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: shortness of breath major surgical or invasive procedure: pericardiocentesis, with placement of pericardial drain history of present illness: this is a 62 year old female with history of resected pancreatic cancer stage iib on current gemcitabine rx who presents to ccu s/p pericardial drain. . she intially presented to with shortness of breath and dyspnea on exertion over the last week. she complained of sharp cp in the side of the chest wall bilaterally. moderate severity, not alleviated by sitting forward, not radiating. she also complained of puffy eyes and le edema. her sister had a uri recently. she has a history of pulmonary tuberculosis (with pleural effusion) in her 40s. she has been on several diuretics for the edema. the patient also notes cough productive of clear sputum which began in the past few months after the initiation of lisinopril. she denies purulent sputum, fevers/chills. . at , cxr showed cardiomegaly and a subsequent us showed a pericardial effusion. she was transferred to for further evauation. . in the ed her initial vital signs were: 97.3 83 181/87 20 96%ra. cxr showed cardiomegaly and ecg showed nsr. cardiology was called and they confirmed the effusion on bedside echo. a pulsus was intially 12, as evaluated by the fellow. on report her pulsus decreased to after several hrs but there were no interventions in the ed. her vital signs prior to transfer were 98 165/65 83 20 96ra. . the patient underwent pericardial drain placement with drainage of 450 cc of blood-tinged serous fluid. right heart cath showed ra 20/18/13, rv , pa 54/23/40, pcw 32/34/50. . the patient was transferred to the ccu, where her initial vital signs were hr 85, bp 162/74, rr 16, sat 93%/4l nc. on arrival, the patient was complaining of bilateral chest/shoulder pain with inspiration. she denied dyspnea or lightheadedness. . ros: she denied any fever, chills, headache, dizziness, lightheadedness, abdominal pain, vomiting, diarrhea, weakness, tingling, numbness, difficulty speaking/swallowing, or bowel/bladder incontinence. past medical history: past medical history: pancreatic cancer s/p whipple in 09 htn history of tuberculosis treated 40 years ago with inh and pyrazinamide r eyelid basal cell skin cancer (r) carpal tunnel syndrome s/p hysterectomy for symptomatic fibroids (menorrhagia and anemia) in carpal tunnel release basal cell skin cancer excision from (r) eyelid . oncologic history: in , the patient was noted to have biliary obstruction secondary to pancreatic cancer. she underwent whipple procedure and open cholecystectomy. one of eight lymph nodes were involved, margins were positive, and lymphovascular invasion was indeterminate with positive perineural invasion seen. she was diagnosed with t3n1a stage iib pancreatic cancer with positive margins. she is status post cyberknife boost on followed by radiation with concurrent capecitabine. currently, she is undergoing gemcitabine rx, that has been complicated by neutropenia, requiring dose reduction. she completed her course (c6d8) on 02/. social history: former rn, lives at home with husband, has two children (son and daughter) - both are healthy; denies tobacco currently, quit >40yrs ago, previously smoked approx. 6 cigarettes per day for 3yrs, ocassional etoh with dinner, no ivdu. family history: mom - ovarian ca, cml; older brother - prostate ca, grandmother on father's side - colon ca, grandfather on mom's side - hogkin's lymphoma; denies any breast or pancreatic cancer in family. physical exam: exam on admission to ccu: vs: hr 85, bp 162/74, rr 16, sat 93%/4l nc, pulsus 10 (sbp 190->180) gen: complaining of chest pain. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. no xanthalesma. neck: supple. cannot assess jvd with patient lying flat post-cath. cv: rrr. loud s1, s2. no m/g/r. chest: normal respiratory effort. cta anteriorly. abd: soft, ntnd. ext: no femoral bruits. clean dressing in place over right cath site. bilateral pitting le edema. skin: no stasis dermatitis, ulcers, or xanthomas. neuro: a+ox3. moving all extremities. . pulses: right: radial 2+ dp 2+ pt 2+ left: radial 2+ dp 2+ pt 2+ pertinent results: 11:35pm wbc-5.5 rbc-2.45* hgb-7.7* hct-21.5* mcv-88 mch-31.5 mchc-35.9* rdw-18.8* 11:35pm neuts-74.8* lymphs-12.4* monos-10.6 eos-1.9 basos-0.3 11:35pm plt count-138* 11:35pm glucose-92 urea n-47* creat-2.2* sodium-137 potassium-4.3 chloride-108 total co2-19* anion gap-14 02:46am pt-13.0 ptt-25.1 