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: admit to ccu s/p pericardial drain major surgical or invasive procedure: pericardial drainage and drain placement , with drain removal history of present illness: ms. is a 58 y/o f with a a remote history of breast carcinoma in situ (18 yrs ago, treated with radiation/lumpectomy) who presented to her pcp with shortness of breath, found to have a pericardial effusion. she endorses a one month prodrome of weight gain that started after a diarrhea illness. in the past couple of weeks she has notice increasing dyspnea on exertion and chest discomfort. she says that the chest discomfort is associated with palpitations. she thought she was coming down with pneumonia which she has had in the past because she has had a dry cough, chills at night, and post-nasal drip. she states that she typically exercises 45 minutes daily on a treadmill and suddenly found her self only able to last 5-10 minutes. she states that she also now struggles to climb one flight of stairs. she reported feeling presyncopal on treadmill after 15 minutes prior to admission. . patient went to see her pcp and was noted to have enlarged cardiac shadow on cxr, with concern of large pericardial effusion accounting for her symptoms. in the er, patient's initial vs were 99.4 100 112/91 24 98%ra. bedside ultrasound revealed pericardial effusion, however patient did not have pulsus on examination. . on transfer to floor, patient's vs were stable. . she had an echo this am that showed a moderate pericardial effusion but no tamponade. she had a pericardial drain placed in cath lab and 260cc of serosanguinous fluid was removed and sent for analysis. . on review of systems, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she admits to fevers, chills one month ago. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is positive for chest discomfort and dyspnea on exertion. denies paroxysmal nocturnal dyspnea, orthopnea, ankle edema, or syncope. past medical history: breast cancer(cis) 18 years ago treated with lumpectomy and radiation social history: -tobacco history: none -etoh: none -illicit drugs: none family history: father had a mi in 50s and is alive in 80s with cad. mother with cad in 80s. many uncles with . otherwise, no family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: t=99.3 bp=112/65 hr=95 rr=15 o2 sat=95%ra general: nad. 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 10 cm. cardiac: rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. pulsus 8. lungs: ctab, no crackles, wheezes or rhonchi. abdomen: soft, nd. mild ruq ttp. no hsm or tenderness. extremities: no c/c/e. no femoral bruits. 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: 11:53pm d-dimer-1580* 08:13pm urine color-yellow appear-clear sp -1.025 08:13pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-150 bilirubin-neg urobilngn-neg ph-5.0 leuk-tr 08:13pm urine rbc-0-2 wbc-* bacteria-rare yeast-none epi-0-2 08:13pm urine mucous-mod 08:12pm glucose-93 urea n-19 creat-0.6 sodium-140 potassium-3.8 chloride-105 total co2-23 anion gap-16 08:12pm ld(ldh)-327* ck(cpk)-86 08:12pm ctropnt-<0.01 08:12pm ck-mb-notdone 08:12pm tsh-1.4 08:12pm rheu fact-11 08:12pm wbc-6.4 rbc-3.76* hgb-11.1* hct-33.5* mcv-89 mch-29.5 mchc-33.1 rdw-13.2 08:12pm neuts-57.1 lymphs-35.2 monos-6.2 eos-0.8 basos-0.7 08:12pm plt count-296 02:40pm glucose-88 02:40pm urea n-20 creat-0.6 sodium-141 potassium-4.0 chloride-105 total co2-23 anion gap-17 02:40pm estgfr-using this 02:40pm alt(sgpt)-271* ast(sgot)-209* alk phos-189* tot bili-0.7 02:40pm tot prot-5.8* albumin-3.8 globulin-2.0 calcium-8.5 phosphate-2.8 magnesium-2.0 02:40pm wbc-6.2 rbc-3.62* hgb-10.8* hct-32.7* mcv-90 mch-29.8 mchc-33.1 rdw-12.8 02:40pm neuts-57.4 lymphs-32.4 monos-8.9 eos-0.9 basos-0.4 02:40pm plt count-313# 02:40pm sed rate-20 . ekg: nsr at 100bpm, na, ni, no sttw changes . 2d-echocardiogram: pre-pericardiocentesis the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the aortic valve leaflets (3) are mildly thickened. the mitral valve appears structurally normal with trivial mitral regurgitation. there is a moderate sized pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. no right atrial or right ventricular diastolic collapse is seen. post pericardiocentesis: left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is a very small residual pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. no right atrial or right ventricular diastolic collapse is seen. compared with the findings of the prior study (images reviewed) of , the pericardial effusion is much smaller; no tamponade. brief hospital course: 58 y/o f with a a remote history of breast carcinoma in siut who presented to her pcp with shortness of breath, found to have a pericardial effusion now s/p pericardial drain. . # pericardial effusion: patient found to have moderate effusion on ct and echo but no evidence of tamponade. fluid analysis consistent with exudate. given history of cancer there is concern that this could represent metastasis, ovarian cancer, vs new lymphoma given history of radiation. also possible is a viral process which she is currently endorsing. otherwise, she is uptodate on age appropriate cancer screening. . no evidence of uremia by labs. she was monitored in ccu, pulsus in am was 4mmhg, ancef was given for prophylaxis with drain in place. repeat echo in am, with no reaccumulation of fluid drain to be pulled. fluid pathology pending. tsh, rf wnl. pending at time of discharge. her drain did not drain significantly, follow-up echo revealed no reaccumulation, her drain was pulled and shw as discharged home. . # pump: despite a mildly elevated jvp ms never displayed evidence of venous congestion or tamponade physioloyg. she has no history of heart failure. aside from pericardial effusion, tte without evidence of heart failure. repeat tte showed decrease in fluid amount. . # transaminitis: if viral syndrome is cause for effusion, it may also explain transient transaminitis. lfts were trending down on the day of discharge. she has no risk factors of hepatitis. it is doubtful that this is hepatic congestion but of concern an underlying metastatic process should be ruled out. no elevated bili to suggest cholecystitis. . # small pleural effusions: deferred for pcp follow up. pt stable on room air at discharge and notified of warning signs. as with above discussion, oncologic and rheumatologic origins would be unfortunate unifying diagnoses and should be followed up. medications on admission: calcium with vitamin d discharge medications: calcium with vitamin d discharge disposition: home discharge diagnosis: pericardial effusion of unknown etiology pleural effusion of unknown etiology transaminitis of unknown etiology ?viral syndrome discharge condition: stable discharge instructions: ms : you were admitted to the hospital with shortness of breath and a ct scan was performed which found a small amount of fluid in your lungs and around the heart. while this fluid around your heart was not dangerous at the time, we were concerned it might worsen and you were taken to the catheterization lab for drainage. the fluid around your heart was drained and the fluid sent for analysis. . no changes were made to your home medications and you can feel free to continue your calcium with vitamin d. . please schedule an appointment with dr. ( to be seen this week to follow-up on your elevated liver enzymes, fluid in your lungs, and the fluid around her heart. . if you develop chest pain, shortness of breath, palpitations, cough, fever, chills, nausea/vomiting, diarrhea, abdominal pain, lightheadness or dizziness, please call your primary care doctor or go to your local emergency room. followup instructions: please schedule an appointment with dr. ( to be seen this week to follow-up on your elevated liver enzymes, fluid in your lungs, and the fluid around her heart. procedure: pericardiocentesis diagnoses: unspecified pleural effusion personal history of malignant neoplasm of breast unspecified disease of pericardium unspecified viral infection 

Answer: The patient is high likely exposed to