CHIEF COMPLAINT: Pruritis and rash
Cirrhosis secondary to ETOH

PRESENT ILLNESS: 70M with ESLD, h/o UGIB s/p variceal banding, s/p TIPS,
cholangitis, and recent admission [**8-16**] with candidemia and coag
negative staph bacteremia comes in with persistent pruritus and
rash worse over the last two days. He was previously evaluated
in the ED on [**10-24**] for these complaints and treated
symptomatically with benadryl and ranitidine with report of some
symptomatic relief. Apparently the rash began ~4 days PTA. At
this point it involves most of his body, although with lesser
involvement of his lower extremities. The rash begins as small
erythematous papules which eventually become more confluent most
noticeably on his bilateral upper extremities. He reports the
rash is quite painful - even to light touch and is quite itchy.
He has not noticed any vesicles or pustules. He denies any mouth
sores or other mucus membrane involvement. He denies any
arthralgias, myalgias, adenopathy, fevers, chills, or sweats. He
has been taking he fluconazole consistently.
.
In the ED, his triage vitals were T97.8, P 90 Bp 98/55, RR 16,
O2 99% on room air. He was given Benadryl 50mg IV once.
Dermatology was consulted and obtained a punch biopsy of the
rash.

MEDICAL HISTORY: 1. ESLD with portal hypertension, formerly with refractory
ascites requiring bimonthly paracentesis (now s/p TIPS, see
below)
2. Upper GI bleed ([**2174**]) s/p variceal banding at [**Hospital1 2025**], second
UGIB s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and TIPS on [**2174-1-14**] - EGD with varices in
lower 3rd of esophagus, portal gastropathy
3. Candidemia [**8-16**]
--no evidence of ocular involvement on exam, TTE clean
--s/p IV fluconazole, to continue PO fluconazole ppx
indefinitely (until transplant)
4. h/o alcohol abuse, quit with dx of liver disease
5. Biliary Colic s/p biliary stenting -- now removed
6. Cholangitis complicated elective ERCP
7. h/o hyponatremia as low as 119
8. Herniated discs between L3/L4
9. Psoriasis
10. Liver transplant [**2174-10-29**]

MEDICATION ON ADMISSION: furosemide 20 mg daily
spironolactone 50mg daily
fluconazole 200mg PO BID
lactulose
protonix 40mg daily
spectavite
fluocinonide cream

ALLERGIES: Penicillins / Macrolide Antibiotics / Quinolones / Ursodiol /
Tape

PHYSICAL EXAM: T 98 P 83 BP 110/60 RR 18 O2 100% on room air
General: Elderly man sitting up eating dinner in no acute
distress
HEENT: Sclera white, conjunctiva pale. No oral lesions
Neck: No adenopathy
CV: Regular rate S1 S2 II/VI HSM LLSB
Pulm: Lungs clear bilaterally
Abd: Soft, +BS, umbilical and ventral hernia present. Very light
touch of the rash over his abdomen is painful.
Extrem: Warm, no edema
Derm: Jaundice. Small erythematous papular rash diffusely
located bilaterally on trunk, arms, and lower extremities to
mid-calf. Not in any clear dermatomal or sun-exposed
distribution. Palms and soles are spared. Erythema is more
confluent over his forearms with bruising. No vesicles/bullae.
The rash is - inconsistently - very tender.

FAMILY HISTORY: His father was an alcoholic. There is no known family history of
liver disease.

