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 sulfate / iv dye, iodine containing attending: chief complaint: dyspnea on exertion, observation post-pericardial drainage. major surgical or invasive procedure: pericardiocentesis history of present illness: ms is a 65-year-old female with left renal cell carcinoma s/p nephrectomy (), who was found to have a pericardial effusion. . a ct scan last wednesday () revealed volume overload with increased pleural and pericardial effusions, pulmonary and periportal edema and ascites. she also felt unwell and developed a cough with purulent sputum. she was started on levaquin as an outpatient, but continued to have shortness of breath. this shortness of breath lasted for the last 2 weeks but became worse in the past 24 hours. she could not ambulate up a flight of stairs and had to be assisted into a wheelchair, and ended up cyanotic and diaphoretic by the time she reached her follow-up appointment. an echocardiogram that afternoon revealed an ef of >70% and early signs of cardiac tamponade (collapsed right atrium but not ventricle). she was transferred to the cardiac floor for further management. . on arrival to the floor, her initial vitals were as follows: t 97.7 bp 149/96 hr 95 rr 18 sao2 98% on room air. labs and imaging were significant for na 131, cr 0.9 and alt 51. her urinalysis was negative. . on review of systems, she reports some occasional rib pain on her posterior back. she also had a lot of nausea and vomiting last week but that has resolved. she did not have any tuberculosis exposure or recent travel. . otherwise, she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, dizziness, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . 500ccs were drained during pericardiocentesis by dr . past medical history: 1. cardiac risk factors: -diabetes, -dyslipidemia, -hypertension 2. cardiac history: - cabg: none - percutaneous coronary interventions: none - pacing/icd: none 3. other past medical history: - left renal cell carcinoma s/p nephrectomy () - motor vehicle accident - complicated by pneumothorax, rib fractures and incidental findings of pulmonary nodules () - right mid, left lower lobectomy for spread of renal cancer () - nodules in lobes were found to be malignant with histology compatible to those from a primary renal cell carcinoma source - hypothyroidism - c-section x2 - appendectomy - hemochromatosis gene carrier (reported by patient) social history: - family: married. has 5 children and 14 grandchildren. - occupation: works as a nurse ~3 days/week at acute rehab facility, but reports it has been increasingly difficult to go to work due to shortness of breath. - tobacco history: ex-smoker, quit over 20 years ago. smoked 40 pack years. - etoh: occasionally. - illicit drugs: none. family history: - grandfather had possible throat cancer - 3 children have hemochromatosis - sister has systemic lupus erythematosus - father has alzheimer's disease - no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: on admission: pulsus 8 general: no acute distress, oriented x3, mood is appropriate. able to carry a full conversation w/o appearing short of breath; no accessory muscle use. heent: perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of 8cm. 2 right supraclavicular lymph nodes, non-matted, non-tender. 1cm and 2cm in size. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills. no s3/s4. lungs: decreased breath sounds on right below nipple line and posterior below inferior angle of scapula. clear to auscultation bilaterally, no crackles, wheezes or rhonchi. abdomen: soft, nontender, nondistended, +bowel sounds. left nephrectomy scar noted. extremities: no cyanosis or peripheral edema. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ . on discharge: general: no acute distress, oriented x3 heent: perrl, eomi. mmm neck: supple with jvp of 8cm , hard multilobulated monbile lymphnode in right lateral neck cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no m/r/g. no thrills. no s3/s4. lungs: clear to auscultation bilaterally, no crackles, wheezes or rhonchi, reduced air entry lower right chest abdomen: soft, nontender, nondistended, + bowel sounds. extremities: no cyanosis or peripheral edema. pulses: right: carotid 2+ dp 2+ pt 2+ left: carotid 2+ dp 2+ pt 2+ pertinent results: cbc trend: 01:17pm blood wbc-10.4 rbc-5.28 hgb-15.7 hct-47.2 mcv-89 mch-29.8 