CHIEF COMPLAINT: nausea, vomiting, headache

PRESENT ILLNESS: [**Doctor First Name **] is a 23 year-old FTM transgender patient with HIV ([**2197-2-7**]:
VL 931, cd4 318; started Truvada/atazanavir/ritonavir on
[**2197-2-21**], discontinued, restarted two weeks ago), chronic
untreated hepatitis C, and recent zoster who presents with two
days of acute on chronic headache, fevers, nausea, vomiting, and
diarrhea. He describes feeling well until [**2197-1-2**], when he
was hospitalized [**Date range (1) **] with epigastric/LUQ abdominal pain of
unclear etiology and herpes zoster.  He began [**Date range (1) 2775**] [**2197-2-21**]
and was admitted [**2197-2-23**] for headache, fever to 103, nausea,
vomiting and ?zoster recurrence after not completing the course
of acyclovir from the prior admission. He had a negative LP and
largely unremarkable evaluation at that time.
.
He reports persistent malaise since [**Month (only) 956**], never returning to
baseline after the two admissions, and experiencing persistent
headache (distinguished from usual migraines by location and
absence of aura and photophobia), nausea, 2-3 episodes NBNB
emesis per week, intermittent fevers.  Over the last few days,
he developed worsening of these symptoms (severe nausea, [**5-9**]
episodes vomiting, diarrhea x4, fever to 100.5, frontal headache
behind eyes, with new myalgias and arthralgias x1day) for which
he presented to the ED.
.
In the ED, initial vs were: 97.6 83 134/86 18 100. He was given
acylovir 600 mg iv, morphine 4 mg iv x 2, zofran 4mg iv x 1, and
2L NS. An LP was negative and she was treated empirically with
zosyn and acylovir. CT head and abdominal ultrasound were also
negative.
.
On the floor on the morning after admission, he is lying in bed,
mildly anxious, complaining of nausea, headache, and "general
malaise."
.
ROS as per HPI.  In addition, he reports 13 lb weight loss over
2-3 months. He also notes rash and tingling/pain of left arm in
same distribution of previously treated shingles.  Denies
rhinorrhea, congestion, sore throat. Denies cough, shortness of
breath, chest pain or tightness, palpitations, abdominal pain,
dysuria, recent change in bowel or bladder habits.  Denies SI.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
- HIV ([**Month/Day (3) 2775**] started [**2197-2-21**]: Truvada, atazanavir, ritonavir;
diagnosed approx [**2191**], took PMTCT 1 yr ago; [**2197-2-7**]: VL 931, cd4
318; no history OI)
- Hepatitis C diagnosed in [**9-6**], no IFN therapy, last Hep C VL
558,000 [**2197-2-25**]
- Cerebral Palsy, s/p multiple surgeries, persistent leg
spasticity requiring use of wheelchair for long distances, mild
urinary retention at times.
- Asthma, mild intermittent
- Prior thrush due to Advair for asthma
- h/o multiple UTIs secondary to neurogenic bladder

MEDICATION ON ADMISSION: 1. Oxcarbazepine 300 [**Hospital1 **]
2. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for fever, pain.
3. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for headache.
4. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. Concerta 18 daily
6. Truvada, Reyataz, Norvir

ALLERGIES: Latex / Fentanyl / Risperidone

PHYSICAL EXAM: PHYSICAL EXAMINATION (on floor morning of [**2197-4-12**]):
Vitals: T: 98.2 BP: 108/68 P: 81 R: 16 O2: 99% RA
General: Alert, oriented, mild distress
HEENT: +sclera icteric, MMM
Neck: Supple, no meningismus, no cervical or supraclavicular LAD

FAMILY HISTORY: Mother: cancer, ? cervical, ovarian, endometrial (died [**2196-12-2**])

