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: syncope major surgical or invasive procedure: pericardiocentesis and drain placement history of present illness: ms. is a 28y/o woman with a h/o untreated sle (dx ) presenting with one day of syncopal episodes on and a 6wk h/o worsening fatigue. on the morning of , she awoke to go to the bathroom, urinated, and began feeling dizzy upon rising from the toilet. she walked a few steps and then experienced a "blackout" with loss of sensation. she hit her head on the way down, but reports no pain at site of trauma. since she didn't have insurance, she arranged to see a new pcp on , who referred her to osh, where she was found to have hypotension, tachycardia, pancyptopenia w/ bandemia, cardiomyopathy, and have a pericardial effusion. she was transferred to , and a tte revealed tamponade. a pericardiocentesis was performed, and 340cc serous fluid was drained from the pericardium. . she reports joint pain with activity and had 40lb weight loss since the birth of her daughter in summer of . her symptoms worsened during the winter of , and then even more in the last 6wks. she reports trying to control her lupus with diet and holistic therapy. she also notes severe dry mouth beginning on , which she claims often portends worsening lupus symptoms. . she reports polyuria, nocturia, night sweats, anorexia, early satiety, 40lb weight loss, hair loss, joint pain, general aches, extreme fatigue, dry mouth, and vaginal dryness. unable to gain weight with effort. no menses for 1yr. reports scalp lesions and tingling with sun exposure. fh significant for father with h/o ra. reports feeling of always being cold. reports more confusion and memory difficulty in last year. reports oral ulcers approx. once per month. denied melana, diarrhea, constipation. past medical history: # lupus- diagnosed in . untreated. sought consultation b/c hairloss, fatigue, weight loss, dry mouth. attempted to control with diet and holistics. recent symptoms include flairs in shoulder joint and rash on eyelid with sun exposure. #amenorrhea - one year. not on any form of medical contraception. #lock jaw- uses guard at home social history: denies smoking, etoh, drugs. has 4 children (all full term). recently under greater stress b/c move from to ma and breakup with former boyfriend. n.b. decided not to treat lupus because her brother told her "it was all in her head" and so began holistic therapy. family from barbados and . family history: father w/ , dm, "englarged heart" physical exam: gen: young woman looking somnelent but comfortable lying in bed talking to family. vs tm 95.9 hr 100 bp 90/64, 95% ra rr 14 heent: nc,at. sclera anicteric, vfftc, perlla, eomi. clear op, mmm. neck: supple. trachea midline. thyroid not palpable. shoddy lad bilaterally in anterior cervical chain. lungs and thorax: decreased breath sounds. decreased respirations. respirations unlabored. cv: tachycardic. s3 gallop. radial, pedal pulses 1+ bilaterally. abdomen: + bowel sounds. ntnd. no bruits. no hsm appreciated. skin: cool. dry texture. no jaundice. extremities: no clubbing, cyanosis, or edema. bruising on distal fingers. swollen, warm l ankle. toes and ankles tender to touch bilaterally. neuro: mental status-a&ox3. no dysarrthria. pertinent results: 11:45pm blood wbc-1.9* rbc-2.65* hgb-7.1* hct-22.1* mcv-84 mch-26.8* mchc-32.1 rdw-16.0* plt ct-119* 11:45pm blood neuts-37* bands-0 lymphs-51* monos-11 eos-0 baso-0 atyps-1* metas-0 myelos-0 04:04am blood esr-150* gran ct-520* 04:04am blood alt-105* ast-196* ld(ldh)-422* alkphos-96 amylase-109* totbili-0.3 04:04am blood c3-23* c4-less than 04:04am blood caltibc-153* vitb12-1120* folate-15.1 hapto-30 ferritn-719* trf-118* 04:23am blood pt-12.5 ptt-86.1* inr(pt)-1.1 03:00pm blood cryoglb-positive 03:00pm blood rheufac-29* 03:00pm blood pep-polyclonal igg-2231* iga-352 igm-349* ife-no monoclo 03:00pm blood granulocyte antibodies- 03:00pm blood sm antibody-test 03:00pm blood ro & - 03:00pm blood rnp antibody-test 03:00pm blood parvovirus b19 antibodies (igg & igm)-test 03:00pm blood cyclic citrullinated peptide (ccp) antibody, igg-test 06:15am blood hypochr-1+ anisocy-1+ poiklo-2+ macrocy-normal microcy-occasional polychr-occasional ovalocy-occasional burr-occasional fragmen-occasional ellipto-1+ 05:50pm blood thrombn-60.2* 05:50pm blood aca igg-11.4 aca igm-45.4* 06:50am blood thrombn-31.7*# 06:58am blood calcium-7.6* phos-3.2 mg-1.7 09:05am blood wbc-3.6* rbc-2.93* hgb-8.0* hct-25.0* mcv-85 mch-27.3 mchc-32.0 rdw-17.4* plt ct-179 09:05am blood alt-167* ast-141* alkphos-87 totbili-0.3 brief hospital course: ms. is a 28 year old female with pmh of sle, diagnosed in but untreated, who was transferred from osh with fever, hypotension, tachycardia and pericardial effusion with evidence of early tamponade on admission echo. she presented to an osh after several syncopal episodes and was transferred to when echocardiogram suggested pericardial effusion and tamponade. at , tte confirmed early pericardail tamponade and a pericardiocentesis was performed wit drainage of 340cc of serous pericardial fluid. her pericardial effusion was exudative and was determined to be likely her sle. she was started on prednisone and hydroxychloroquine for suspected sle and autoimmune panel was ordered. her pericardial drain was removed the day after placement and she did well with no evidence of recurrance of her effusion. she was initially treated with azithromycin and cefepime however these were discontinued on transfer to the floor as infectious workup was negative and fevers and leukocytosis were more likely associated was sle flare and systemic inflammation. . 