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: sob doe major surgical or invasive procedure: pericardial tap and window placement vats procedure pleural fluid tap pleurex catheter placement history of present illness: mr. is a 53 y/o m with stage four metastatic renal cell carcinoma (since ) with multiple mets to lymph nodes and to bone. the patient presented with five days of worsening dyspnea to the ed. he states that he was not able to lie flat while sleeping because of the shortness of breath and this morning found himself needing to tripod himself to catch his breath. patient reported cough associated with his dyspnea. he states that he has had fatigue for several months and it was thought that his baseline dyspnea was related to his malignancy. . when patient presented for evaluation he had an ecg that was concerning for ischemia. on presentation, the patient's vs were 98.4, 118/78, 115, 22, 100 ra. the patient had a cta to r/o pe, but was found to have a large pericardial effusion, a concerning etiology to the patient's shortness of breath. the patient had an echocardiogram that showed a large circumferential effusion concerning for tamponade physiology. the patient had a positive pulsus of 20 in the ed and was found to have elevated jvp. . the patient was taken to the cath lab where he underwent a pericardiocentesis, draining approx 1l of bloody fluid. patient's cardiac catheterization demonstrated near equalization of pressures. the patient was transferred from the cath lab to the ccu for further monitoring with a drain in place. . on arrival to the ccu, patient's vital signs are stable, however remains in sinus tachycardia (100s). he denies any nausea, vomiting, diarrhea, chest discomfort (other than at drain site). he reports that his dyspnea is improved. . . past medical history: 1. metastatic rcc 2. s/p bilateral knee scopes 3. s/p vasectomy social history: the patient grew up in . he lives in . he works commercial real estate. he is married and has three daughters. has a 20-pack-year history of tobacco use but quit >19 years ago. he has occasional alcohol use and drinks one to two glasses of wine a few times a week. he denies any illicit drug use. family history: he has two brothers and one sister, all of whom are well. his father is deceased from melanoma. his paternal grandfather died from emphysema. his paternal grandmother died from mi. his mother is alive. his maternal grandfather died at the age of 96. his maternal grandmother died from . he has three daughters, all of whom are well. physical exam: at admission general: oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 8cm cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. +friction rub. no s3 or s4. lungs: diffuse fine crackles on left lung fields (anterolaterally). unable to auscultate bases given venous sheath. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial bruits. extremities: bilateral, asymmetrical lower extremity pitting edema (tr-1+). l > r. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ pertinent results: 09:00pm other body fluid tot prot-4.6 glucose-42 ld(ldh)- amylase-57 albumin-2.6 09:00pm other body fluid wbc-2444* hct-12* polys-67* lymphs-20* monos-0 eos-1* mesotheli-6* macrophag-6* 12:10pm glucose-130* urea n-25* creat-1.2 sodium-136 potassium-4.8 chloride-101 total co2-21* anion gap-19 12:10pm ck(cpk)-84 12:10pm estgfr-using this 12:10pm ctropnt-<0.01 12:10pm ck-mb-notdone 12:10pm wbc-16.5* rbc-4.64 hgb-10.7* hct-33.9* mcv-73* mch-23.0* mchc-31.5 rdw-19.6* 12:10pm neuts-85.3* lymphs-9.1* monos-4.7 eos-0.7 basos-0.2 12:10pm plt count-494* 12:10pm pt-14.0* ptt-33.1 inr(pt)-1.2* cytology - pending brief hospital course: # bilateral pleural effusion/respiratory distress ?????? exudative in origin on thoracentesis, drainage of r. lung was performed via thoracentesis, with large improvement in symptoms, although continued to have severe drops in ambulatory o2. interventional thoracics plans to place pleurex catheter. cytology is still pending at the time of discharge. for symptomatic relief he was placed on benzonatate, guaifenesin-dextromethorphan, ipratropium bromide neb prn for supportive care. . # cardiac tamponade: presumed to be malignancy. s/p vats with pericardial window, unfortunately repeat echo shows persistent, organized pericardial effusion. respiratory distress improved symptomatically with pericardial drain, and effusion. cytology is still pending on the pericardial fluid that was drained. thoracics was consulted and will consider pericardial stripping