SOCIAL HISTORY: Female-to-male gender, has all female organs, does not take
hormones. Currently lives in [**Hospital1 3494**] with 1 yo son and is in
a relationship with female partner.  Hx of crystal meth, heroin,
cocaine use. Occasional EtOH, +tobacco, reports cutting down to
5 cig/day.  Reports close relationship with his mother's
adoptive family (his grandparents).
Bacteremia,Hydronephrosis,Herpes zoster with other nervous system complications,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Asymptomatic human immunodeficiency virus [HIV] infection status,Other pulmonary insufficiency, not elsewhere classified,Dehydration,Chronic hepatitis C without mention of hepatic coma,Trans-sexualism with unspecified sexual history,Neurogenic bladder NOS,Cirrhosis of liver without mention of alcohol,Infantile cerebral palsy, unspecified,Depressive disorder, not elsewhere classified,Posttraumatic stress disorder,Tobacco use disorder,Panic disorder without agoraphobia,History of physical abuse,Personal history, urinary (tract) infection,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Headache
Bacteremia,Hydronephrosis,H zoster nerv syst NEC,Streptococcus group b,Asymp hiv infectn status,Other pulmonary insuff,Dehydration,Chrnc hpt C wo hpat coma,Trans-sexualism NOS,Neurogenic bladder NOS,Cirrhosis of liver NOS,Cerebral palsy NOS,Depressive disorder NEC,Posttraumatic stress dis,Tobacco use disorder,Panic dis w/o agorphobia,Hx of physical abuse,Personal history UTI,Migrne unsp wo ntrc mgrn,Headache
Admission Date:  [**2197-4-12**]              Discharge Date:   [**2197-4-24**]

Date of Birth:  [**2173-9-6**]             Sex:   F

Service: MEDICINE

Allergies:
Latex / Fentanyl / Risperidone

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
nausea, vomiting, headache

Major Surgical or Invasive Procedure:
None


History of Present Illness:
[**Doctor First Name **] is a 23 year-old FTM transgender patient with HIV ([**2197-2-7**]:
VL 931, cd4 318; started Truvada/atazanavir/ritonavir on
[**2197-2-21**], discontinued, restarted two weeks ago), chronic
untreated hepatitis C, and recent zoster who presents with two
days of acute on chronic headache, fevers, nausea, vomiting, and
diarrhea. He describes feeling well until [**2197-1-2**], when he
was hospitalized [**Date range (1) **] with epigastric/LUQ abdominal pain of
unclear etiology and herpes zoster.  He began [**Date range (1) 2775**] [**2197-2-21**]
and was admitted [**2197-2-23**] for headache, fever to 103, nausea,
vomiting and ?zoster recurrence after not completing the course
of acyclovir from the prior admission. He had a negative LP and
largely unremarkable evaluation at that time.
.
He reports persistent malaise since [**Month (only) 956**], never returning to
baseline after the two admissions, and experiencing persistent
headache (distinguished from usual migraines by location and
absence of aura and photophobia), nausea, 2-3 episodes NBNB
emesis per week, intermittent fevers.  Over the last few days,
he developed worsening of these symptoms (severe nausea, [**5-9**]
episodes vomiting, diarrhea x4, fever to 100.5, frontal headache
behind eyes, with new myalgias and arthralgias x1day) for which
he presented to the ED.
.
In the ED, initial vs were: 97.6 83 134/86 18 100. He was given
acylovir 600 mg iv, morphine 4 mg iv x 2, zofran 4mg iv x 1, and
2L NS. An LP was negative and she was treated empirically with
zosyn and acylovir. CT head and abdominal ultrasound were also
negative.
.
On the floor on the morning after admission, he is lying in bed,
mildly anxious, complaining of nausea, headache, and "general
malaise."
.
ROS as per HPI.  In addition, he reports 13 lb weight loss over
2-3 months. He also notes rash and tingling/pain of left arm in
same distribution of previously treated shingles.  Denies
rhinorrhea, congestion, sore throat. Denies cough, shortness of
breath, chest pain or tightness, palpitations, abdominal pain,
dysuria, recent change in bowel or bladder habits.  Denies SI.

Past Medical History:
PAST MEDICAL HISTORY:
- HIV ([**Month/Day (3) 2775**] started [**2197-2-21**]: Truvada, atazanavir, ritonavir;
diagnosed approx [**2191**], took PMTCT 1 yr ago; [**2197-2-7**]: VL 931, cd4
318; no history OI)
- Hepatitis C diagnosed in [**9-6**], no IFN therapy, last Hep C VL
558,000 [**2197-2-25**]
- Cerebral Palsy, s/p multiple surgeries, persistent leg
spasticity requiring use of wheelchair for long distances, mild
urinary retention at times.
- Asthma, mild intermittent
- Prior thrush due to Advair for asthma
- h/o multiple UTIs secondary to neurogenic bladder

PSH:
- s/p appendectomy [**12-7**]
- c-section [**2194**]

