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: history of present illness: the patient is a 78-year-old female, with a past medical history significant for metastatic breast carcinoma with stable metastases to the lung, as demonstrated on a ct scan in , who presents with a 1-month history of progressive dyspnea on exertion. she also states that she has shortness of breath at rest, and reports mild chest pressure with exertion and at rest. she also reports bilateral lower extremity edema increasing over the last 1 month. for work-up of this, her primary care provider had the patient undergo a cardiac stress test on which was negative for reversible perfusion defects. however, the patient did experience atrial fibrillation at that time. she also did have an echocardiogram done on , which showed a moderate pericardial effusion which had increased slightly since her previous echo. the patient denied any symptoms suggestive of lightheadedness or syncope. she denies fevers and cough. past medical history: 1. new atrial fibrillation. 2. pericardial effusion status post echo , which showed moderate pericardial effusion, no tamponade physiology, ejection fraction of 60%, mild mr, moderate tr. 3. history of metastatic breast cancer, status post ct in which showed stable lung metastases, and at that time stable pericardial effusion. 4. status post persantine-mibi , which showed no reversible perfusion defects. 5. chronic renal insufficiency, status post nephrectomy. 6. hypertension. 7. hypothyroidism. 8. hypercholesterolemia. 9. gout. 10.glaucoma. allergies: no known drug allergies. medications on admission: 1. levoxyl. 2. allopurinol. 3. amaryl. 4. arimidex. 5. avandia. 6. colace. 7. iron. 8. folate. 9. protonix. 10.lipitor. 11.vitamin b12. 12.norvasc. social history: the patient denies tobacco or alcohol. she lives with her husband in . she does have a daughter in who is involved in her care. the patient does have stressors at home, including her husband who has bipolar disease longstanding. vitals on admission: temperature 97.6, blood pressure 127/56, pulse 70, respiratory rate 22, satting 100% on 2 liters. heent: her extraocular movements were intact. her oropharynx was clear. neck: she had jvd to the midneck. chest: she had bilateral crackles, left greater than right. cardiac exam: she was irregularly irregular with a ii/vi harsh systolic murmur at the left lower sternal border. abdomen: benign. extremities: 2+ edema. of note, she had no pulses paradoxus on exam. laboratories on admission: white count 4.4, hematocrit 33.7, platelets 198. her chem-7 was normal. she had a ua which was negative. chest x-ray showed right heart border was obscured with possible infiltrate. ekg was irregular with poor r wave progression, which was new. hospital course: the patient was admitted for pericardial drain procedure. she went to the cardiac catheterization laboratory where under fluoro guidance she had a pericardiocentesis and drain placement, and 450 cc of straw-colored fluid was removed. micro on pericardial fluid was negative. however, cytology was still pending. the patient did have follow-up echocardiogram. her systolic function was normal with an lv-ef of 55%. ventricular wall thickness and cavity size were also normal. she still had moderate tr. she also had mild to moderate pulmonary artery systolic hypertension, and she showed only a small pericardial effusion. no tamponade. this echo was performed after her pericardial drain was pulled. a total of approximately 460 cc of pericardial fluid was collected in the drain post her pericardiocentesis for a total of approximately 900 cc of straw-colored fluid removed. her drain was pulled 24 hours after placement. the patient was sent to the ccu for observation post pericardial drain placement. there, she did have atrial fibrillation. coumadin therapy was not started secondary to her known metastatic disease. the patient also had a temperature to 101. this was most likely attributable to her right infiltrate which was seen on her admission chest x-ray, and she was started on levofloxacin for presumed pneumonia. she will complete a 7-day course of levofloxacin. the patient did not spike any further fevers after that initial temperature of 101. the patient also had increasing oxygen requirement during the end of her hospital stay. it was believed this was secondary to pneumonia, but more importantly signs of congestive heart failure. she had serial x-rays which showed worsening pulmonary congestion. she was treated with iv lasix 20 mg po bid with good urine output. on the day of discharge, her oxygen saturation improved. initially, the patient was satting 92% on 5 liters. on discharge, she was satting 95% on 2 liters. the ccu team also felt that her hypoxia could be attributable to either obstructive sleep apnea, or hypoxia secondary to obesity, considering that a number of her oxygen desaturations occurred at night. the patient will continue lasix therapy for heart failure. she did have improved exam and oxygen saturation on the day of discharge. she will be continued on lasix 40 at rehabilitation. in terms of her breast cancer, the patient was seen by dr. , her primary oncologist. no therapy was initiated for this during her hospital stay. she was continued on her arimidex which she was on as an outpatient, and she will follow-up with dr. on . the patient was continued on her vitamin b12 for her anemia, and for her atrial fibrillation no coumadin was started, again because of her known metastatic disease. however, she was started on lopressor 37.5 mg po bid. the patient was also depressed during the course of her hospital stay. social work was involved. the patient did not want to see psychiatry. she was on an ssri previously as an outpatient; however, she self-discontinued this and was not interested in pharmacologic therapy. social work provided services, and also helped her in terms of estate planning for the future. condition on discharge: fair. discharge status: rehabilitation facility. discharge diagnoses: 1. pericardial effusion, status post pericardiocentesis and drain placement. 2. atrial fibrillation. 3. congestive heart failure. 4. pneumonia. 5. metastatic breast cancer. discharge medications: 1. allopurinol 100 mg po qd. 2. arimidex 1 mg po qd as treatment for breast cancer. 3. colace 100 mg po bid. 4. ferrous sulfate 325 mg po bid. 5. levothyroxine 50 mcg po qd. 6. folic acid 1 mg po qd. 7. atorvastatin 10 mg po qd. 8. protonix 40 mg po qd. 9. vitamin b12 1,000 mcg po qd. 10.amlodipine 5 mg po qd. 11.lopressor 37.5 mg po bid. 12.miconazole powder tid prn. 13.lasix 40 mg po bid. 14.senna 1 tablet po bid. 15.levofloxacin 250 mg po q 24 h, continue through , then stop for a full 7-day course. 16.amaryl 1 mg po qd. 17.avandia 4 mg po qd. follow-up: 1. the patient will follow-up with dr. on at 2:30. 2. she will also see dr. on at 3:30. 3. the patient will also receive an echocardiogram in 1 month's time to reevaluate for pericardial effusion. dr., 12-661 dictated by: medquist36 d: 10:58 t: 11:09 job#: procedure: pericardiocentesis non-invasive mechanical ventilation diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified acquired hypothyroidism gout, unspecified atrial fibrillation secondary malignant neoplasm of other specified sites secondary malignant neoplasm of lung 

Answer: The patient is high likely exposed to