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: no known allergies / adverse drug reactions attending: chief complaint: chest pain/ shortness of breath major surgical or invasive procedure: cardiac cath pericardial fluid drained history of present illness: 77 yo m with hx of asthma, hl, multiple myeloma presented to in with cough and fever of one week duration . the patient describes intermittent pleuritic chest pain and general malaise and weakness during a 5 day driving trip from . he said he took nsaids without relief. he denied fevers/chills but endorsed a runny nose. at , he had a low-grade fever and was originally treated empirically for presumed pna. however on the day of admission he became tachypneic into the 140s and underwent a ct-a of his chest to rule out pe which showed a large pericardial effusion. patient also had evidence of pericardial tamponade with elevated neck veins, tachycardia. his systolic bp was stable between 110- 115. he had a pulsus paradoxus of 30 to 40 mmhg. he was transfered here and underwent emergent echo which showed large pericardial effusion and hypercontractile ventricle. he then underwent a rh cath. his effusion was drained, a drain was placed and he was admitted to the ccu. on arrival, his vitals were afebrile, 107, 114/70, 22, 94% 2l past medical history: 1. cardiac risk factors: dyslipidemia 2. cardiac history: -cabg: none -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: multiple myeloma - igg kappa monoclonal protein essential thrombocytosis asthma social history: -tobacco history: none -etoh: occasionally -illicit drugs: none - lived in montreal and moved to ma 20 years ago family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. . physical exam: on admission: t=afebrile bp=114/70 hr=110 rr=20 o2 sat=94%ra general: nad, lying in bed post-cath. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with no jvd cardiac: pmi located in 5th intercostal space, midclavicular line. irregular tachycardic heart rate, distant heart sounds, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi in frontal fields (pt could not sit s/p cath) abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. extremities: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ on discharge: alert, walking around halls without difficulty. rrr, lungs ctab. pertinent results: labs on admission: 11:30pm other body fluid tot prot-6.7 glucose-110 ld(ldh)-587 amylase-44 albumin-2.3 11:30pm other body fluid wbc-2988* rbc-* polys-35* lymphs-37* monos-16* eos-3* atyps-1* macrophag-8* 08:39pm glucose-128* urea n-16 creat-1.2 sodium-125* potassium-5.4* chloride-96 total co2-20* anion gap-14 08:39pm estgfr-using this 08:39pm lactate-1.7 k+-4.6 08:39pm wbc-15.6* rbc-3.51* hgb-10.2* hct-30.4* mcv-87 mch-29.1 mchc-33.6 rdw-16.8* 08:39pm neuts-78.2* lymphs-10.8* monos-9.5 eos-1.0 basos-0.4 08:39pm plt count-871* 08:39pm pt-15.8* ptt-33.6 inr(pt)-1.4* sodium 08:39pm blood na-125* 09:20pm blood na-127* 07:20am blood na-128* creatinine 08:39pm blood creat-1.2 09:20pm blood creat-1.3* 07:20am blood creat-1.1 microbiology: blood cultures x5: no growth upon discharge urine culture: no growth legionella urine ag: negative sputum cx: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in short chains and in clusters. respiratory culture (final ): moderate growth commensal respiratory flora. pericardial fluid: 11:30 pm fluid,other pericardial fluid. gram stain (final ): 3+ (5-10 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. acid fast culture (preliminary): acid fast smear (final ): no acid fast bacilli seen on direct smear. imaging: echo the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses are normal. left ventricular systolic function is hyperdynamic (ef 75%). right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. the mitral valve leaflets are mildly thickened. there is a moderate to large sized pericardial effusion. the effusion appears circumferential. no right atrial or right ventricular diastolic collapse is seen. there is significant, accentuated respiratory variation in tricuspid valve inflows, consistent with impaired ventricular filling. impression: moderate to large circumferential pericardial effusion with early tamponade physiology. echo overall left ventricular systolic function is normal (lvef>55%). the right ventricular free wall is hypertrophied. there is a small pericardial effusion, possibly loculated, subtending the right ventricular free wall and also the basal lateral wall of the left ventricle. there are no echocardiographic signs of tamponade. no right atrial or right ventricular diastolic collapse is seen. compared with the prior study (images reviewed) of the pericardial effusion is mostly gone. echo the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , the pericardail effusion now appears slightly larger. cxr comparison is made to prior study from the day before. there is patchy airspace opacification at the bilateral lower lobes, small bilateral pleural effusions. heart and mediastinum within normal limits. no pneumothorax. brief hospital course: 77 yo m with