PAST PSYCHIATRIC HISTORY:
- Depression: Sees Dr. [**Last Name (STitle) 57035**] at [**Hospital3 55848**] Health Center,
taking Cymbalta.
- History of suicide attempts: last SA was in [**10-8**], requiring
ICU admission at [**Hospital 8**] Hospital. Pt overdosed on his
medications at that point (Prozac, Trileptal, Seroquel). Reports
hx of 2 SA by OD, and 2 SA by cutting. First SA at age 13-14.
- History of self cutting, last circa [**2191**], self reports near
fatal cut.
- History of anorexia/bulimia, currently with active behaviors
including restricting and purging.
- PTSD - rape survivor
- ADHD - on Concerta
- OCD
- Trauma/Abuse


Social History:
Female-to-male gender, has all female organs, does not take
hormones. Currently lives in [**Hospital1 3494**] with 1 yo son and is in
a relationship with female partner.  Hx of crystal meth, heroin,
cocaine use. Occasional EtOH, +tobacco, reports cutting down to
5 cig/day.  Reports close relationship with his mother's
adoptive family (his grandparents).

Family History:
Mother: cancer, ? cervical, ovarian, endometrial (died [**2196-12-2**])


Physical Exam:
PHYSICAL EXAMINATION (on floor morning of [**2197-4-12**]):
Vitals: T: 98.2 BP: 108/68 P: 81 R: 16 O2: 99% RA
General: Alert, oriented, mild distress
HEENT: +sclera icteric, MMM
Neck: Supple, no meningismus, no cervical or supraclavicular LAD

Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: Nonerythematous, papular lesions on left forearm and arm,
no vesicles.

Exam at discharge ([**4-24**]):

Vitals: T: 98.0 BP: 99/62 P: 64 R: 16 O2: 97% RA
General: Alert, oriented, no distress
HEENT: extraocular movements intact, conjunctivae noninjected,
sclera anicteric, moist mucous membranes
Neck: Supple, no meningismus, no cervical or supraclavicular LAD

Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: No erythema, icterus, or exanthem


Pertinent Results:
[**2197-4-11**]: WBC-6.9# RBC-4.81 Hgb-12.3 Hct-37.8 MCV-78* RDW-14.0
Plt Ct-339
Neuts-66.9 Lymphs-26.4 Monos-5.3 Eos-0.8 Baso-0.6

[**2197-4-12**] calTIBC-355 Ferritn-50 TRF-273

[**2197-4-12**]: WBC-7.9 Lymph-7* Abs [**Last Name (un) **]-553 CD3%-80 Abs CD3-441*
CD4%-36 Abs CD4-200* CD8%-40 Abs CD8-220 CD4/CD8-0.9

[**2197-4-15**] ESR-30*
[**2197-4-12**] CRP-32.9*

[**2197-4-11**]: Glucose-98 UreaN-7 Creat-0.7 Na-135 K-4.0 Cl-98
HCO3-27 AnGap-14
ALT-49* AST-43* LD(LDH)-151 AlkPhos-89 TotBili-6.9* DirBili-0.2
IndBili-6.7 Lipase-27

