CHIEF COMPLAINT: Fever, cough

PRESENT ILLNESS: 64yo man with history of pulmonary fibrosis on 2L home O2, on
lung transplant list, presents with worsening cough, fever,
chills and increasing O2 requirement. He has felt generally
unwell for about 2 weeks, noting that he had decreased exercise
tolerance and decreased energy. Then starting Thursday, he had
fevers up to 101.7 accompanied by sweats. Notes worsening of his
baseline, dry cough. He stopped taking pirfenidone then. Started
on azithromycin Saturday morning without improvement. Went to
see his PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1007**] in clinic for a physical, where he had
rales at his bilateral bases and appeared unwell.

MEDICAL HISTORY: - idiopathic pulmonary fibrosis, diagnosed in [**2134**], has been
progressive. Currently on transplant list at [**Hospital1 2025**], where his
work-up included a right-heart cath one year ago with mild
pulmonary HTN. Most recent PFTs have moderate restrictive
pattern and severe diffusion limitation. Wears between 2 and 6
liters O2 at home depending on level of exertion.
- systolic murmur

MEDICATION ON ADMISSION: - iodoquinol 1% cream apply [**Hospital1 **]
- mupirocin 2% ointment daily
- pirfenidone 3 tabs TID (study drug - anti fibrotic [**Doctor Last Name 360**] that
blocks various growth factors) -> stopped Thursday
- sildenafil 20mg TID -> stopped 1 month ago w/o change
- Vitamin D
- multivitamin

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:
Vitals: T: 99.1 BP: 133/56 P: 102 R: 25 O2: 88-90% on 4L NC when
talking, 94% at rest
General: Alert, oriented, moderate respiratory distress when
coughing
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Fine crackles throughout, fair air movement.
CV: Regular rate and rhythm, faint systolic murmur
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses. Finger tips with clubbing
and mild cyanosis. No edema.

FAMILY HISTORY: Father died of TB. Mother died of esophageal cancer. Has two
sisters who are healthy. No history of interstitial lung
disease.

SOCIAL HISTORY: Lives with wife and daughter. [**Name (NI) 1403**] for a mutual fund company.
- Tobacco: denies
- Alcohol: social
- Illicits: denies
Pneumonia, organism unspecified,Awaiting organ transplant status,Other dependence on machines, supplemental oxygen,Postinflammatory pulmonary fibrosis
Pneumonia, organism NOS,Await organ transplnt st,Depend-supplement oxygen,Postinflam pulm fibrosis
Admission Date:  [**2141-7-24**]              Discharge Date:   [**2141-7-27**]

Date of Birth:  [**2077-6-26**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Doctor Last Name 10493**]
Chief Complaint:
Fever, cough


Major Surgical or Invasive Procedure:
None

History of Present Illness:
64yo man with history of pulmonary fibrosis on 2L home O2, on
lung transplant list, presents with worsening cough, fever,
chills and increasing O2 requirement. He has felt generally
unwell for about 2 weeks, noting that he had decreased exercise
tolerance and decreased energy. Then starting Thursday, he had
fevers up to 101.7 accompanied by sweats. Notes worsening of his
baseline, dry cough. He stopped taking pirfenidone then. Started
on azithromycin Saturday morning without improvement. Went to
see his PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1007**] in clinic for a physical, where he had
rales at his bilateral bases and appeared unwell.

In the ED, initial vs were: T 98.0 P 104 BP 134/73 R 24 O2 sat
96% 4L. Patient was given levofloxacin and 1L NS. Afebrile. UA
negative, WBC count 15 with left shift. Initially to go to floor
but had repeated desats to the 80s requiring additional oxygen.
.
On the floor, the patient has a frequent, paroxysmal,
non-productive cough. He has mild chest pain when coughing. He
has had loose BM's for the last couple of days. Has occasional
mild burning with urination, not worse currently. Denies N/V,
abdominal pain, headache, rash or arthralgias. He has never been
hospitalized. All other ROS negative.


Past Medical History:
- idiopathic pulmonary fibrosis, diagnosed in [**2134**], has been
progressive. Currently on transplant list at [**Hospital1 2025**], where his
work-up included a right-heart cath one year ago with mild
pulmonary HTN. Most recent PFTs have moderate restrictive
pattern and severe diffusion limitation. Wears between 2 and 6
liters O2 at home depending on level of exertion.
- systolic murmur


Social History:
Lives with wife and daughter. [**Name (NI) 1403**] for a mutual fund company.
- Tobacco: denies
- Alcohol: social
- Illicits: denies


Family History:
Father died of TB. Mother died of esophageal cancer. Has two
sisters who are healthy. No history of interstitial lung
disease.