SOCIAL HISTORY: Significant history of alcohol use, drinking from the age of 25
until recently, stopping approximately one year ago. He has no
history of illicit drug use. He smoked half a pack of cigarettes
per day for 20 years, but has been off them for 20 years. He
never received a blood transfusion prior to [**2157**].
Dermatitis due to drugs and medicines taken internally,Acute kidney failure, unspecified,Portal hypertension,Urinary tract infection, site not specified,Unspecified pleural effusion,Other ascites,Other and unspecified mycoses,Alcoholic cirrhosis of liver,Other and unspecified anti-infectives causing adverse effects in therapeutic use,Other acute pain
Drug dermatitis NOS,Acute kidney failure NOS,Portal hypertension,Urin tract infection NOS,Pleural effusion NOS,Ascites NEC,Mycoses NEC & NOS,Alcohol cirrhosis liver,Adv eff antinfct NEC/NOS,Acute pain NEC
Name:  [**Known lastname 3205**],[**Known firstname **] D.               Unit No:   [**Numeric Identifier 11899**]

Admission Date:  [**2174-10-26**]              Discharge Date:   [**2174-11-7**]

Date of Birth:  [**2103-11-23**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Macrolide Antibiotics / Quinolones / Ursodiol /
Tape

Attending:[**First Name3 (LF) 4097**]
Addendum:
Mr. [**Known lastname **] experienced a short duration of acute renal failure
during his hospital stay.  His serum creatinine peaked at 2.1 on
[**2174-10-31**].  By [**2174-11-3**] his serum creatinine was back to his
baseline of 1.1.

Discharge Disposition:
Home With Service

Facility:
[**Company 720**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 4098**] MD [**MD Number(2) 4099**]

Completed by:[**2174-11-25**]

Admission Date:  [**2174-10-26**]              Discharge Date:   [**2174-11-7**]

Date of Birth:  [**2103-11-23**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / Macrolide Antibiotics / Quinolones / Ursodiol /
Tape

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
Pruritis and rash
Cirrhosis secondary to ETOH

Major Surgical or Invasive Procedure:
Liver transplant [**2174-10-29**]


History of Present Illness:
70M with ESLD, h/o UGIB s/p variceal banding, s/p TIPS,
cholangitis, and recent admission [**8-16**] with candidemia and coag
negative staph bacteremia comes in with persistent pruritus and
rash worse over the last two days. He was previously evaluated
in the ED on [**10-24**] for these complaints and treated
symptomatically with benadryl and ranitidine with report of some
symptomatic relief. Apparently the rash began ~4 days PTA. At
this point it involves most of his body, although with lesser
involvement of his lower extremities. The rash begins as small
erythematous papules which eventually become more confluent most
noticeably on his bilateral upper extremities. He reports the
rash is quite painful - even to light touch and is quite itchy.
He has not noticed any vesicles or pustules. He denies any mouth
sores or other mucus membrane involvement. He denies any
arthralgias, myalgias, adenopathy, fevers, chills, or sweats. He
has been taking he fluconazole consistently.
.
In the ED, his triage vitals were T97.8, P 90 Bp 98/55, RR 16,
O2 99% on room air. He was given Benadryl 50mg IV once.
Dermatology was consulted and obtained a punch biopsy of the
rash.

Past Medical History:
1. ESLD with portal hypertension, formerly with refractory
ascites requiring bimonthly paracentesis (now s/p TIPS, see
below)
2. Upper GI bleed ([**2174**]) s/p variceal banding at [**Hospital1 2025**], second
UGIB s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and TIPS on [**2174-1-14**] - EGD with varices in
lower 3rd of esophagus, portal gastropathy
3. Candidemia [**8-16**]
--no evidence of ocular involvement on exam, TTE clean
--s/p IV fluconazole, to continue PO fluconazole ppx
indefinitely (until transplant)
4. h/o alcohol abuse, quit with dx of liver disease
5. Biliary Colic s/p biliary stenting -- now removed
6. Cholangitis complicated elective ERCP
7. h/o hyponatremia as low as 119
8. Herniated discs between L3/L4
9. Psoriasis
10. Liver transplant [**2174-10-29**]

Social History:
Significant history of alcohol use, drinking from the age of 25
until recently, stopping approximately one year ago. He has no
history of illicit drug use. He smoked half a pack of cigarettes
per day for 20 years, but has been off them for 20 years. He
never received a blood transfusion prior to [**2157**].