[**2197-4-17**]: ALT-33 AST-30 AlkPhos-67 TotBili-0.4 DirBili-0.1
IndBili-0.3

[**2197-4-12**]: tTG-IgA-1

[**2197-4-12**] URINE RBC-0-2 WBC-[**5-11**]* Bacteri-FEW Yeast-NONE Epi-3-5
Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG
Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-TR
.
[**2197-4-12**] CEREBROSPINAL FLUID (CSF):
WBC-3 RBC-0 Polys-0 Lymphs-93 Monos-7 TotProt-29 Glucose-60
HERPES SIMPLEX VIRUS PCR-NEGATIVE
CRYPTOCOCCAL ANTIGEN NEGATIVE
.
[**4-12**]: blood culture negative x2
[**4-12**], [**4-13**]: blood culture positive x3 for Group B Strep
[**4-12**]: urine culture positive for Group B Strep
.
HCV VIRAL LOAD (Final [**2197-4-13**]): 2,720,000 IU/mL.
CMV PCR negative
.
Head CT ([**2197-4-12**]): negative for mass or bleed
CXR ([**2197-4-12**]): negative
RUQ Ultrasound ([**2197-4-12**]): no abnormalities noted
KUB ([**2197-4-12**]): no abnormalities noted
.
TTE ([**2197-4-14**]): no evidence of endocarditis
TEE ([**2197-4-20**]): no evidence of endocarditis
.
CT abd/pelvis ([**2197-4-14**]): 1. New left hydronephrosis and
hydroureter. While no obstructing stone or mass is seen, stones
in patients who are on Indivir are not radioopaque on CT and
this cannot be excluded. 2. Mild periportal edema and probable
mild gallbladder wall edema represent nonspecific findings. No
biliary ductal dilatation. 3. Splenomegaly, similar to before.
4. Borderline retroperitoneal and pelvic lymph node enlargement
redemonstrated. 5. Dependent atelectatic changes in both lung
bases.
.
Abdominal ultrasound ([**2197-4-15**]): no hydronephrosis; small
amount of fluid at superior pole of right kidney; gallbladder
with large amount of sludge, not overly dilated, apparent
gallbladder wall thickening and edema is seen, but the patient
was not in pain and there was no son[**Name (NI) 493**] [**Name2 (NI) 515**] sign.
.
Labs on discharge ([**4-24**]):
[**2197-4-23**] 07:12AM BLOOD WBC-6.7 RBC-4.27 Hgb-10.9* Hct-34.4*
MCV-81* MCH-25.4* MCHC-31.6 RDW-14.8 Plt Ct-457*
[**2197-4-23**] 07:12AM BLOOD Neuts-65.4 Lymphs-27.2 Monos-6.5 Eos-0.2
Baso-0.8
[**2197-4-23**] 07:12AM BLOOD Glucose-76 UreaN-12 Creat-0.5 Na-137
K-4.5 Cl-101 HCO3-28 AnGap-13

Brief Hospital Course:
Reviewed by problem:
.
1. Group B Strep (GBS) bacteremia.  On the day of admission
([**2197-4-12**]), [**Doctor First Name **] developed fever to 100.5.  The next day, he
was hypotensive to SBP of 70 (responsive to IVF) and his
temperature spiked to 104.  Blood and urine cultures drawn [**4-12**]
were positive for gram positive cocci, and he was started on
vancomycin; once the results showed Group B Streptococcus, he
was changed to ceftriaxone.  Blood and urine cultures cleared by
[**2197-4-14**], and he remained afebrile throughout the
hospitalization.  AFB/fungal blood cultures were negative.  No
source for the bacteremia was identified on CT abd/pelvis or
abdominal US and the patient refused a pelvic exam.  TTE was
negative for endocarditis.  TEE performed [**4-20**] was also negative
for endocarditis, but was complicated by respiratory distress
(stridor, but no airway obstruction or inflammation on
laryngo-bronchoscopy) leading to intubation.  [**Doctor First Name **] was extubated
the next day without incident.  A midline was placed [**4-20**] and
the patient was discharged with VNA and infusion services to
complete a 3 week course of IV antibiotics.
.
2. Respiratory distress ([**2197-4-20**]). Per the report of the PACU
staff, the patient recovered from the TEE sedation (primarily
propofol) well, and the patient reports being awake and feeling
fine.  Then around 5:15pm, he developed tachypnea and chest
discomfort, "as if someone was sitting on my chest", that was
unlike any of his previous asthma exacerbations.  He began
making stridorous upper airway sounds and using accessory
muscles to breath, though he remained normotensive and was
satting in the mid to upper 90s.  Epinephrine had no effect and
no airway edema was visualized on laryngoscopy, but given the
persistent distress, the team decided to electively intubate,
and the patient was transferred to the MICU.  After intubation,
the respiratory team in the PACU performed bronchoscopy, which
failed to reveal any evidence of airway inflammation or
obstruction.  The patient was extubated the following morning
without incident.  The etiology of the distress seems most
likely to be psychiatric in etiology.
.
3.  Headache. The patient reported a different quality to this
headache than is usual for his migraines, but neurological exam
was nonfocal and CSF was negative for infection.  He was treated
symptomatically with acetaminophen, ketorolac, fioricet, and at
times po narcotics.  It improved during the hospitalization and
the patient denied headache on the day of discharge.
.
4. Nausea and emesis.  The etiology is unclear from prior
studies and abdominal exam was benign throughout the
hospitalization.  His symptoms seemed to be exacerbated by the
antiretrovirals, especially ritonavir.  He was treated
symptomatically with ondansetron and metoclopramide.  Compazine
was tried, but made the patient sedated; he also reported a
dystonic type reaction.
.
5. HIV. Truvada, atazanavir, and ritonavir were continued during
the hospitalization.  His unconjugated hyperbilirubinemia was
attributed to atazanavir and was probably exacerbated by
decreased urine output secondary to neurogenic bladder.
.
6. Neurogenic bladder. A Foley was placed during the admission
after hydronephrosis was seen on CT abd/pelvis; the
hydronephrosis resolved after placement.  He was discharged with
a Foley in place (to be changed by VNA) and to follow up with
urology.
.
7. Left arm pain/tingling.  Initially was thought to be possible
zoster recurrence, but absence of rash/progression was more
consistent with post-herpetic neuralgia.  Was initially treated
with gabapentin (which was discontinued due to sedation and
possible GI side effects) and lidocaine patch (which was
continued throughout hospitalization).
.
8. Gallbladder wall thickening/edema.  Unclear significance,
with no clinical correlation, most likely related to aggressive
IV fluid hydration for hypotension.
--Would recommend following up with RUQ US in [**1-4**] months.

