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: anasarca, sob, anemia major surgical or invasive procedure: none history of present illness: 57 yo woman with no significant pmh, last seen by a physician decades ago, who presents with 6 week history (since ) of increasing le edema progressing to anasarca to the point that she wasn't able to walk on day of admission, abdominal distension, doe, facial swelling, and jaundiced eyes since per husband. upon further questioning, she reports the doe may have started in . she also reports 60lb intentional wt loss from exercise earlier this year. she denies any abdominal pain. she had a brief boute of diarrheal illness in , but her icteric sclera started before then and has been intermittent since it began. she initially presented to where bili was 3.3, hct 7, plts 95. other lfts were wnl. she was hypoxic to the 80s. cardiomegaly was noted by cxr but bedside echo reportedly showed trace pericardial effusion. she was guaiac negative. she was transferred from the osh for further workup. . in the emergency department, initial vitals were 98.0 78 98/46 24 100. rij was placed bc of poor access. she was described as alert, oriented, and comfortable. dullness in left base was noted as well as nontender abdominal distension with normoactive bs. she had 4+ le edema. were notable for a hct of 6.5, mcv of 134, wbc of 2.7 (diff n56.7, 0 bands, l39.6, m1.6, e0.8, bas1.4), plt 111, tbili of 3.2 (direct 0.4), nl lfts, unremarkable chem 7, and ldh of 4360, pt 18, ptt 35.1, inr 1.6, vit b12 of 50, hapto < 5, and reticulocyte count of 3.4. . she was ordered for 4 units of prbcs and had received 1-2u before transfer with plan for 10mg iv lasix after the first unit. . most recent vitals before transfer: p77 bp 106/57 rr 16 o2 100%on 3l past medical history: rosacea social history: scientist. lives in with her husband. children. previous project manager, but currently unemployed. denies significant travel. etoh: denies tobacco: never illicits: denies family history: - oa, ? ra - no other inflammatory disorders - no bleeding problems - no ca physical exam: 98.7 72 104/53 93%2l 14 . . physical exam general: pleasant, well appearing, in nad heent: normocephalic, atraumatic. mild scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. + s3. no murmurs, rubs or . 14cm jvd lungs: bilateral basilar rales, r>l abdomen: nabs. soft, nt, nd. no hsm extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. skin: cheek and nose rash neuro: a&ox3. appropriate. cn 2-12 grossly intact. preserved sensation throughout. 5/5 strength throughout. normal coordination. gait assessment deferred psych: listens and responds to questions appropriately, pleasant pertinent results: 08:30pm wbc-2.7* rbc-0.48* hgb-2.2* hct-6.5* mcv-134* mch-46.2* mchc-34.4 rdw-27.1* 08:30pm plt count-111* 08:30pm neuts-56.7 bands-0 lymphs-39.6 monos-1.6* eos-0.8 basos-1.4 08:30pm ret man-3.4* 08:30pm pt-18.0* ptt-35.1* inr(pt)-1.6* 08:30pm glucose-97 urea n-21* creat-0.9 sodium-135 potassium-4.3 chloride-103 total co2-24 anion gap-12 08:30pm albumin-3.6 calcium-8.3* magnesium-2.3 iron-201* 08:30pm alt(sgpt)-14 ast(sgot)-29 ld(ldh)-4360* alk phos-44 tot bili-3.2* dir bili-0.4* indir bil-2.8 08:30pm lipase-53 08:30pm caltibc-213* vit b12-50* folate-7.6 haptoglob-<5* ferritin-226* trf-164* 08:42pm lactate-1.9 03:01am blood hypochr-3+ anisocy-normal poiklo-2+ macrocy-normal microcy-normal polychr-1+ ovalocy-2+ schisto-occasional stipple-occasional tear dr2+ 03:01am blood fibrino-134* 08:30pm blood alt-14 ast-29 ld(ldh)-4360* alkphos-44 totbili-3.2* dirbili-0.4* indbili-2.8 08:30pm blood lipase-53 06:51pm blood homocys-113* 03:01am blood tsh-17* 03:01am blood t4-1.9* 09:54am blood t3-34* 06:51pm blood free t4-0.36* 09:54am blood cortsol-18.1 11:13am blood parietl-negative 03:01am blood -negative dsdna-negative . micro: urine cx neg blood cx ngtd cmv vl pending . imaging: ct c/a/p:1. volume overload as evidenced by body wall anasarca, ascites within the abdomen, bilateral pleural effusions, and periportal edema. there is no evidence for hemorrhage. 2. bilateral pleural effusions with atelectasis, larger on the right. there is also a small pericardial effusion. 3. cholelithiasis without cholecystitis. 4. heterogeneous appearance to the uterus in presumed postmenopausal patient. an underlying lesion within the uterus cannot be excluded. would recommend correlation with gynecologic symptoms and exam. a pelvic ultrasound may be useful for further evaluation. . tte the left atrium is dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). diastolic function could not be assessed. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. brief hospital course: 57 yo female with no known pmh who presents with six weeks of progressive anasarca and pancytopenia with hemolysis. . #. anemia/pancytopenia: patient presented with a very impressive hct of 6. this was chronic, since she described only mild, indolent symptoms and was relatively well compensated. ct c/a/p did not reveal any acute bleed. given patient's lack of medical care in past, ddx was broad. patient was transfused 4 u prbc, with post-transfusion hct 21. this remained relatively stable, and was 19.8 24 hours after transfusion. patient improved symptomatically with transfusion, with increased energy. heme/onc was consulted. several studies including b12, folate, iron studies, dic , , dsdna, pnh , ebv, cmv, hiv viral loads, parvovirus ab. most notable lab result was low b12 of 50. . pt had no e/o ttp/hus, dic (fibrinogen normal). rheum w/u (, dsdna) neg. coombs neg. folate and iron wnl, but likely to demonstrate deficiency with increased hematopoiesis after b12 repletion. peripheral smear was consistent with b12 deficiency and ineffective hematopoiesis. hemolysis was also consistent with severe b12 deficiency. coagulopathy less readily explained, but may also be due to nutritional deficiency and stress on bone marrow. . heme/onc felt that b12 deficiency did explain complete clinical picture, and most likely etiology was pernicious anemia given other autoimmune disease (see below). intrinsic factor ab pending. . heme/onc recommended 7 day course of 1000 mg im b12, with folate and vitamin k repletion. homocystein was elevated, mma pending. these should be repeated after 7 days, as should iron studies since patient will likely need iron supplementation as hematopoiesis increases. patient will receive injections at heme/onc clinic in for next 2 days and then from vna. patient has appt with dr. on fri. . . on discharge, hct had remained stable around 20 for 48 hours. platelet count was slightly trending down from 90 to 70s and should continue to be monitored. . #. anasarca: patient was at risk of high output right heart failure from prolonged anemia. tte was done, which showed normal ef, however this does not rule out high output state. no e/o nephrotic syndrome. of note, tsh was elevated and t4 low. endocrine was consulted for hypothyroidism and felt that anasarca was explained by hypothyroidism of this degree. most likely etiology is hashimoto (autoimmune thyroiditis) given absence of thryoid tenderness. patient was started on levothyroxine 125 mcg daily. t3, t4 and ft4 were all low. anti-thryoglobin and tpo ab were pending. prior to discharge, thyroid panel was rechecked to ensure adequate absorption of synthroid. patient should f/u with dr. at in weeks for repeat to assess adequacy of dosing. . patient had bilateral pleural effusions and ascites, likely part of general anasarca picture hypothyroidism. patient should be monitored with thyroid treatment to ensure resolution of these fluid collections. thoracentesis could be considered if effusions persist despite treatment. . #. low voltage of ekg: pt met criteria for low voltage. tte did show small pericardial effusion with no e/o tamponade. this should be monitored as underlying nutritional deficiencies and thyroid disease is treated to ensure resolution. medications on admission: none discharge medications: 1. cyanocobalamin 1,000 mcg/ml solution sig: 1000 (1000) mcg injection daily (daily) for 4 days. disp:*4 mcg* refills:*0* 2. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. folic acid 1 mg tablet sig: five (5) tablet po daily (daily). disp:*90 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: b12 deficiency anemia autoimmune hypothyroidism discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: it was a pleasure taking care of you. you were admitted with severe anemia and total body swelling. you were found to have severe vitamin b12 deficiency, as well as hypothyroid disease. you were treated with b12 injections, folate and vitamin k. you were also treated with thyroid hormone replacement. you will need 4 more days of b12 injections, and to continue taking folic acid daily. you will also need thyroid hormone replacement daily, probably indefinitely. . please take the following medications: 125 mcg levothyroxine by mouth daily folic acid tab by mouth daily b12 injections daily x 4 more days followup instructions: you have an appointment to see dr. (hematology) at on friday . you should set up regular visits with a primary care doctor. you have received phone numbers to call for this. . please make an appointment to see dr. (endocrinology) in in weeks for your thyroid. . md procedure: venous catheterization, not elsewhere classified diagnoses: unspecified pleural effusion other vitamin b12 deficiency anemia other ascites other specified acquired hypothyroidism 

Answer: The patient is high likely exposed to