inr(pt)-1.1 06:19am blood qg6pd-10.7 09:10am blood esr-89* 04:35pm blood cd55-done cd59-done 06:19am blood -negative ret aut-6.8* 09:10am blood ret aut-6.7* 09:10am blood caltibc-208* hapto-<5* ferritn-> trf-160* 06:19am blood hapto-33 02:45am blood hapto-<5* 06:40pm blood hapto-<5* 06:15am blood hapto-<5* 06:10am blood hapto-13* 06:00am blood hapto-44 06:30am blood hapto-48 09:10am blood tsh-2.6 09:10am blood free t4-1.4 06:19am blood anca-negative b 06:19am blood dsdna-negative 09:10am blood -negative 06:19am blood c3-142 c4-30 pericardial fluid: 03:00pm other body fluid wbc-500* rbc-* polys-1* lymphs-3* monos-0 mesothe-11* macro-52* other-33* 03:00pm other body fluid wbc-500* rbc-* polys-1* lymphs-3* monos-0 mesothe-11* macro-52* other-33* 03:00pm other body fluid totprot-3.5 glucose-107 ld(ldh)-120 albumin-2.4 05:33pm other body fluid tuberculosis-pcr-pnd 05:33pm other body fluid tuberculosis-pcr-pnd 01:27pm other body fluid adenosine deaminase, fluid-test cytology negative for malignant cells tte impression: moderate circumferential pericardial effusion with echocardiographic evidence of increased pericardial pressure/early tamponade physiology. if clinically indicated, follow-up studies are suggested. ct torso impression: 1. slight decrease in pericardial effusion post-placement of a pericardial catheter. 2. increase in right greater than left pleural effusions with compressive atelectasis. 3. peri-bronchovascular ground-glass opacity may represent pulmonary edema. 4. at least one subcentimeter nodular opacity which was not previously identified; recommend continued ct followup to exclude recurrence, and if possible iv contrast. tte the left atrium is mildly dilated. the right atrium is moderately dilated. the estimated right atrial pressure is 0-10mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is mild pulmonary artery systolic hypertension. there is a very small pericardial effusion anterior to the right atrium. pathology from renal biopsy pending at the time of discharge brief hospital course: #. pericardial effusion: pt admitted to micu and pericardial drain placed. pericardial fluid with wbc 500 (diff polys 1, lymphs 3, mesothel 11, macro 52, other 33), rbc . total protein 3.5, glucose 107, ldh 120, albumin 2.4. gram stain negative. cultures ngtd. viral titers were not c/w acute infection. , c3, c4wnl, tsh normal and wnl. pt had repeat tte after pericardial effusion removed (see above). etiology of pericardial effusion was ultimately idiopathic. . #. renal insufficiency: thought to most likely represent gemcitabine induced hus. anca, , dsdna, c3, c4, antihistone ab, spep, upep all within normal limits. pt had renal biopsy which showed tma (by prelim path) which would be c/w hus. -final pathology pending at the time of discharge . #. hemolysis: treated supportively. pt required 3 transfuions over the course of her admission. g6pd and flow cytometry for pnh both wnl. prep negative. dat neg x2. haptoglobin trended up throughout admission. . # b/l le edema: lower extremity u/s negative for dvt. pt treated c teds, elevation of le and lasix 40 mg daily. she will follow up closely with nephrology in 1 week. , #. htn: thought secondary to new renal failure. pt was continued on amlodipine and hctz-lisinopril switched to labetolol given . . #. pancreatic cancer: stage iib s/p whipple, radiation, capecitabine and recent gemcitabine course. pt to f/u c outpt providers after discharge. . # pulmonary nodule: new, recommend re-imaging with iv contrast once renal function improves. pt will require repeat ct chest . #. communication: hcp is husband ( (cell) medications on admission: amlodipine - 10 mg tablet - 1 tablet(s) by mouth daily lipase-protease-amylase - 120,000 unit-,000 unit-,000 unit capsule, delayed release (e.c.) - 1 capsule(s) by mouth four times a day lisinopril-hydrochlorothiazide - 10 mg-12.5 mg tablet - 1 tablet(s) by mouth daily pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth two times a day paroxetine hcl - 10 mg tablet - 1 tablet(s) by mouth daily calcium citrate-vitamin d3 - 315mg-200 unit tablet - 2 tablet(s) by mouth daily cholecalciferol (vitamin d3) - 400 unit tablet - 1 tablet(s) by mouth daily multivitamin,tx-minerals - capsule - 1 capsule(s) by mouth daily omega-3 fatty acids - 1,200 mg-144 mg capsule - 1 capsule(s) by mouth daily discharge medications: 1. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 2. creon 24,000-76,000 -120,000 unit capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po four times a day. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 4. paxil 10 mg tablet sig: one (1) tablet po once a day. 5. calcitrate-vitamin d 315-200 mg-unit tablet sig: two (2) tablet po once a day. 6. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 7. multivitamin,tx-minerals capsule sig: one (1) capsule po once a day. 8. omega-3 fatty acids capsule sig: one (1) capsule po daily (daily). 9. labetalol 200 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 10. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. outpatient lab work cbc, bun/cr, pt/ptt/inr, haptoglobin, total bilirubin, ldh, d-dimer, fibrinogen to be done at pcp . results to be faxed to attn: fax 12. furosemide 20 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*0* 13. zofran odt 8 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po every eight (8) hours as needed for nausea. discharge disposition: home discharge diagnosis: primary: gemcitabine induced hemolytic uremic syndrome, pericardial effusion secondary: pancreatic cancer discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: you were transferred to because of fluid around your heart. we also noticed that you were having hemolysis (red blood cells were bursting) and an injury to your kidneys that was new. we did lots of blood tests and biopsied your kidney and took out the fluid from around your heart. with all of the information that we have we think you probably had a rare side effect of gemcitabine called gemcitabine-induced hemolytic uremic syndrome which causes hemolysis and kidney injury. this does not usually cause the fluid around your heart but there have been other rare reports of getting fluid around the heart with syndrome in the medical literature. it is also possible that the fluid around your heart was unrelated and was caused by a virus or by tuberculosis (the tuberculosis test is still pending). the good news is that there were not any cancer cells in the fluid around your heart. when you go home, please continue all of your regular medicines with the following changes: 1. stop hydrochlorothiazide-lisinopril 2. start labetolol 3. lasix 40 mg daily 4. folic acid 1 mg daily you can discuss with dr and dr whether you need additional chemotherapy when you see them next week. you will not be able to get gemcitabine in the future. followup instructions: appointment #1 md: dr. specialty: internal medicine-primary care date/ time: 9:45am location: , ma phone number: special instructions for patient: please have cbc, hemolysis labs, and bun/cr drawn at this office visit and have results faxed to attn: fax . this is the hematology/oncology fellow. appointment #2 md: dr. specialty: hematology date/ time: 3:00pm location: building , ma phone number: appointment #3: provider: , md phone: date/time: 11:30 provider: , md phone: date/time: 1:00 appointment #4: nephrology (kidney doctor) physician: . date: wednesday time: 10:00 am address: .; , phone: patient instructions: clinic will call you if they have a cancellation and can see you earlier. *** if you do not hear from their office by wednesday, , please arrange to be seen at the next week to ensure your kidneys are doing ok. it is very important you are seen by a nephrologist next week. if you need to be seen at , the # to call is ( and you should be seen by dr (attending) and dr (fellow). if they don't have an appointment, you can be seen by dr. in the same office. if you cannot get an appointment, please ask them to get in touch with (who saw you while you were here) and who will help arrange for you to be seen. after you are seen by the kidney doctors , sooner, (they are recommended by your pcp) you should continue to follow up at that office. **you previously had a cat scan scheduled for . please talk to dr or dr at before going to this appointment as they may not want to do it anymore given your kidney function. procedure: combined right and left heart cardiac catheterization pericardiocentesis closed [percutaneous] [needle] biopsy of kidney transfusion of packed cells diagnoses: unspecified essential hypertension acute kidney failure, unspecified unspecified disease of pericardium antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use other specified peripheral vascular diseases anemia in neoplastic disease cardiac tamponade malignant neoplasm of pancreas, part unspecified acute pericarditis in diseases classified elsewhere hemolytic-uremic syndrome 

Answer: The patient is high likely exposed to