Physical Exam:
On admission:
Vitals: T: 99.1 BP: 133/56 P: 102 R: 25 O2: 88-90% on 4L NC when
talking, 94% at rest
General: Alert, oriented, moderate respiratory distress when
coughing
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Fine crackles throughout, fair air movement.
CV: Regular rate and rhythm, faint systolic murmur
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses. Finger tips with clubbing
and mild cyanosis. No edema.

On Discharge:
97.5 110/68 74 18 98% 1L
Well appearing, breathing comfortably with oxygen in place.
Bilateral crackles persist on discharge but improved from
admission.

Pertinent Results:
ADMISSION LABS
--------------
[**2141-7-24**] 02:00PM BLOOD WBC-15.0*# RBC-4.91 Hgb-15.4 Hct-44.7
MCV-91 MCH-31.3 MCHC-34.4 RDW-14.6 Plt Ct-223
[**2141-7-24**] 02:00PM BLOOD Neuts-90.0* Lymphs-6.3* Monos-3.1 Eos-0.5
Baso-0.2
[**2141-7-24**] 02:00PM BLOOD Glucose-105* UreaN-22* Creat-1.0 Na-138
K-3.9 Cl-101 HCO3-22 AnGap-19
[**2141-7-24**] 02:09PM BLOOD Lactate-1.6
.
DISCHARGE LABS
--------------
[**2141-7-27**] 06:45AM BLOOD WBC-8.9 RBC-4.50* Hgb-13.8* Hct-41.1
MCV-91 MCH-30.7 MCHC-33.6 RDW-14.3 Plt Ct-243
[**2141-7-27**] 06:45AM BLOOD Glucose-108* UreaN-17 Creat-0.9 Na-139
K-4.7 Cl-102 HCO3-27 AnGap-15

.
MICROBIOLOGY
------------
Blood culture [**7-24**] x 2: pending
Legionella urine antigen: negative
.
[**2141-7-25**] 11:13 am Rapid Respiratory Viral Screen & Culture
      Source: Nasopharyngeal swab.

   Respiratory Viral Culture (Preliminary):

   Respiratory Viral Antigen Screen (Final [**2141-7-25**]):
      Negative for Respiratory Viral Antigen.
      Specimen screened for: Adeno, Parainfluenza 1, 2, 3,
Influenza A, B,
      and RSV by immunofluorescence.
      Refer to respiratory viral culture for further
information.
.
IMAGING
-------
Chest X-ray on admission:
IMPRESSION: Mild increase in interstitial markings which could
reflect
worsening fibrosis or superimposed pulmonary interstitial edema.
Please
correlate clinically.


Brief Hospital Course:
64 year old male w/ h/o of advanced idiopathic pulmonary
fibrosis presenting with fever, cough and increased O2
requirement.

ACTIVE ISSUES
-------------
# Dyspnea: Patient had worsening of chronic dyspnea, which was
most likely secondary to infection, either viral or bacterial
superinfection after viral infection.  Viral studies are so far
negative, and are thus far pending.  Worsening of patient's
idiopathic pulmonary fibrosis is also a possibility, and repeat
CT scan may be useful as an outpatient.  Given patient's tenuous
baseline respiratory status and ICU admission, coverage for
hospital acquired pneumonia was deemed reasonable,, and he is
often in pulmonary rehabilitation and at support groups with
chronically ill individuals, giving him significant exposure to
resistant organisms and patient was initiated on vancomycin,
levofloxacin and cefepime.  Patient was narrowed to
levofloxacin, after patient improved and culture data remained
negative
At this point, since we are 48 hours out without culture
positivity, antibiotic regimen can be narrowed to seven day
course of levofloxacin.  Blood cultures and viral swab are
currently pending.  Patient's pirfenidone, a study drug, was
held on admission, and patient will follow up with his
pulmonologist, Dr. [**Last Name (STitle) **], after discharge to determine if he
should continue this medication.  He will also follow up with
his primary care provider.

TRANSITION OF CARE:
# Follow-up: patient will follow up with his primary care
provider and pulmonologist upon discharge.  He has pending blood
cultures and nasopharyngeal viral swab data which will need to
be followed up.