Family History:
His father was an alcoholic. There is no known family history of
liver disease.

Physical Exam:
T 98 P 83 BP 110/60 RR 18 O2 100% on room air
General: Elderly man sitting up eating dinner in no acute
distress
HEENT: Sclera white, conjunctiva pale. No oral lesions
Neck: No adenopathy
CV: Regular rate S1 S2 II/VI HSM LLSB
Pulm: Lungs clear bilaterally
Abd: Soft, +BS, umbilical and ventral hernia present. Very light
touch of the rash over his abdomen is painful.
Extrem: Warm, no edema
Derm: Jaundice. Small erythematous papular rash diffusely
located bilaterally on trunk, arms, and lower extremities to
mid-calf. Not in any clear dermatomal or sun-exposed
distribution. Palms and soles are spared. Erythema is more
confluent over his forearms with bruising. No vesicles/bullae.
The rash is - inconsistently - very tender.

On Discharge:
Gen: no acute distress
HEENT: anicteric sclera, mucus membranes moist
Neck: no lymphadenopathy
CV: RRR
Pulm: clear bilaterally
Abd: soft, nontender, nondistended, incisions clean and without
erythema or drainage
Ext: 2+ distal pulses, 2+ pitting edema up to the mid-shin
level, echymoses on both arms

Pertinent Results:
On Admission:
[**2174-10-26**] 02:00PM BLOOD WBC-6.1 RBC-2.92* Hgb-9.3* Hct-27.8*
MCV-95 MCH-32.0 MCHC-33.5 RDW-15.1 Plt Ct-132*
[**2174-10-27**] 06:05AM BLOOD PT-15.5* PTT-40.6* INR(PT)-1.4*
[**2174-10-26**] 02:00PM BLOOD Glucose-100 UreaN-10 Creat-1.2 Na-130*
K-4.1 Cl-99 HCO3-26 AnGap-9
[**2174-10-26**] 02:00PM BLOOD ALT-32 AST-89* CK(CPK)-130 AlkPhos-416*
Amylase-74 TotBili-2.1*
[**2174-10-26**] 02:00PM BLOOD Lipase-51
[**2174-10-27**] 06:05AM BLOOD Albumin-2.2* Calcium-8.0* Phos-3.9 Mg-2.0

POD #1 labs:
[**2174-10-29**] 08:46AM BLOOD ALT-1532* AST-2306* AlkPhos-181*
Amylase-37 TotBili-1.9* DirBili-1.0* IndBili-0.9

On Discharge:
[**2174-11-7**] 04:10AM BLOOD WBC-7.1 RBC-3.10* Hgb-9.6* Hct-27.6*
MCV-89 MCH-31.1 MCHC-35.0 RDW-19.4* Plt Ct-225#
[**2174-11-7**] 04:10AM BLOOD Glucose-89 UreaN-24* Creat-1.2 Na-137
K-4.8 Cl-104 HCO3-26 AnGap-12
[**2174-11-7**] 04:10AM BLOOD ALT-148* AST-39 AlkPhos-115 TotBili-1.2


Brief Hospital Course:
ASSESSEMENT/PLAN: 70 yo M with alcoholic cirrhosis admitted with
erythematous, pruritic rash with associated hyperesthesia.
Urine culture grew bactrim sensitive e. coli. Bactrim was
started for a 7 day course. He was monitored for drug reactions.
 The rash was consistent with prior drug reactions in the past.
This rash was worrisome for possible disseminated zoster,
therefore he was started on IV acyclovir. Dermatology was
consulted, biopsy revealed drug reation (unknown which drug),
recommended treatment with Clobatesol cream and followup with
dermatology. Provided benadryl, sarna lotion and eucerin cream
prn for pruritus. IV acyclovir was discontinued after biopsy
results.