mchc-33.4 rdw-14.5 plt ct-319 07:00am blood wbc-9.1 rbc-4.66 hgb-14.1 hct-41.1 mcv-88 mch-30.2 mchc-34.2 rdw-14.9 plt ct-277 05:09am blood wbc-13.8*# rbc-5.29 hgb-15.8 hct-47.0 mcv-89 mch-29.8 mchc-33.5 rdw-15.2 plt ct-301 06:20am blood wbc-15.0* rbc-5.21 hgb-15.1 hct-46.0 mcv-88 mch-29.0 mchc-32.9 rdw-15.5 plt ct-318 05:55am blood wbc-12.2* rbc-5.08 hgb-15.3 hct-44.5 mcv-88 mch-30.2 mchc-34.5 rdw-15.3 plt ct-315 06:20am blood wbc-11.1* rbc-5.17 hgb-15.4 hct-45.7 mcv-88 mch-29.9 mchc-33.8 rdw-15.3 plt ct-335 . chemistry trend: 01:17pm blood urean-18 creat-0.9 na-131* k-4.1 cl-96 hco3-27 angap-12 07:00am blood glucose-86 urean-14 creat-0.7 na-135 k-4.2 cl-101 hco3-25 angap-13 05:09am blood glucose-166* urean-17 creat-0.9 na-135 k-4.4 cl-103 hco3-22 angap-14 06:20am blood glucose-102* urean-17 creat-0.7 na-134 k-4.4 cl-101 hco3-26 angap-11 05:55am blood glucose-93 urean-14 creat-0.9 na-132* k-4.6 cl-98 hco3-26 angap-13 06:20am blood glucose-98 urean-18 creat-0.9 na-135 k-4.8 cl-99 hco3-28 angap-13 . ca/mg/po4 trend 01:17pm blood calcium-9.5 phos-3.0 mg-2.1 07:00am blood calcium-9.0 phos-2.6* mg-2.0 05:09am blood calcium-9.2 phos-3.2 mg-2.0 06:20am blood calcium-9.6 phos-2.4* mg-2.1 05:55am blood calcium-9.8 phos-3.0 mg-2.1 06:20am blood calcium-10.8* phos-4.0 mg-2.2 . lfts 01:17pm blood alt-51* ast-36 ld(ldh)-244 alkphos-92 . tfts 07:00am blood tsh-12* 05:55am blood free t4-1.3 . serum osmolality levels: 05:09am blood osmolal-291 . pericardial fluid: wbc rbc polys lymphs monos eos mesothe macro 250* * 41* 13* 8* 1* 3* 34* pericardial fluid totprot glucose ld(ldh) amylase albumin 4.1 101 285 41 2.7 . micro: 6:15 pm fluid,other pericardial fluid. gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): . 6:15 pm fluid received in blood culture bottles pericardial fluid. fluid culture in bottles (preliminary): no growth . pericardial fluid cytology: pending on discharge . studies: tte: the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 70%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is a large pericardial effusion. the effusion appears circumferential. no right ventricular diastolic collapse is seen. there is brief right atrial diastolic collapse. impression: large circumferential pericardial effusion with evidence of early cardiac tamponade ekg: sinus rhythm at upper limits of normal rate. low voltage t wave abnormalities. since the previous tracing of the rate is faster. t wave abnormalities are new. clinical correlation is suggested. tte: overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a large pericardial effusion. saline contrast injected via a pericardial drain is seen within the pericardium prior to removal of pericardial fluid. 500 ml of pericardial fluid was removed with resolution of the pericardial effusion visualized by echocardiography. compared with the prior study (images reviewed) of , post tap resolution of the pericardial effusion is seen. cxr: bibasilar opacities likely due to association of atelectasis and bilateral pleural effusion. no pneumothorax is noted. tte: there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. the epicardial surface of the right ventricular free wall (particularly toward the apex) appears somewhat thickened, suggestive of residual organized effusive material, thrombus, neoplastic tissue, or possibly even fat pad. tte: there is a very small pericardial effusion. there are no echocardiographic signs of tamponade. brief hospital course: 65-year-old female with history of metastatic renal cell carcinoma who presented to the outpatient clinic with worsening shortness of breath secondary to a large pericardial effusion with right atrial tamponade. . # large pericardial effusion with right atrial tamponade: effusion had likely gone on for weeks and was likely a malignant effusion. patient was hd stable but found to have tamponade physiology as shown by echocardiography. she underwent pericardiocentesis with drainage of 500cc () with serosanguinous exudative fluid. a pericardial drain was placed and drained another 400cc over the next 48 hours. in the ccu, the patient was hemodynamically stable with pulsus ~8, which was within normal limits. an echo done on showed no reaccumulation of fluid. drainage from the pericardial drain subsequantly stopped and the drain was removed on . repeat tte on showed a very small pericardial effusion, but no echocardiographic signs of