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: morphine / penicillins / chocolate flavor / erythromycin base / tape / monosodium glutamate / mold extracts / oxycodone / iv dye, iodine containing contrast media / iodine attending: chief complaint: dyspnea major surgical or invasive procedure: pericardial history of present illness: ms. is a 57-year-old woman with renal cell carcinoma metastatic to her lungs with a recent progression of disease in the area of her right mainstem bronchus status post mechanical debridement of the endobronchial exophytic lesion by dr. who is transferred to from er with shortness of breath. she has a history of recurrent pleural effusions and has baseline doe. however, this week, she felt dyspnea at rest, whereas she can normally walk 10 feet before becoming short of breath. she has a mild cough but no significant sputum production. she also has some chest pressure with dyspnea that may be associated with nausea, diaphoresis but does not radiate. at , cxr showed right-sided volume loss, likely secondary to post-obstructive atelectasis from tumor, and bedside echo showed a "moderate pericardial effusion" without evidence of tamponade. she was transferred here for further management. also of note, she had a foley placed on and has had recurrent utis, for which she has been on 3 courses of bactrim (to which she developed an allergy), and son she was started on cipro. she states that since starting cipro, she has felt cramping and increased frequency. review of systems: ms. appetite has been poor. she reports significant weight loss over the past six months. she gets intermittent migraines accompanied by visual changes (white and dark spots). she denies fever, chills, hearing changes, palpitations, dysuria, rashes, focal weakness, numbness, dizziness or fainting, easy bruising or bleeding. review of systems is otherwise negative. past medical history: oncologic history: - ct scan showed large left renal mass. mri/mrv demonstrated a large 7.5 cm left lower pole mass, with no filling defect of the left renal vein. bone scan negative for osseous metastases. - : left nephrectomy/adrenalectomy. pathology: 5.5 cm mass, extending locally beyond the capsule, grade ii to iii, not extending beyond gerota's fascia. venous invasion was present; the renal vein margin was negative. there were negative margins and negative adrenal glands. (pt3a nx mx) - : a ct scan demonstrated multiple bilateral pulmonary nodules, the largest 7 mm in diameter. - pet scan: multiple pulmonary nodules and posterior cervical lymphadenopathy. - : video-assisted thoracoscopic right lower lobe and right middle lobe wedge resections and mediastinal lymph node dissection. pathology confirmed the presence of metastatic carcinoma of renal origin in the two wedge resections and in the level 8r paraesophageal lymph node. - : cycle 1, weeks of high-dose il-2 ( and doses received). - ct scan: increase in the size of a right infra-hilar lymph node. decrease in size of numerous small pulmonary nodules. - ct scan: right hilar lymph node slightly increased in size. stable tiny pulmonary nodules as well as nodular scarring in the right lower lobe. - ct torso showed slight increase in dominant right infrahilar mass when measured in the axial plane compared to the prior two exams. - : flexible bronchoscopy revealed extrinsic compression, with near complete occlusion of the anterior segment of the right lower lobe bronchus and mucoid secretions emanating from the superior segment of the right lower lobe. transbronchial needle aspiration was performed x3 with pathology revealing atypical clusters of epithelioid cells suspicious for metastatic renal cell carcinoma. in addition, bronchial washings and brushings were obtained, revealing atypical cells in scattered clusters. - : flexible bronchoscopy and video-assisted thoracic surgery with right lower lobe wedge resection and intralobar pulmonary artery lymph node excision. pathology revealed lymph node fragments with metastatic carcinoma consistent with renal cell carcinoma. the excised fragment of the right lower lobe demonstrated no evidence of malignancy. - : cycle 2, weeks high-dose il-2 ( and doses received) - - : multiple ct torso showing gradual growth of right hilar lymphadenopathy. - : began therapy with mdx 1411 on phase i protocol 08-209 - : began palliative sunitinib after scans showed disease progression with mdx 1411; needed to terminate first cycle one week early due to severe thrombocytopenia (platelets 27k). began cycle 2 on at reduced dose of 37.5 mg daily. began cycle 3 on at 25 mg daily. - : switched to pazopanib because of progressive difficulties tolerating sunitinib (and progressing disease on lower doses of sunitinib); dose reduced to 600 mg daily due to side effect. on pazopanib dose was increased to 800 mg daily considering worsening clinical symptoms. - ct torso shows overall improvement of pulmonary nodules and hilar lymphadenopathy - ct torso shows disease progression - bronchoscopy showed tumor infiltration of the endobronchial mucosa throughout the right main stem and bronchus intermedius. endobronchial exophytic lesion partially obstructing the opening of the right main