CHIEF COMPLAINT: Allergy to penicillin, asymptomatic neurosyphilis

PRESENT ILLNESS: Ms. [**Known lastname **] is a 52yo female with PMH significant for
neurosyphillis who is being admitted to the MICU for penicillin
desensitization therapy. Per patient, she was diagnosed in
[**4-/2116**] when she was tested for HIV and other STDs. She had
routine bloodwork which revealed an elevated syphilis titer
(1:128) which was then confirmed with a spinal tap. She denies
any history of fevers, chills, headaches, rashes, or chancre
prior to being diagnosed. Per patient, she was started on
Doxycycline (given PCN allergy) but did not complete treatment
since she traveled to [**Country 2560**] for personal reasons. She
returned in [**2117**] but it has been difficult for her to receive
treatment due to her immigration status. Recently, with the help
of her ID physician she will be able to start treatment at
[**Hospital1 18**].

MEDICAL HISTORY: 1)Inflammatory arthropathy
2)Neurosyphillis
3)Migraines

MEDICATION ON ADMISSION: Prilosec 20mg PO QHS
Plaquenil 200mg PO BID
.
ALLERGIES: Penicillin-Given at 6 months of age and within 24
hours developed swelling of her entire body. At 12 yo she was
given Pantomicina (trade name for erythromycin) for tonsillitis.
About 2 days later she developed nephritis and developed
swelling of lower legs, dark urine.

ALLERGIES: Penicillins

PHYSICAL EXAM: vitals T 98.4 BP 109/73 AR 84 RR 18 O2 sat 96 RA
Gen: Pleasant female, well appearing
HEENT: MMM
Heart: RRR, no m,r,g
Lungs: CTAB
Abdomen: Soft, NT/ND, +BS
Extremities: No edema, 2+ DP/PT pulses bilaterally; no rashes on
palms and soles

FAMILY HISTORY: Mother died at age 72 due to a cardiopulmonary illness. Father
died at 70 with cirrhosis.

SOCIAL HISTORY: She lives in [**Location (un) 538**]. She is married and lives with
husband. [**Name (NI) **] one son. Denies tobacco, alcohol, or IVDA.
Neurosyphilis, unspecified,Arthropathy, unspecified, site unspecified,Other specified disorders of circulatory system
Neurosyphilis NOS,Arthropathy NOS-unspec,Circulatory disease NEC
Admission Date:  [**2118-6-30**]              Discharge Date:   [**2118-7-7**]

Date of Birth:  [**2066-1-3**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 603**]
Chief Complaint:
Allergy to penicillin, asymptomatic neurosyphilis

Major Surgical or Invasive Procedure:
Placement of L brachial PICC line

History of Present Illness:
Ms. [**Known lastname **] is a 52yo female with PMH significant for
neurosyphillis who is being admitted to the MICU for penicillin
desensitization therapy. Per patient, she was diagnosed in
[**4-/2116**] when she was tested for HIV and other STDs. She had
routine bloodwork which revealed an elevated syphilis titer
(1:128) which was then confirmed with a spinal tap. She denies
any history of fevers, chills, headaches, rashes, or chancre
prior to being diagnosed. Per patient, she was started on
Doxycycline (given PCN allergy) but did not complete treatment
since she traveled to [**Country 2560**] for personal reasons. She
returned in [**2117**] but it has been difficult for her to receive
treatment due to her immigration status. Recently, with the help
of her ID physician she will be able to start treatment at
[**Hospital1 18**].

Past Medical History:
1)Inflammatory arthropathy
2)Neurosyphillis
3)Migraines


Social History:
She lives in [**Location (un) 538**]. She is married and lives with
husband. [**Name (NI) **] one son. Denies tobacco, alcohol, or IVDA.

Family History:
Mother died at age 72 due to a cardiopulmonary illness. Father
died at 70 with cirrhosis.


Physical Exam:
vitals T 98.4 BP 109/73 AR 84 RR 18 O2 sat 96 RA
Gen: Pleasant female, well appearing
HEENT: MMM
Heart: RRR, no m,r,g
Lungs: CTAB
Abdomen: Soft, NT/ND, +BS
Extremities: No edema, 2+ DP/PT pulses bilaterally; no rashes on
palms and soles