tamponade. pericardial fluid cytology was still pending at discharge. patient was discharged for continued out-patient follow-up with oncology and cardiology. . outpatient issues: - f/u pericardial fluid cytology - tte planned for 7 days post discharge; will need to be arranged - cardiology appointment - oncology appointment . # renal cell cancer: history of rcc s/p left nephrectomy () + right lung lower & middle lobectomy (). she has since progressed on several treatment regimens including interleukin-2, avastin, pazopanib, everolimus and as shown on radiology has involvment of lungs, bones and thoracic and abdominal lymph nodes. for the last couple of months prior to this admission she was back on avastin. she did miss one dose last month when her father died. oncologist dr was emailed regarding prognosis and treatment options and his thoughts were to do what was necessary (including pericardial window placement if indicated- ultimately was not needed). plan is to f/u with her oncologist in the outpatient setting and resume avastin. . outpatient issues: - oncology f/u . # hypothyroidism - tsh = 12, ft4 = 1.3 continued levothyroxine 125mcg daily . outpatient issues: - f/u thyroid function . # gerd: remained stable and asymptomatic with regards to gerd this admission. she was continued on her home dose of omeprazole 40mg po daily. . # hyponatremia: had mild euvolemic hyponatremia with na stable at 131. her serum and urine indices were consistent with siadh which is likely to her malignant pulmonary involvment. . outpatient issues: - f/u na . # dvt prophylaxis: the patient was treated with subcutaneous heparin during this admission. . # code status: was full during this admission # comm: , daughter () medications on admission: - levothyroxine 125mcg qd - lorazepam 5mg q6-8h prn anxiety - omeprazole 40mg - zofran 8mg - acetaminophen 1000mg qd - melatonin 3mg qhs - ipratropium 42mcg - multivitamin discharge medications: 1. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po twice a day. 3. lorazepam 0.5 mg tablet sig: one (1) tablet po every hours as needed for anxiety. 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. melatonin 3 mg tablet sig: one (1) tablet po at bedtime. 6. zofran 8 mg tablet sig: one (1) tablet po twice a day as needed for nausea. 7. ipratropium bromide powder inhalation 8. acetaminophen 500 mg tablet sig: two (2) tablet po once a day as needed for pain. discharge disposition: home discharge diagnosis: primary: pericardial effusion metastatic renal cell carcinoma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms , it was pleasure taking care of you. you were admitted to for further evaluation and management of your shortness of breath. work-up of your symptoms revealed a collection of fluid in the lining surrounding your heart. a drain was placed to facilitate removal of the fluid. with drainage, your symptoms improved. it is important that you follow up at the cardiology appointment below- you will need a repeat echocardiogram (ultrasound of your heart) in one week to assess if there is reaccumulation of the fluid. we have made no changes to your home medications. again it was a pleasure taking care of you. we wish you a speedy recovery. followup instructions: please follow up at the following appointments: department: cardiac services when: wednesday at 1:20 pm with: , md building: sc clinical ctr campus: east best parking: garage name: , t. location: sj family medical centers address: , , phone: appt: at 4:30pm please follow up at your previously scheduled appointments: department: hematology/oncology when: wednesday at 2:30 pm with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: wednesday at 2:30 pm with: , rn building: campus: east best parking: garage department: hematology/oncology when: wednesday at 4:00 pm with: , rn building: campus: east best parking: garage procedure: pericardiocentesis diagnoses: pneumonia, organism unspecified esophageal reflux hyposmolality and/or hyponatremia unspecified acquired hypothyroidism secondary malignant neoplasm of other specified sites secondary malignant neoplasm of lung personal history of malignant neoplasm of kidney secondary malignant neoplasm of bone and bone marrow acute pericarditis, unspecified cardiac tamponade secondary and unspecified malignant neoplasm of lymph nodes of multiple sites 

Answer: The patient is high likely exposed to