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: chest pain. major surgical or invasive procedure: pericardial drain placement . history of present illness: 67yom with hx of hcc s/p liver in now relisted, s/p ichemic cholangiopathy with bilateral biliary stent placements, and recent admission for similiar symptoms, re-presents today with persistent chest pain. during his prior admission, dates () through (), the patients chest was worked up and was ruled out for mi, pe and aortic disection. during the admission the patient had his left percutaneous biliary catheter exchanged, treated for suspected cholangitis with cipro/flagyl however his chest pain persisted. his total bili, which was elevated to 7 from a baseline of 1.5 to 3, improved following the drain exchange. an echo during the admission saw a small pericardial effusion, which was not there during a tte in (). the patient was given po tylenol that decreased the severity of the pain, however the pain was still persistenting on his discharge. . today the patient presents with continued chest pain. he describes it as band like in nature across the front of his chest with radiation across the top of the back and to his proximal left arm. the pain is constant and severe, limiting him from falling asleep. he states it is worse with movement and upon deep inspiration. it is worse with leaning forward. no alleviating symptoms. the patient was recently discontinued off his naloxone, which he was taking for persistent pruritis. . ros is negative for fevers, chills, sweats, visual changes, loss of consciousness. however the patient has reported two loose dark brown-black stools per day. no brbpr. one episode of "spitting up", no coffee ground emesis. no weightloss. the patient was admitted directly from his gastroenterology physicians clinic. past medical history: - status post liver - cirrohosis due to nash - history of hcc - diffuse biliary strictures due to ichemic cholangiopathy with subsequent bilateral percutaneous biliary drains, with multiple exchanges since placement - type 2 diabetes - hypertension - parathyroid adenoma status post parathyroidectomy - chronic renal failure, baseline creatinine 1.3-1.4 social history: rare etoh. quit smoking . retired. previous director of health services for prison service. married with three children. family history: father - ca mother- cvas brother - dm, htn no family history for liver disease or colon ca. physical exam: vs: 93.6 111/61 57 18 97% gen: very mild distress, middle-aged male, generally well appearing heent: perrl, eomi neck: supple, no lad cv: s1s2, distant hs, no mrg resp: ctab, ?reproduction of identical cp abd: soft, nt, nd bs+. no biliary drainage ext: no c/c/e neuro: motor grossly intact in 4 extremities pertinent results: labwork on admission: 09:00am wbc-12.4*# rbc-3.29* hgb-10.8* hct-31.0* mcv-94 mch-32.8* mchc-34.8 rdw-13.3 09:00am plt count-196 09:00am urea n-50* creat-2.1* sodium-118* potassium-4.8 chloride-91* total co2-16* anion gap-16 09:00am glucose-120* 09:00am pt-14.8* inr(pt)-1.3* 09:00am calcium-8.8 phosphate-4.9*# magnesium-2.3 09:00am alt(sgpt)-67* ast(sgot)-66* alk phos-497* tot bili-4.0* 09:00am tacrofk-6.2 10:55am ck-mb-notdone ctropnt-<0.01 . ecg study date of sinus rhythm. prolonged a-v conduction. ventricular ectopy. borderline low voltage in the limb leads. slightly prolonged q-t interval. compared to the previous tracing of diffuse st segment elevations have improved. ventricular ectopy is not as frequent. voltage in the limb leads, and to some degree the precordial leads, has decreased. . tte (complete) done the left atrium is mildly dilated. the right atrial pressure is indeterminate. 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 root is mildly dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is borderline pulmonary artery systolic hypertension. there is a moderate sized circumferential pericardial effusion with sustained right atrial collapse, consistent with low filling pressures or early tamponade. compared with the prior study (images reviewed) of , the pericardial effusion is larger and increased pericardial pressure is now suggested. serial evaluation and clinical correlation is suggested. . duplex dopp abd/pel study date of impression: 1. large regional/geographic hypoechoic area involving the central portion of the liver, not in a vascular distribution. findings are nonspecific, however, concerning for possible ischemia or cholangitis. further evaluation with contrast-enhanced ct or mr is recommended. this was discussed with dr. on . 2. bilateral pleural effusions and small pericardial effusion. . chest (pa & lat) study date of impression: worsening left lower lobe atelectasis. no acute cardiopulmonary process or displaced rib fractures. . c.cath study date of final diagnosis: 1. pericardial tamponade with improvement in hemodynamics after removal of 610 cc of bloody fluid. 2. moderate systemic arterial hypertension, post pericardiocentesis. . portable tte (focused views) done the left atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. . ct abd w&w/o c study date of impression: 1. small-to-moderate pericardial effusion. bilateral large pleural effusions with bibasilar atelectasis. 