stem, which was mechanically debrided. - external beam radiation to the lesion in the r hilum. additional palliative xrt - everolimus - - avastin, d/c due to worsening symptoms - ct torso shows disease progression - start gemcitabine 750 mg/m2 d1 and d8 q21d, start sutent 25 mg 2 weeks on 1 week off - - progression of pulmonary disease on gemcitabine/sutent, but patient experiencing symptomatic improvement. - - c4d1 gemzar/sutent - - c4d15 gemzar/sutent - - rigid bronchoscopy and tumor debridement - - c5d15 gemzar/sutent - - c6d1 past medical history: - osteoarthritis of her lower spine - asthma - cluster migraines social history: ms. is married and lives with her husband. she worked as a phlebotomist part time. she used to smoke one to one and a half packs per day for 25 years, but quit at the age of 38. family history: ms. family history is largely unknown as she was adopted. her son was with spina bifida and her daughter had mitral valve prolapse. physical exam: physical exam: vs: t: t 95.7 bp 102/60 hr 124 rr 23 sao2 100ra gen: nad, responds appropriately to questions card: nl s1, s2, rrr, no r/m/g/heaves resp: diminished breath sounds on the right with some rhonchi, mild dyspnea at rest, slightly increased work of breathing. lobe abd: soft, nt, nd, +bs ext: +2 pulses throughout, from, no c/c/e neuro: no focal deficits skin: no rashes psych: pleasant, cooperative, moderate insight discharge exam: vs: 95.6/98.1, 135/76, 88, 22, 100%l o2 gen: lying in hospital bed, nad heent: eomi, op moist cvs: nl s1, s2, rrr, no r/m/g/heaves pulm: diminished breath sounds on the right, otherwise clear to auscultation abd: soft, nt, nd, +bs ext: +2 pulses throughout, from, no c/c/e neuro: no focal deficits skin: no rashes psych: pleasant, cooperative pertinent results: 10:29pm glucose-129* urea n-14 creat-1.0 sodium-133 potassium-4.6 chloride-99 total co2-19* anion gap-20 10:29pm alt(sgpt)-14 ast(sgot)-22 ld(ldh)-255* alk phos-156* tot bili-0.6 10:29pm lipase-23 10:29pm albumin-3.0* calcium-8.7 phosphate-3.5 magnesium-1.8 10:29pm wbc-6.0 rbc-3.09* hgb-10.5* hct-31.5* mcv-102* mch-34.0* mchc-33.4 rdw-19.8* 10:29pm plt count-218# 10:29pm pt-15.4* ptt-27.8 inr(pt)-1.3* cxr : near complete opacification of the right lung field, no infiltrate appreciated on the left, pleural effusions r >> l. path report (pericardial fluid):pericardial fluid, cell block: rare atypical epithelioid cells; mesothelial cells, and histiocytes; see cytology report c11-33091g and see note. note: immunostains for cytokeratin cocktail, calretinin, d2-40, and wt-1 highlight mesothelial cells. immunostain for cd68 shows many histiocytes. immunostains for renal cell carcinoma antigen and pax-2 do not show any immunoreactive cells. immunostain for cd10 is non-contributory. of note is the negative stain for pax-2. this profile does not show an evidence of a renal cell carcinoma. dr. reviewed pax-2 immunostain slide and concurred. echo reports: : large pericardial effusion with echocardiographic evidence of early tamponade. :there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of earlier on , the pericardial effusion has been drained, with minimal residual effusion. :the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. right ventricular chamber size is normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. there is a trivial/physiologic pericardial effusion. there is an anterior fat pad. compared with the prior study (images reviewed) of earlier in the day on , the findings are similar. :small pericardial effusion overlying the right ventricle without evidence of tamponade physiology. compared with the prior study (images reviewed) of , the findings are similar. ct chest:1. increased large pericardial effusion; no evidence of cardiac tamponade. 2. increased small-to-moderate left pleural effusion and unchanged loculated right effusion. little appreciable change in the large right infiltrative hilar mass with bronchovascular compromise. no endobronchial lesion is identified. 3. interval increase in left upper lobe mass. brief hospital course: 57-year-old woman with renal cell carcinoma, metastatic to her lungs with a recent progression of disease in the area of her right mainstem bronchus status post mechanical debridement of the endobronchial exophytic lesion by dr. who is transferred to from with shortness of breath found to have early cardiac tamponade on echo. active issues: # pericardial effusion: pt found on ct chest to have pericardial effusion. tte showed evidence of tamponade physiology. she was brought to the cardiac cath lab, where a pericardiocentesis was done. she was then transferred to the ccu. a pericardial was left in place for 2 days. repeat tte showed resolution of effusion, and the was pulled after 2 days (on ). troponins were negative x 2. effusion fluid was sent for culture and cytology; cultures were negative and cytology did not show renal cell carcinoma. echo on did not show reaccumulation of fluid and she was transferred back to the omed service. she remained stable. repeat echo on showed small amount of fluid but no tamponade, so echo was again repeated on and findings were stable. she was weaned down to 1l o2 nc at the time of