in the future. . # leukocytosis: remained stable throughout admission from 13-16. most likely etiology is rcc. there were never clear signs of infection. he persisted to be afebrile for 72 hours. he was empirically treated with levo, given multiple intraparenchymal nodules and productive cough. mr has been very cooperative with incentive spirometry. - incentive spirometer - monitor cxr . . # pain control: was acheived post procedure with roxanol. he no longer requires this medication. - . # coronaries: patient with no known h/o cad, however patient with mild regional left ventricular systolic dysfunction with mild basal to mid inferior wall hypokinesis and mid inferolateral wall hypokinesis on echo. patient has not had cardiac cath given other co-morbidities and lack of symptoms. not active currently. . # pump: patient with lymphangitic involvement of lungs. ct scan near admission showed pulmonary edema and pulmonary effusion r>l. patient had pcwp of 19, rvedp 22, pa pressures 41/17, mean ra pressures of 8 on first echo. has tumor burden impacting pulmonary artery. currently appears euvolemic. patient will behave like he has a pe, hemodynamically. removeal of his tamponade physiology obviously improved his pump function. . # rhythm: in and out sinus tachycardia/atrial bigeminy. unclear etiology or chronicity. likely cont pericardial effusion. last tsh in wnl, had history of elevated tsh over year ago, unclear if related to chemotherapy. he was in sinus tach at the time of d/c. - tsh ?????? 6.5 currently . # asymmetrical ble edema: patient with a history of asymmetrical le edema l > r; has been documented in past. no tenderness to palpation or acute concern for underlying dvt, though patient at higher risk given malignancy. this is secondary to compression from massive lymphadenopathy. . # metastatic renal cell carcinoma: patient with shoulder and l iliac mets, s/p xrt to hip and rfa to shoulder. patient was on a new experimental chemotherapeutic , mdx-1106, which has unclear benefits in patient's condition. patient is s/p multiple rounds of different agents, and it is unclear if any can have pericardial effusion as secondary effect. inr rising, could be poor diet. plan to discuss sutent with heme/onc on d/c. medications on admission: mdx-1106 infusion (per oncology) - last dose 10/20 discharge medications: 1. phytonadione 5 mg tablet sig: one (1) tablet po daily (daily) for 1 days. disp:*1 tablet(s)* refills:*0* 2. benzonatate 100 mg capsule sig: capsules po tid (3 times a day) as needed for cough. disp:*60 capsule(s)* refills:*0* 3. multiple vitamin tablet sig: one (1) tablet po once a day. 4. lorazepam 0.5 mg tablet sig: 1-2 tablets po four times a day as needed for anxiety. 5. acetaminophen extra strength 500 mg tablet sig: 1-2 tablets po four times a day as needed for pain. discharge disposition: home with service facility: discharge diagnosis: pericardial and pleural effusions metastatic renal cell carcinoma discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: you had a collection of fluid around your heart that was tapped and a window was placed that will continuously drain any other fluid that accumulates from now on. an echo done on showed some reaccumulation of the fluid around your heart, possibly some blood and clots. you also had some fluid collections in your lungs that were drained on and __ permanant tubes were placed for continued drainage. you also will be seen next week in oncology for further treatment of your cancer. . medication changes: 1. benzonatate: to take for your cough 2. lorazepam: to take for anxiety or sleep 3. vitamin k: to take for one more day to help your blood to clot. followup instructions: primary care: , k. phone: date/time: . oncology: date/time: tuesday office will call you with a time. provider: , : date/time: 1:30 provider: , rn phone: date/time: 1:30 provider: , md phone: date/time: 1:30 procedure: pericardiocentesis thoracentesis thoracentesis transpleural thoracoscopy pericardiotomy right heart cardiac catheterization diagnoses: pulmonary collapse other and unspecified hyperlipidemia other specified cardiac dysrhythmias hypotension, unspecified hypoxemia hypovolemia personal history of malignant neoplasm of kidney secondary malignant neoplasm of bone and bone marrow leukocytosis, unspecified acute edema of lung, unspecified acute pericarditis, unspecified cardiac tamponade secondary and unspecified malignant neoplasm of lymph nodes of multiple sites malignant pleural effusion 

Answer: The patient is high likely exposed to