2. non-obstructive left renal calculus. 3. focal hyperemia in the left hepatic lobe as described above; this could represent early inflammatory hyperemia or focal pericholangitis or reactive changes secondary to trauma from recent percutaneous catheter exchange. no microabscesses, focal hepatic lesions, or masses were identified. there is mild intrahepatic biliary ductal dilation, unchanged. . chest (pa & lat) study date of impression: 1) slight decrease in pericardial effusion. 2) slight increase in right pleural effusion but unchanged small left pleural effusion. . labwork on discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:00am 6.1 2.64* 8.6* 25.2* 95 32.5* 34.0 13.7 204 renal & glucose glucose urean creat na k cl hco3 angap 05:00am 127* 29* 1.5* 131* 3.9 96 24 15 enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 05:00am 68* 60* 673* 3.1* brief hospital course: 67 year-old man with history of hepatocellular carcinoma status post liver in now relisted presenting with chest pain and found to have tamponade/pericarditis. . 1. tamponade/pericarditis: the patient presented with tamponade physiology and was sent to the cardiac cath laboratory for drain placement, with 700 cc serosanguinous drainage. the patient was initially monitored in the ccu. the drain was removed and repeat tte showed only a trivial effusion. the etiology of the effusion remains unclear. differential diagnosis includes cirrhosis, infection, malignant. bacterial cultures are negative at the time of discharge. viral cultures and serologies for ebv, cmv, vzv, adenovirus, and virus are pending at the time of discharge and should be followed-up as an outpatient. this was unlikely to represent tuberculosis with minimally elevated and ppd negative. cytology was negative for malignant cells. an autoimmune etiology is unlikely given his degree of immunosuppression. the patient was initially treated with nsaids, which were discontinued due to chronic renal failure, and he was subsequently treated with a prednisone burst with good effect. he was treated with prednisone 20 mg daily x 2 days and 10 mg x 2 days during admission, and discharged with 10 mg x 4 days until further evaluation by dr. at his follow-up appointment. he was scheduled for follow-up with dr. in cardiology. . 2. hyperechoic liver lesion: there was a hyperechoic liver lesion noted on ultrasound as above. ct abdomen was performed for further evaluation, and the lesion was most likely an area of hyperemia or inflammation, and was not thought to represent a recurrence of hepatoma. . 3. atrial flutter/fibrillation: the patient had atrial flutter with variable block during the time of transfer to the ccu with tamponade. he reverted back to sinus rhythm, but then returned to atrial flutter during admission. he was rate-controlled with metoprolol. it is unlikely that this represented cardiac ischemia and cardiac enzymes were negative at the time, however, he has numerous risk factors and should be considered for outpatient cardiac stress test for further evaluation. his chads2 score is 2, and he should be considered for anticoagulation as an outpatient. anticoagulation was not addressed during admission due to pericarditis and risk of hemorrhagic effusion. he was scheduled for follow-up with dr. in cardiology. . 4. acute on chronic renal failure: baseline creatinine 1.6, with creatinine 2.1 on admission. hydrochlorothiazide and valsartan were held. the patient's creatinine improved with gentle fluids. . 5. bilateral pleural effusions: he was noted to have small bilateral pleural effusions on chest x-ray. the patient denied shortness of breath or other symptoms. the effusions may be related to liver disease. further evaluation and management was deferred to the outpatient setting. . 6. hyponatremia: improved on discharge. the patient is hypervolemic and his hyponatremia is likely from cirrhosis. diuretic use was likely contributing, and his hydrochlorothiazide was held during admission. he was placed on free water restriction of 1.2 liters per day. . 7. status post liver : he is now relisted due to donor-graft-associated cholangiography. the patient was continued on tacrolimus and mycophenolate, with adjustment of the tacrolimus level during admission. he was continued on rifampin and bactrim prophylaxis. he was continued on ursodiol for cholangiopathy. . 8. hypertension: the patient was normotensive during admission. his valsartan and triamterene-hydrochlorothiazide were held for acute renal failure as above. his valsartan was restarted on discharge, but triamterene-hydrochlorothiazide was not. he was continued on felodipine and metoprolol. . 9. type 2 diabetes: no active issues. the patient was continued on with lantus with sliding scale insulin. . 