Medications on Admission:
1. Oxcarbazepine 300 [**Hospital1 **]
2. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for fever, pain.
3. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for headache.
4. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. Concerta 18 daily
6. Truvada, Reyataz, Norvir

Discharge Medications:
1. Oxcarbazepine 150 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
2. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
3. Ritonavir 100 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
4. Atazanavir 150 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
5. Emtricitabine-Tenofovir 200-300 mg Tablet Sig: One (1) Tablet
PO DAILY (Daily).
6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
7. Concerta 18 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet
Extended Rel 24 hr PO once a day.
8. Outpatient Lab Work
Weekly (on [**4-10**], [**5-9**]): CBC, chem7, ALT, AST, alk phos,
bilirubin (total and direct), CRP, ESR, tox screen

Please fax results to [**Telephone/Fax (1) 1419**], attn: [**First Name8 (NamePattern2) 2808**] [**Last Name (NamePattern1) 1352**].
9. Ceftriaxone in Dextrose,Iso-os 2 gram/50 mL Piggyback Sig:
One (1)  Intravenous Q24H (every 24 hours) for 12 days: starting
[**2197-4-24**]
last dose [**2197-5-5**].
Disp:*12 bags* Refills:*0*
10. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily).
Disp:*14 Adhesive Patch, Medicated(s)* Refills:*0*
11. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO every six
(6) hours as needed for nausea.
Disp:*40 Tablet(s)* Refills:*0*
12. Clotrimazole 1 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day).
Disp:*1 tube* Refills:*0*
13. Ondansetron 4 mg Tablet, Rapid Dissolve Sig: [**12-3**] Tablet,
Rapid Dissolves PO every 4-6 hours as needed for nausea.
Disp:*40 Tablet, Rapid Dissolve(s)* Refills:*0*
14. Foley
Please change Foley on [**2197-5-22**].
15. Foley Catheter 14 Fr Misc Sig: One (1)  Miscellaneous once a
month.
Disp:*2 * Refills:*0*
16. leg bag for Foley
dispense 20
17. Heparin Flush 10 unit/mL Kit Sig: One (1)  Intravenous once
a day for 12 days.
Disp:*12 * Refills:*0*
18. Saline Flush 0.9 % Syringe Sig: Two (2)  Injection once a
day as needed for before and after antibiotic for 12 days.
Disp:*36 * Refills:*0*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Primary:
group B strep bacteremia

Secondary:
HIV
chronic hepatitis C


Discharge Condition:
Hemodynamically stable, ambulating without assistance,
tolerating oral diet and medications.
Mental Status: Clear and coherent.



Completed by:[**2197-4-24**]
{'Bacteremia,Hydronephrosis,Herpes zoster with other nervous system complications,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Asymptomatic human immunodeficiency virus [HIV] infection status,Other pulmonary insufficiency, not elsewhere classified,Dehydration,Chronic hepatitis C without mention of hepatic coma,Trans-sexualism with unspecified sexual history,Neurogenic bladder NOS,Cirrhosis of liver without mention of alcohol,Infantile cerebral palsy, unspecified,Depressive disorder, not elsewhere classified,Posttraumatic stress disorder,Tobacco use disorder,Panic disorder without agoraphobia,History of physical abuse,Personal history, urinary (tract) infection,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Headache'}


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: nausea, vomiting, headache