asthma, mm, hl presents with one week of fatigue/malaise and chest pain with pericardial effusion. the most likely etiology is viral pneumonia with associated pericardial effusion. . active issues . # pericardial effusion respiratory viral process: he presented with a large effusion by tte, explaining his chest pain. percardiocentesis was done and the >500cc was drained. the drain was left in place until there was no further drainage. to rule out other causes, further testing was done: tsh normal (2.2), hiv negative, negative. pericardial fluid studies were unrevealing. he continued to spike fevers and infectious work-up did not reveal any additional causes. we felt this was likely due to his pericarditis. repeat ttes were done s/p drainage and when the drain was pulled, showing resolution of the effusion. since he continued to have mild chest discomfort, he was started on colchicine on discharge until follow-up with his outpatient cardiologist, after consultation with his outpatient oncologist. an echocardiogram will be repeated as an outpatient. his upper respiratory symptoms improved and he will finish out a 7-day course of levofloxacin for his presumed pneumonia. . # rhythm: pt presented with rapid a-fib, which appeared to be new and coincided with his effusion. it is likely that the effusion is the cause of his afib through dynamic wall stretch. on the morning after admission, pt had an asymptomatic episode of bradycardia into the 30s while converting to sinus rhythm. he had received 2.5mg lopressor iv push as well as a 12.5mg po am dose. in this setting his bp transiently decreased to sbp 70s but quickly increased to 100s. he had no further episodes and his ekgs were stable upon discharge, in nsr. . # hyponatremia: looking through past records, it appears that this hyponatremia (nadir to 125) is new. urine studies and very small response to fluid boluses made this clinical picture more consistent with siadh. the sodium improved to 128, but he will be receiving outpatient lab work to monitor his sodium. . # acute kidney injury: creatinine peaked at 1.3, initially thought to be secondary to hypovolemia. resolution to 1.1 on discharge. renal function should be followed up as an outpatient. . inactive issues . # asthma: chronic and stable. he was continued on his home advair and albuterol on discharge. . # multiple myeloma: he is followed closely as outpatient with skeletal surveys, appears to be "smoldering" and he has not undergone treatment so far. medications on admission: advair 500/50 twice a day. lipitor 0.5 mg daily. albuterol p.r.n.. aspirin 81mg daily discharge medications: 1. atorvastatin 10 mg tablet sig: 0.5 tablet po daily (daily). 2. levofloxacin 750 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 3 days. disp:*3 tablet(s)* refills:*0* 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 4. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. 6. acetaminophen 500 mg capsule sig: capsules po every eight (8) hours as needed for pain fever. 7. colchicine 0.6 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*1* discharge disposition: home discharge diagnosis: primary diagnosis: pericardial effusion pneumonia, viral . multiple myeloma hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you had a collection of fluid around your heart that we believe was related to your fever and possible pneumonia. this was causing your chest pain. you were transferred to and a drain was placed in the space around your heart and fluid was drained out. this fluid was sent to the lab to check for abnormal cells and infection. these tests are currently pending and will be followed up by dr. and our team. your pain and breathing improved after removal of the fluid and 2 subsequent echocardiograms did not show that the fluid was coming back. you will need to follow up with a new cardiologist: dr. at as well as dr. . another echocardiogram will be done in about a 1-2 weeks. . we made the following changes to your medicines: 1. start taking levofloxacin for your pneumonia, you have 3 more days to complete a 7 day course 2. please start taking colchicine, once daily. this medication is used to treat the inflammation around your heart. please continue this medication until you see dr. . please note, you will need to have your kidney function rechecked when you see dr. . followup instructions: name: , a. address: , , phone: when: thursday, , 4:15pm cardiology follow up: 4pm please see dr. on at 4pm. his office is located at , , , ma. phone number is . echocardiogram: your follow up echocardiogram is scheduled for monday 1pm. his office is located at , , , ma. phone number is . procedure: pericardiocentesis right heart cardiac catheterization diagnoses: acute kidney failure, unspecified atrial fibrillation asthma, unspecified type, unspecified other and unspecified hyperlipidemia multiple myeloma, without mention of having achieved remission other disorders of neurohypophysis viral pneumonia, unspecified acute idiopathic pericarditis cardiac tamponade essential thrombocythemia 

Answer: The patient is high likely exposed to