10. hyperlipidemia: no active issues. the patient was continued on statin, zetia. medications on admission: rifampin 300 mg po q12h sertraline 100 mg po qpm ezetimibe 10 mg po qpm simvastatin 10 mg po daily ferrous gluconate 325 mg po daily sulfameth/trimethoprim ss 1 tab po daily insulin sc tacrolimus 14 mg po q12h metoprolol tartrate 50 mg po tid terazosin 5 mg po hs multivitamins 1 tab po daily triamterene-hydrochlorothiazide 2 cap po daily mycophenolate mofetil 1000 mg po bid ursodiol 900 mg po bid omeprazole 20 mg po daily valsartan 320 mg po daily potassium chloride 20 meq po daily felodipine 10 mg sr po daily discharge medications: 1. multivitamin tablet sig: one (1) tablet po daily (daily). 2. mycophenolate mofetil 500 mg tablet sig: two (2) tablet po bid (2 times a day). 3. rifampin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 4. sertraline 100 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 5. ferrous gluconate 325 mg (37.5 mg iron) tablet sig: one (1) tablet po daily (daily). 6. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 7. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 8. terazosin 5 mg capsule sig: one (1) capsule po hs (at bedtime). 9. ursodiol 300 mg capsule sig: three (3) capsule po bid (2 times a day). 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 11. ezetimibe 10 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 12. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 13. insulin glargine 100 unit/ml solution sig: thirty (30) units subcutaneous at bedtime. 14. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain for 5 days. disp:*30 tablet(s)* refills:*0* 15. prednisone 10 mg tablet sig: one (1) tablet po daily (daily) for 4 days. disp:*4 tablet(s)* refills:*0* 16. tacrolimus 1 mg capsule sig: ten (10) capsule po 6am and 6pm: adjust as indicated. 17. valsartan 160 mg tablet sig: two (2) tablet po daily (daily): 320mg dose. (diovan). 18. felodipine 10 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 19. humalog 100 unit/ml cartridge sig: per sliding scale subcutaneous recs. 20. potassium chloride 10 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po once a day. discharge disposition: home discharge diagnosis: primary: - tamponade - pericarditis - hypoechoic liver lesion - atrial flutter - acute on chronic renal failure . secondary: - status post liver - cirrohosis due to nash - history of hcc - diffuse biliary strictures due to ichemic cholangiopathy with subsequent bilateral percutaneous biliary drains, with multiple exchanges since placement - type 2 diabetes - hypertension - parathyroid adenoma status post parathyroidectomy - chronic renal failure, baseline creatinine 1.3-1.4 discharge condition: afebrile, vital signs stable. chest-pain free. discharge instructions: you were admitted to the hospital with fluid and inflammation in the sac surrounding your heart, called tamponade and pericarditis. your pain improved after drainage of the fluid and treatment with steroids and oxycodone. we remain unsure as to the cause of your symptoms, but it likely represented an infection, with some studies pending. . you had an area of concern noted on liver ultrasound. you had an abdominal ct that showed this area was unlikely to be a cancer and was more likely an area of inflammation. . while in the hospital, you developed an irregular heart rhythm called atrial flutter or fibrillation. you should discuss future use of coumadin, a blood thinner, and your personal risk of stroke with your primary care physician and cardiologist. . you had a bump in your kidney tests on admission. this improved with discontinuation of triamterene-hydrochlorothiazide. these medications have been on hold. you should discuss with dr. resuming this medication. . please contact a physician or report to an emergency department if you experience fevers, chills, chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, or any other concerning symptoms. . please take your medications as prescribed. - you should continue prednisone 10 mg daily for 4 more days--until your appointment as with dr. . - you can take oxycodone every four hours as needed for pain; this medication is sedating and you should use caution when driving or operating heavy machinery. - your tacrolimus dose was adjusted to 10 mg daily. dr. will contact you regarding dosage adjustment. - your triamterene-hydrochlorothiazide was discontinued. - no other changes were made to your medications. . please keep your follow-up appointments as below. followup instructions: previously scheduled appointments: follow-up with your primary care doctor: provider: , m.d. phone: date/time: 10:00 provider: , md phone: date/time: 3:15 provider: ,one date/time: 7:00 . please see dr. as scheduled this week, call his office at ( with questions about the time. . please call dr. office to schedule an appointment for follow-up within the next 10days. procedure: coronary arteriography using a single catheter pericardiocentesis right heart cardiac catheterization diagnoses: unspecified pleural effusion cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation atrial flutter chronic kidney disease, unspecified complications of transplanted liver personal history of malignant neoplasm of liver surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation obstruction of bile duct acute pericarditis, unspecified cardiac tamponade 

Answer: The patient is high likely exposed to