PRESENT ILLNESS: [**Doctor First Name **] is a 23 year-old FTM transgender patient with HIV ([**2197-2-7**]:
VL 931, cd4 318; started Truvada/atazanavir/ritonavir on
[**2197-2-21**], discontinued, restarted two weeks ago), chronic
untreated hepatitis C, and recent zoster who presents with two
days of acute on chronic headache, fevers, nausea, vomiting, and
diarrhea. He describes feeling well until [**2197-1-2**], when he
was hospitalized [**Date range (1) **] with epigastric/LUQ abdominal pain of
unclear etiology and herpes zoster.  He began [**Date range (1) 2775**] [**2197-2-21**]
and was admitted [**2197-2-23**] for headache, fever to 103, nausea,
vomiting and ?zoster recurrence after not completing the course
of acyclovir from the prior admission. He had a negative LP and
largely unremarkable evaluation at that time.
.
He reports persistent malaise since [**Month (only) 956**], never returning to
baseline after the two admissions, and experiencing persistent
headache (distinguished from usual migraines by location and
absence of aura and photophobia), nausea, 2-3 episodes NBNB
emesis per week, intermittent fevers.  Over the last few days,
he developed worsening of these symptoms (severe nausea, [**5-9**]
episodes vomiting, diarrhea x4, fever to 100.5, frontal headache
behind eyes, with new myalgias and arthralgias x1day) for which
he presented to the ED.
.
In the ED, initial vs were: 97.6 83 134/86 18 100. He was given
acylovir 600 mg iv, morphine 4 mg iv x 2, zofran 4mg iv x 1, and
2L NS. An LP was negative and she was treated empirically with
zosyn and acylovir. CT head and abdominal ultrasound were also
negative.
.
On the floor on the morning after admission, he is lying in bed,
mildly anxious, complaining of nausea, headache, and "general
malaise."
.
ROS as per HPI.  In addition, he reports 13 lb weight loss over
2-3 months. He also notes rash and tingling/pain of left arm in
same distribution of previously treated shingles.  Denies
rhinorrhea, congestion, sore throat. Denies cough, shortness of
breath, chest pain or tightness, palpitations, abdominal pain,
dysuria, recent change in bowel or bladder habits.  Denies SI.

MEDICAL HISTORY: PAST MEDICAL HISTORY:
- HIV ([**Month/Day (3) 2775**] started [**2197-2-21**]: Truvada, atazanavir, ritonavir;
diagnosed approx [**2191**], took PMTCT 1 yr ago; [**2197-2-7**]: VL 931, cd4
318; no history OI)
- Hepatitis C diagnosed in [**9-6**], no IFN therapy, last Hep C VL
558,000 [**2197-2-25**]
- Cerebral Palsy, s/p multiple surgeries, persistent leg
spasticity requiring use of wheelchair for long distances, mild
urinary retention at times.
- Asthma, mild intermittent
- Prior thrush due to Advair for asthma
- h/o multiple UTIs secondary to neurogenic bladder

MEDICATION ON ADMISSION: 1. Oxcarbazepine 300 [**Hospital1 **]
2. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for fever, pain.
3. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for headache.
4. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. Concerta 18 daily
6. Truvada, Reyataz, Norvir

ALLERGIES: Latex / Fentanyl / Risperidone

PHYSICAL EXAM: PHYSICAL EXAMINATION (on floor morning of [**2197-4-12**]):
Vitals: T: 98.2 BP: 108/68 P: 81 R: 16 O2: 99% RA
General: Alert, oriented, mild distress
HEENT: +sclera icteric, MMM
Neck: Supple, no meningismus, no cervical or supraclavicular LAD

FAMILY HISTORY: Mother: cancer, ? cervical, ovarian, endometrial (died [**2196-12-2**])

SOCIAL HISTORY: Female-to-male gender, has all female organs, does not take
hormones. Currently lives in [**Hospital1 3494**] with 1 yo son and is in
a relationship with female partner.  Hx of crystal meth, heroin,
cocaine use. Occasional EtOH, +tobacco, reports cutting down to
5 cig/day.  Reports close relationship with his mother's
adoptive family (his grandparents). 

### Response:
{'Bacteremia,Hydronephrosis,Herpes zoster with other nervous system complications,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Asymptomatic human immunodeficiency virus [HIV] infection status,Other pulmonary insufficiency, not elsewhere classified,Dehydration,Chronic hepatitis C without mention of hepatic coma,Trans-sexualism with unspecified sexual history,Neurogenic bladder NOS,Cirrhosis of liver without mention of alcohol,Infantile cerebral palsy, unspecified,Depressive disorder, not elsewhere classified,Posttraumatic stress disorder,Tobacco use disorder,Panic disorder without agoraphobia,History of physical abuse,Personal history, urinary (tract) infection,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Headache'}