discharge. # metastatic renal cell carcinoma: pt has metastatic lesions to her lungs with involvement near right mainstem bronchus. she was s/p debridement of endobronchial exophytic lesion at the time of admission. she is currently undergoing chemotherapy (cycle 6 gemzar/sutent started ), which she began taking again on after having medications held upon admission due to her worsening shortness of breath. pt was tolerating sutent well at the time of discharge and felt her breathing had improved. she was maintained on albuterol and ipratropium nebs as needed for shortness of breath during her hospitalization. she will continue sutent in the rehab facility with follow up per her primary oncologist. # uti: pt is s/p nephrectomy with recurrent utis. upon admission she complained of dysuria and frequency and u/a showed large wbc, no nitrites. she reports having recently had a foley in at osh. she was treated empirically for uti with cipro for 5 days. urine cultures came back negative. inactive issues: # hypothyroidism: continued synthroid. # migraine: pt has h/o migraine but this was not an active issue. she was continued on relpax prn, and tylenol. topiramate was on hold at the time of admission so continued to hold this. transitional issues: 1. wean o2 as tolerated 2. follow up with primary oncologist re: chemotherapy schedule medications on admission: albuterol sulfate - 90 mcg hfa aerosol inhaler - puff inh q4-6h as needed for wheezing relpax 20mg po daily prn headache ipratropium 21mcg nasal spray daily prn allergy lidocaine swish and spit prn mucocytis eletriptan hbr - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth prn levothyroxine - 75 mcg tablet - 1 tablet(s) by mouth daily omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth twice a day take 30 minutes before eating ondansetron hcl - 4 mg tablet - 1 tablet(s) by mouth every eight (8) hours as needed for nausea topiramate - (prescribed by other provider; on hold) - 25 mg tablet - 1 tablet(s) by mouth q am medications - otc acetaminophen - (prescribed by other provider) - 500 mg tablet - tablet(s) by mouth every 4-6 hours calcium carbonate-mag hydroxid - (prescribed by other provider) - dosage uncertain discharge medications: 1. relpax 20 mg tablet sig: one (1) tablet po daily prn () as needed for ha. 2. ipratropium bromide 0.03 % spray, non-aerosol sig: one (1) spray nasal daily prn () as needed for allergy. 3. lidocaine hcl 2 % solution sig: twenty (20) ml mucous membrane (2 times a day) as needed for mouth pain: swich and spit. 4. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day): 30 min before meals. 6. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. 7. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 8. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 9. sutent 50 mg capsule sig: one (1) capsule po daily (daily). 10. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q4h (every 4 hours) as needed for wheeze/sob. discharge disposition: extended care facility: health center discharge diagnosis: primary diagnosis: pericardial effusion secondary diagnoses: metastatic renal cell carcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: thank you for letting us take part in your care at . you came to the hospital because you were having shortness of breath. you were found to have fluid around your heart (pericardial effusion), so a was placed to remove the fluid. after removal of the , ultrasound of your heart (echocardiogram) did not show reaccumulation of the fluid. you restarted your chemotherapy and should follow up with your oncologist about your chemo regimen. the following changes were made to your medications: started 1. benzonatate 100mg by mouth three times a day for cough 2. sutent 50mg by mouth daily stopped 2. topiramate followup instructions: department: primary care name: dr. when: dr. office is working on a hospital follow up appointment for 4-8 days after your hospital discharge. if you have not heard from the office in 2 business days please call the office number listed below. location: clinic/medicine address: , , phone: department: hematology/ oncology name: dr. when: dr. office is working on a hospital follow up appointment for 4-8 days after your hospital discharge. if you have not heard from the office in 2 business days please call the office number listed below. location: -division of hematology/oncology address: , 9, , phone: 3 department: hematology/oncology when: monday at 4:30 pm with: drs. / building: sc clinical ctr campus: east best parking: garage procedure: pericardiocentesis diagnoses: obstructive sleep apnea (adult)(pediatric) urinary tract infection, site not specified unspecified acquired hypothyroidism asthma, unspecified type, unspecified personal history of tobacco use pulmonary collapse long-term (current) use of other medications hypoxemia encounter for palliative care secondary malignant neoplasm of lung personal history of malignant neoplasm of kidney migraine, unspecified, without mention of intractable migraine without mention of status migrainosus personal history of irradiation, presenting hazards to health cardiac tamponade malignant pleural effusion 

Answer: The patient is high likely exposed to