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: none history of present illness: 56-year-old man with history of cad (angioplasty in , in lcx in ), small-cell lung cancer, type ii dm, hyperlipidemia, hypertension was transferred from with tamponade. the patient had a chest ct for lung cancer that showed a large pericardial effusion. he denied sob, palpitations, lightheadedness, chest pain. he had an echo that showed ef 65-70%, large circumferential pericardial effusion with evidence of diastolic collapse of ra but not rv. ecg showed no active ischemic changes and troponin t was < 0.01. an attempted pericardiocentesis drained out only 30 ml of bloody fluid. re-insertion of needle yielded no fluid. repeat echo showed a 1-cm decrease in circumferential pericardial effusion. he was transferred to for further management, including possible percardial window. . on review of systems, he 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. he denies recent fevers, chills or rigors. he 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, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: 1. cardiac risk factors:: diabetes (+), dyslipidemia (+), hypertension (+) 2. cardiac history: -cabg: -percutaneous coronary interventions: angioplasty in (unclear which vessel), in mid lcx in -pacing/icd: 3. other past medical history: type ii diabetes: was on oral hypoglycemics then insulin, but has been off insulin and meds for more than 1 year due to reportedly normal glucose family history: no history of heart disease or dm. physical exam: general: middle-aged man in nad, conversational heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 8 cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, 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. bibasilar crackles. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominial 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+ pertinent results: labs on admission: . 09:34pm blood wbc-11.6* rbc-2.51*# hgb-7.4*# hct-21.3*# mcv-85 mch-29.6 mchc-34.9 rdw-15.6* plt ct-365 09:34pm blood neuts-82.4* lymphs-12.7* monos-3.3 eos-1.3 baso-0.3 09:34pm blood pt-15.1* ptt-31.7 inr(pt)-1.3* . 09:34pm blood glucose-107* urean-15 creat-1.0 na-138 k-4.2 cl-108 hco3-22 angap-12 09:34pm blood calcium-8.3* phos-3.2 mg-1.8 . 09:34pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg . cardiac enzymes: 09:34pm blood ctropnt-<0.01 ck(cpk)-33* ck-mb-notdone 12:42pm blood ctropnt-0.08* ck(cpk)-105 ck-mb-6 09:34pm blood ctropnt-0.22* ck-mb-12* mb indx-11.4* . 04:07pm blood hapto-205* 07:10am blood cea-25* 09:21am blood wbc-17.5*# rbc-2.55* hgb-8.1* hct-22.4* mcv-88 mch-31.9 mchc-36.3* rdw-14.9 plt ct-275 . labs on discharge: 06:50am blood wbc-10.6 rbc-3.81* hgb-11.7* hct-32.4* mcv-85 mch-30.7 mchc-36.1* rdw-15.8* plt ct-247 06:50am blood pt-18.3* ptt-37.0* inr(pt)-1.7* 07:10am blood glucose-79 urean-19 creat-0.8 na-137 k-4.1 cl-103 hco3-22 angap-16 07:10am blood calcium-8.4 phos-3.0 mg-2.1 . tte () conclusions the left atrium is elongated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). the estimated cardiac index is borderline low (2.0-2.5l/min/m2). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size is normal. with mild global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. 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 mitral/tricuspid valve inflows, consistent with impaired ventricular filling. compared with the prior study (images reviewed) of , the left ventricle appears hypertrophied and small, consistent with underfilling. the moderate to large pericardial effusion is new with early tamponade physiology. mild aortic regurgitation is new. there is a mass lateral to the left atrium. . tte () conclusions the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with focal mild hypokinesis of the basal half of the inferolateral wall. the remaining segments contract normally and overall systolic function is preserved (lvef = 55-60 %). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral leaflets are structurally normal. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a moderate sized circumferential pericardial effusion most prominently (1.5cm) inferior to the left ventricle and around the right atrium with less (<1cm elsewhere). there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , the findings are similar. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. . . radiology: . ct torso (): impression: 1. large mixed attenuation but predominantly hyperdense collection which appears to display mass effect on the adjacent left lobe of the liver is highly concerning for a large intraperitoneal or possibly subcapsular hemorrhage. tiny pockets of air identified and may be related to recent procedure. underlying mass lesion is a source of the hemorrhage cannot be excluded without iv contrast. moderate amount of intra- abdominal and intrapelvic ascites of which has a hemorrhagic component within the pelvis. 2. ill-defined soft tissue mass within the posterior mediastinum, which appears to extend into/through the pericardium and possibly into the left atrium. this mass extends towards the bifurcation of the lingular and lower lobe bronchus and results in postobstructive changes involving the lingula and lower lobes. superinfection of these atelectatic portions of lung cannot be excluded by imaging. appearnce of the volume loss may also be related to prior xrt. 3. moderate to large pericardial effusion. small bilateral pleural effusions. no regions of hemorrhage are identified within these fluid collections. 