Alcoholic cirrhosis: Had no evidence of GIB or encephalopathy
when initially admitted. Was continued on home regimen
diuretics, lactulose & pantoprazole. Was on liver transplant
list upon admission when a donor liver became available. He
underwent liver transplant [**2174-10-29**]. Surgeon was Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **]. Please see operative report for full details. Periop
antibiotics were vanco and ceftaz. Two 19-[**Doctor Last Name 406**] drains were
placed, 1 behind the right lobe of the liver and the 2nd behind
the porta hepatis. Postop, he was transferred to the SICU
intubated. U/S of the liver was limited exam demonstrating
appropriate venous and arterial flow in a post transplant liver.
There was a small right lower quadrant ascites and a small right
pleural effusion noted. He self extubated or tongued out his ET
tube. He was eventually transferred out of the SICU. LFTs
continued to trend down. The [**Doctor Last Name 406**] drains were removed and
sutured.

Diet was advanced and tolerated. He was ambulatory with PT using
a rolling walker. The walker was not needed at time of
discharge.  Vital signs remained stable. His weight was above
his preop weight by 15.4kg. IV lasix and albumin were given with
weight and edema decreasing. On the day of discharge, his weight
was 71.3 Preop weight was 70.9. He had 2+pitting edema to mid
tibias. Lasix 20mg [**Hospital1 **] was ordered for home for 5 days.

Prograf was started on pod 2. This was adjusted based on levels.
On the day of discharge, prograf level was 11.9. He remained on
prograf 4mg [**Hospital1 **]. Cellcept 1 gram [**Hospital1 **] continued and solumedrol
was tapered to 20mg starting on [**11-4**]. The incision was open to
air, well approximated with staples and clean.

VNA services were arranged for continuation of insulin/glucose
management. Sliding scale insulin was required on a prn basis
for mild hyperglycemia secondary to steroids.


Medications on Admission:
furosemide 20 mg daily
spironolactone 50mg daily
fluconazole 200mg PO BID
lactulose
protonix 40mg daily
spectavite
fluocinonide cream

Discharge Medications:
1. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO once a day.

2. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO prn: q 4 hours.
Disp:*30 Tablet(s)* Refills:*0*
3. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
6. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
7. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): stop if loose stool or diarrhea.
Disp:*60 Capsule(s)* Refills:*2*
9. Valganciclovir 450 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Insulin Regular Human 100 unit/mL Solution Sig: follow
sliding scale  Injection four times a day.
Disp:*1 bottle* Refills:*1*
11. Syringes
1 box of low dose insulin syringes for sliding scale insulin qid
prn
refill: 1
12. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 5
days.
Disp:*10 Tablet(s)* Refills:*0*
13. Test Strips
1 box-One Touch Ultra
refill: 1
14. Lancets
1 box
refill: 1


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
 Rash secondary to drug reaction
ETOH cirrhosis


Discharge Condition:
good


Discharge Instructions:
Please call the Transplant office [**Telephone/Fax (1) 673**] if fever, chills,
nausea, vomiting, inability to take any of your medications,
jaundice, abdominal pain, incision redness/bleeding/drainage or
any concerns
Labs every Monday and Thursday
[**Month (only) 116**] shower
no driving while taking pain medication

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 156**] TRANSPLANT SOCIAL WORK Date/Time:[**2174-11-17**]
11:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2174-11-17**] 1:20
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2174-11-24**] 1:40
{'Dermatitis due to drugs and medicines taken internally,Acute kidney failure, unspecified,Portal hypertension,Urinary tract infection, site not specified,Unspecified pleural effusion,Other ascites,Other and unspecified mycoses,Alcoholic cirrhosis of liver,Other and unspecified anti-infectives causing adverse effects in therapeutic use,Other acute pain'}


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: Pruritis and rash
Cirrhosis secondary to ETOH