1)pericardial effusion/early tamoponade: s/p percardiocestesis with removal of 340cc yellow fluid removed, exudative on analysis. she tolerated removal of drain well with no hemodynamically consequent recurrance of her effusion. she was treated with prednisone and hydroxychloroquine and slowly improved throughout her admission. she had a repeat echo on prior to discharge which did not show any evidence of repeat effusion. she was discharged with follow up with dr. in cardiology clinic. 2)cardiomyopathy: on echocardiogram she was noted to have global lv hypokinesis and systolic dysfunction with ef of 35% most likely due to lupus cardiomyopathy. she was followed by rheumatology consultants who felt that her cardiomyopathy would likely resovle with treatment of her sle as above. she was treated with afterload reduction in the meantime with lisinopril. she will follow up in cardiology clinic. 3)sle: the patient reports receiving a dx of sle in , which she claims to have controlled with diet. on presention, her symptoms and labs were c/w an acute sle flare and included amenorrhea, unintentional weight loss, fevers, fatigue, alopecia, sun sensitivity, xerostomia, sicca, and vaginal dryness. she also reports frequent "lumps" under her chin, indicating possible enlarged salivary glands. these symptoms are consistent with sjogren's syndrome, which is most frequently associated with ra but can also underlie other autoimmune conditions such as sle. she had comprehensive lab work up that was consistent with a diagnosis of sle including diminished c3, positive ssa, positive , pancytopenia, positive antigranulocyte antibodies, positive antirnp antibodies, elevated igg, igm, and elevated rf. she was treated with prednisone and hydroxychloroquine and will follow up in one week of discharge in lupus clinic. 4)pancytopenia: most likley to her diagnosis of acute sle flare. she was followed by hematology during her admission. blood titers for cmv, ebv, and parvovirus were negative. she was treated with high dose folate. 5) proteinuria: she was evaluted by nephrology team due to concern for possible lupus nephritis given that she had proteinuria. her urine sediment was reviewed with no evidence of lupus nephritis. given her increased risk she will follow up in nephrology clinic for close monitoring of her renal function. medications on admission: mvi white oak bark discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 3. prednisone 20 mg tablet sig: three (3) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* 4. hydroxychloroquine 200 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. calcium carbonate 500 mg (1,250 mg) tablet, chewable sig: one (1) tablet, chewable po tid with meals . disp:*90 tablet, chewable(s)* refills:*2* 6. vitamin d 400 unit tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 7. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 8. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: all care vna of greater discharge diagnosis: pericardial effusion with early tamponade lupus discharge condition: fair discharge instructions: you were transferred to the because you were having shortness of breath and passed out and you were found to have fluid around your heart. you were seen by the cardiologists and the fluid was drained. this was most likely caused by lupus. you were followed by the rheumatologists and you were started on prednisone and plaquenil. it is very important that you continue to take these medications and that you follow up with the rheumatology doctors as outpatient to prevent further serious complications of untreated lupus. you will also need to follow up with the kidney doctors to be sure that you are not sustaining kidney damage from the lupus. medications: 1) you were started on prednisone 60mg daily which you will need to continue until instructed to decrease or change the medication by the rheumatologists. 2) you were started on plaquenil which you should also take for your lupus 3) you were started on lisinopril which you will take to protect your heart. 4)you should take calcium and vitamin d to protect your bones while you are on prednisone. 5)you were started on prilosec which you should take to protect your stomach while you are on prednisone. 6)you were started on folic acid for your anemia. 7)you were started on bactrim which you should take daily to prevent infections in your lungs while you are on prednisone. please follow up as below. please call your doctor or return to the hospital if you experience any concerning symptoms including chest pain, difficulty breathing, lightheadedness, fainting, fevers or any other worrisome symptoms. followup instructions: 1)the clinic will contact you about making an appointment. if they don't contact you within two days of discharge, please call them at . you should have an appointment within two weeks of discharge. while in the hospital, you saw dr. . 2)you have a followup appointment at the nephrology clinic with dr. on monday at 3:00pm in the building of the of the . please come to the appointment with a full bladder. the nephrology clinic's phone number is . this is important to be sure that there is not any ongoing damage to your kidneys from the lupus. 3)you have a follow up appointment at the cardiology clinic with dr. on monday at 8:40am. the phone number of the clinic is (. 4)you have scheduled an apponintment with your primary care doctor, dr. at , on at 1:30. ( md, procedure: coronary arteriography using a single catheter pericardiocentesis right heart cardiac catheterization diagnoses: systemic lupus erythematosus cardiac tamponade cardiomyopathy in other diseases classified elsewhere 

Answer: The patient is high likely exposed to