4. ill-defined hyperdense 3 x 3 cm right-sided peritoneal mass adjacent to the right paracolic gutter is suspicious for peritoneal metastasis or well formed hematoma. 5. multiple small bilateral pulmonary nodules as described above. these may be inflammatory in etiology, but given underlying history of malignancy, a three-month followup chest ct is recommended if there is lack of prior exams to document stability. 6. exophytic left upper pole renal lesion which is not clearly a simple cyst. dedicated contrast enhanced cross-sectional imaging (mri or ct) is recommended when feasible to exclude underlying renal cell carcinoma/metastasis. . ruq us () impression: in conjunction with the same day ct, a heterogeneous fluid collection surrounding and causing mass effect upon the the left hepatic lobe likely represents hemorrhage, largely subcapsular in location. evaluation of the underlying left hepatic parenchyma is limited. . brief hospital course: mr is a 56-year-old man with history of small cell lung cancer, cad (bms in , in lcx in ), type ii dm, iv drug use was transferred from osh with pericardial effusion. . # pericardial effusion: large pericardial effusion noted at osh on chest ct; tte showed large circumferential pericardial effusion with diastolic collapse of ra but not rv. pt was treated with pericardiocentesis but minimal fluid drained. transferred to for further evaluation and treatment. s/p ccu stay for close monitoring. pericardial window was considered, but pt remained hemodynamically stable and repeat tte x2 showed stable effusion. the effusion is likely malignant in etiology, caused by progression of his known small cell lung cancer. other causes considered include radiation (from xrt) vs infectious vs autoimmune vs uremic, however, these are much less likely. pt was discharged home with followup with his cardiologist (dr , ) at within 1 week. . # cad: s/p angioplasty in and in lcx in . no ischemic changes on ecg. clopidogrel was stopped, since the was placed in . asa, statin, bb, acei continued. . # small cell lung cancer: chest ct reportedly showed recurrent lung tumor. already s/p chemo and xrt in . cea = 25 on this admission. discussed w outpatient oncologist (dr - ) the need for a biopsy w vats (along w a possible pericardial window), however, the oncologist recommended another cycle of chemotherapy if pt stable from a cardiac point of view without further invasive procedures. . # dm2: reportedly off insulin and oral meds due to normoglycemia. . comm: hcp mother-in-law , daughter , son medications on admission: atorvastatin 80 mg qday nitroglycerin sl prn aspirin 325 mg qday clopidogrel 75 mg qday metoprolol 25 mg lisinopril 10 mg qday quetiapine 25 mg qhs discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 4. quetiapine 25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 5. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: home discharge diagnosis: primary: pericardial effusion secondary: small cell lung cancer, coronary artery disease, type 2 diabetes, hyperlipidemia, hypertension discharge condition: stable, with persistent pericardial effusion discharge instructions: you were transferred to for a pericardial effusion. this is likelky due to the recurrence of your lung cancer. you should follow up with your oncologist about further treatment. . in the hospital you were found to have some bleeding around your liver. you needed blood transfusions for this. your blood counts were stable prior to your discharge. . your clopidogrel was stopped in the hospital because you only need to take that medication for 1 year after the stent. we did not change your other medications. . please return to the hospital if you have shortness of breath, chest pain, high fevers and chills, or other symptoms that are concerning to you. followup instructions: please follow up with your oncologist and your primary care physician. . please call your primary cardiologist (dr , ) for appointment within 1 week of your discharge from the hospital. you will need to have a repeat echocardiogram at this time. . if your cardiologist decides a pericardial window is needed, you may follow up with dr. at ( for this. . please call your primary oncologist (dr , ) for appointment within 1 week of your discharge from the hospital. procedure: transfusion of packed cells diagnoses: abnormal coagulation profile coronary atherosclerosis of native coronary artery tobacco use disorder acute kidney failure with lesion of tubular necrosis unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified protein-calorie malnutrition hematoma complicating a procedure secondary malignant neoplasm of other specified sites percutaneous transluminal coronary angioplasty status accidental puncture or laceration during a procedure, not elsewhere classified hemorrhage complicating a procedure malignant neoplasm of other parts of bronchus or lung other specified diseases of pericardium personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health secondary malignant neoplasm of mediastinum leukocytosis, unspecified cardiac tamponade late effect of complications of surgical and medical care accidental cut, puncture, perforation or hemorrhage during aspiration of fluid or tissue, puncture, and catheterization 

Answer: The patient is high likely exposed to