# Code: full code, confirmed


Medications on Admission:
- iodoquinol 1% cream apply [**Hospital1 **]
- mupirocin 2% ointment daily
- pirfenidone 3 tabs TID (study drug - anti fibrotic [**Doctor Last Name 360**] that
blocks various growth factors) -> stopped Thursday
- sildenafil 20mg TID -> stopped 1 month ago w/o change
- Vitamin D
- multivitamin

Discharge Medications:
1. iodoquinol-HC [**2-4**] % Cream Sig: One (1) application Topical
twice a day.
2. mupirocin 2 % Ointment Sig: One (1) application Topical once
a day.
3. sildenafil 20 mg Tablet Sig: One (1) Tablet PO three times a
day.
4. Vitamin D  Oral
5. multivitamin  Oral
6. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 2 days.
Disp:*2 Tablet(s)* Refills:*0*
7. Outpatient medication
Please do not resume taking pirfenidone until instructed by your
pulmonologist, Dr. [**Last Name (STitle) **]
8. Outpatient oxygen therapy
Please resume oxygen therapy per home regimen


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:

Healthcare-associated pneumonia

Secondary diagnosis:

Idiopathic pulmonary fibrosis

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

Discharge Instructions:
Dear Mr. [**Known lastname **],

It was a pleasure taking care of you at [**Hospital1 827**].  You came for further evaluation of shortness of
breath and fever.  Testing showed that you may have bacterial
pneumonia.  It is important that you follow up with your
pulmonologist and primary care provider as listed below and
continue to take your medications as indicated.

The following changes have been made to your medications:

We ADDED levofloxacin, to treat pneumonia, which you should take
until it is totally finished, one more day after discharge

Followup Instructions:
Name: White, [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **], MPH
Address: [**Doctor First Name **],STE 9A, [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 10492**]
Appt: [**Last Name (LF) 2974**], [**7-28**] at 9:30am

Department: MEDICAL SPECIALTIES
When: THURSDAY [**2141-8-3**] at 12:00 PM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**Telephone/Fax (1) 612**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 10491**] MD, [**MD Number(3) 10495**]
{'Pneumonia, organism unspecified,Awaiting organ transplant status,Other dependence on machines, supplemental oxygen,Postinflammatory pulmonary fibrosis'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Fever, cough

PRESENT ILLNESS: 64yo man with history of pulmonary fibrosis on 2L home O2, on
lung transplant list, presents with worsening cough, fever,
chills and increasing O2 requirement. He has felt generally
unwell for about 2 weeks, noting that he had decreased exercise
tolerance and decreased energy. Then starting Thursday, he had
fevers up to 101.7 accompanied by sweats. Notes worsening of his
baseline, dry cough. He stopped taking pirfenidone then. Started
on azithromycin Saturday morning without improvement. Went to
see his PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1007**] in clinic for a physical, where he had
rales at his bilateral bases and appeared unwell.

MEDICAL HISTORY: - idiopathic pulmonary fibrosis, diagnosed in [**2134**], has been
progressive. Currently on transplant list at [**Hospital1 2025**], where his
work-up included a right-heart cath one year ago with mild
pulmonary HTN. Most recent PFTs have moderate restrictive
pattern and severe diffusion limitation. Wears between 2 and 6
liters O2 at home depending on level of exertion.
- systolic murmur

MEDICATION ON ADMISSION: - iodoquinol 1% cream apply [**Hospital1 **]
- mupirocin 2% ointment daily
- pirfenidone 3 tabs TID (study drug - anti fibrotic [**Doctor Last Name 360**] that
blocks various growth factors) -> stopped Thursday
- sildenafil 20mg TID -> stopped 1 month ago w/o change
- Vitamin D
- multivitamin

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On admission:
Vitals: T: 99.1 BP: 133/56 P: 102 R: 25 O2: 88-90% on 4L NC when
talking, 94% at rest
General: Alert, oriented, moderate respiratory distress when
coughing
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Fine crackles throughout, fair air movement.
CV: Regular rate and rhythm, faint systolic murmur
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses. Finger tips with clubbing
and mild cyanosis. No edema.

FAMILY HISTORY: Father died of TB. Mother died of esophageal cancer. Has two
sisters who are healthy. No history of interstitial lung
disease.

SOCIAL HISTORY: Lives with wife and daughter. [**Name (NI) 1403**] for a mutual fund company.
- Tobacco: denies
- Alcohol: social
- Illicits: denies 

### Response:
{'Pneumonia, organism unspecified,Awaiting organ transplant status,Other dependence on machines, supplemental oxygen,Postinflammatory pulmonary fibrosis'}
