms showed resolution of the fluid after drainage without reaccumulation subsequently. your blood tests indicate the fluid was secondary to a condition triggered by your infliximab treatments. your gastroenterologist was notified of this, and you should not be treated with infliximab in the future. while in the hospital, your tpn was held initially for a concern for fluid overload. however, once it was determined that the fluid around your heart was due to infliximab, you were re-started on tpn slowly with close monitoring. you tolerated the tpn well. the following changes were made to your medications: - furosemide was discontinued - heparin drip was discontinued - remicade (infliximab) was discontinued; you should not take this medication in the future as this caused fluid to accumulate around your heart - enoxaparin was changed to an equivalent once-a-day dose - lovenox was started to thin your blood - metoprolol was started for your heart followup instructions: please call to schedule an appointment for a tte (trans-thoracic echocardiogram) in 1 month (around ) to ensure the fluid around your heart has not reaccumulated. you have the following appointments scheduled: provider: , md phone: date/time: 9:00am provider: , md phone: date/time: 4:15pm provider: , md phone: date/time: 8:30 provider: , md phone: date/time: 8:20 provider: study phone: date/time: 9:00 procedure: pericardiocentesis right heart cardiac catheterization diagnoses: systemic lupus erythematosus unspecified pleural effusion congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism gout, unspecified atrial fibrillation depressive disorder, not elsewhere classified regional enteritis of unspecified site osteoporosis, unspecified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits chronic diastolic heart failure other drugs and medicinal substances causing adverse effects in therapeutic use other acute pericarditis other nutritional deficiency 

Answer: The patient is high likely exposed to