PRESENT ILLNESS: 70M with ESLD, h/o UGIB s/p variceal banding, s/p TIPS,
cholangitis, and recent admission [**8-16**] with candidemia and coag
negative staph bacteremia comes in with persistent pruritus and
rash worse over the last two days. He was previously evaluated
in the ED on [**10-24**] for these complaints and treated
symptomatically with benadryl and ranitidine with report of some
symptomatic relief. Apparently the rash began ~4 days PTA. At
this point it involves most of his body, although with lesser
involvement of his lower extremities. The rash begins as small
erythematous papules which eventually become more confluent most
noticeably on his bilateral upper extremities. He reports the
rash is quite painful - even to light touch and is quite itchy.
He has not noticed any vesicles or pustules. He denies any mouth
sores or other mucus membrane involvement. He denies any
arthralgias, myalgias, adenopathy, fevers, chills, or sweats. He
has been taking he fluconazole consistently.
.
In the ED, his triage vitals were T97.8, P 90 Bp 98/55, RR 16,
O2 99% on room air. He was given Benadryl 50mg IV once.
Dermatology was consulted and obtained a punch biopsy of the
rash.

MEDICAL HISTORY: 1. ESLD with portal hypertension, formerly with refractory
ascites requiring bimonthly paracentesis (now s/p TIPS, see
below)
2. Upper GI bleed ([**2174**]) s/p variceal banding at [**Hospital1 2025**], second
UGIB s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and TIPS on [**2174-1-14**] - EGD with varices in
lower 3rd of esophagus, portal gastropathy
3. Candidemia [**8-16**]
--no evidence of ocular involvement on exam, TTE clean
--s/p IV fluconazole, to continue PO fluconazole ppx
indefinitely (until transplant)
4. h/o alcohol abuse, quit with dx of liver disease
5. Biliary Colic s/p biliary stenting -- now removed
6. Cholangitis complicated elective ERCP
7. h/o hyponatremia as low as 119
8. Herniated discs between L3/L4
9. Psoriasis
10. Liver transplant [**2174-10-29**]

MEDICATION ON ADMISSION: furosemide 20 mg daily
spironolactone 50mg daily
fluconazole 200mg PO BID
lactulose
protonix 40mg daily
spectavite
fluocinonide cream

ALLERGIES: Penicillins / Macrolide Antibiotics / Quinolones / Ursodiol /
Tape

PHYSICAL EXAM: T 98 P 83 BP 110/60 RR 18 O2 100% on room air
General: Elderly man sitting up eating dinner in no acute
distress
HEENT: Sclera white, conjunctiva pale. No oral lesions
Neck: No adenopathy
CV: Regular rate S1 S2 II/VI HSM LLSB
Pulm: Lungs clear bilaterally
Abd: Soft, +BS, umbilical and ventral hernia present. Very light
touch of the rash over his abdomen is painful.
Extrem: Warm, no edema
Derm: Jaundice. Small erythematous papular rash diffusely
located bilaterally on trunk, arms, and lower extremities to
mid-calf. Not in any clear dermatomal or sun-exposed
distribution. Palms and soles are spared. Erythema is more
confluent over his forearms with bruising. No vesicles/bullae.
The rash is - inconsistently - very tender.

FAMILY HISTORY: His father was an alcoholic. There is no known family history of
liver disease.

SOCIAL HISTORY: Significant history of alcohol use, drinking from the age of 25
until recently, stopping approximately one year ago. He has no
history of illicit drug use. He smoked half a pack of cigarettes
per day for 20 years, but has been off them for 20 years. He
never received a blood transfusion prior to [**2157**]. 

### Response:
{'Dermatitis due to drugs and medicines taken internally,Acute kidney failure, unspecified,Portal hypertension,Urinary tract infection, site not specified,Unspecified pleural effusion,Other ascites,Other and unspecified mycoses,Alcoholic cirrhosis of liver,Other and unspecified anti-infectives causing adverse effects in therapeutic use,Other acute pain'}