Pertinent Results:
[**2118-6-30**] 06:25PM   WBC-9.4 RBC-4.79 HGB-14.5 HCT-40.9 MCV-85
MCH-30.3 MCHC-35.5* RDW-13.0
[**2118-6-30**] 06:25PM   NEUTS-53.8 LYMPHS-38.9 MONOS-4.1 EOS-2.7
BASOS-0.5 PLT COUNT-399
[**2118-6-30**] 06:25PM   PT-11.7 PTT-24.7 INR(PT)-1.0
.
[**2118-6-30**] 06:25PM   GLUCOSE-95 UREA N-15 CREAT-0.6 SODIUM-142
POTASSIUM-4.2 CHLORIDE-108 TOTAL CO2-26 ANION GAP-12
[**2118-6-30**] 06:25PM   CALCIUM-9.5 PHOSPHATE-4.2 MAGNESIUM-2.2

Brief Hospital Course:

1)Penicillin desensitization: Ms [**Known lastname **] was admitted to the
[**Hospital1 18**] for penicillin desensitization in order to be adequately
treated for neurosyphillis.
.
The protocol for potential allergic reactions was as follows:
- Mild reaction (rash, nausea): Benadryl 25mg PO.
- Moderate reaction (dyspnea, angioedema): Methylprednisolone
40mg, Benadryl 25-50mg, famotidine 20mg PO.
- Severe reaction (acute dyspnea, angioedema, hypotension):
Methylprednisolone, Benadryl, epinephrine, famotidine
.
This was not needed; she underwent desensitization uneventfully
and was soon transferred to the floor. She had no allergic
reactions.
.
2) PICC line: A PICC line was placed. Starting on [**2118-7-4**], and
worsening on [**2118-7-5**], she had some warmth and slight erythema in
the portion of her arm proximal to the PICC insertion site. Her
white count did not change, and she had no fever. An upper
extremity venous ultrasound was done, and showed no thrombus. We
followed and treated symptomatically with warm compresses. If
she were to have fever we would recommend immediate blood
culture from the PICC line, and consideration of changing this
line.
.
2)Neurosyphillis: Her neurosyphillis was asymptomatic and was
found in the process of a medical workup. Given that Penicillin
G was the only acceptable treatment, desensitization was
undertaken as above. A 14 day course was anticipated. She
started desensitization on the night of [**6-30**] and then began her
regular dosing of penicillin on [**7-1**].
.
3)Inflammatory arthropathy: Continued Plaquenil; no issues
.
4)FEN: regular diet
.
5)Prophylaxis: Heparin SQ for DVT prophylaxis
.
6)Access: PICC
.
7)Dispo: [**Hospital1 **]
.
8)Code: presumed full


Medications on Admission:
Prilosec 20mg PO QHS
Plaquenil 200mg PO BID
.
ALLERGIES: Penicillin-Given at 6 months of age and within 24
hours developed swelling of her entire body. At 12 yo she was
given Pantomicina (trade name for erythromycin) for tonsillitis.
About 2 days later she developed nephritis and developed
swelling of lower legs, dark urine.


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
injection Injection TID (3 times a day).
2. Hydroxychloroquine 200 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
3. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO Q6H
(every 6 hours) as needed.
4. Penicillin G Potassium 20,000,000 unit Recon Soln Sig: 4
million units Injection Q4H (every 4 hours) for 8 days: THIS
MEDICINE MUST BE GIVEN ON THIS EXACT EVERY-4-HOUR SCHEDULE. THIS
PATIENT IS ONLY ABLE TO TAKE THIS MEDICATION BECAUSE SHE HAS
UNDERGONE DESENSITIZATION IN AN INTENSIVE CARE UNIT AND CAN NOW
TOLERATE THIS MEDICINE AS LONG AS DRUG LEVELS ARE KEPT CONSTANT.
IF DRUG LEVELS ARE NOT KEPT CONSTANT BY q4H DOSING, SHE [**Month (only) **]
RE-DEVELOP ALLERGIC REACTION TO THE NEXT DOSE. IF THIS WERE TO
HAPPEN SHE COULD DEVELOP ALLERGIC REACTIONS INCLUDING
ANAPHYLAXIS, AIRWAY COMPROMISE, HYPOTENSION, AND POSSIBLY DEATH.
SEE PROTOCOL BELOW FOR MEDICINES TO ADMINISTER IN THE EVENT OF
ALLERGIC REACTION.
5. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
6. Allergic reaction protocol
Please monitor patient and adhere to the following protocol of
medication administration. If any of these reactions (including
mild reactions) take place, [**Name8 (MD) **] MD IMMEDIATELY for medical
evaluation as soon as possible.
- Mild reaction (rash, nausea): Benadryl 25mg PO.
- Moderate reaction (dyspnea, angioedema): Methylprednisolone
40mg, Benadryl 25-50mg, famotidine 20mg PO.
- Severe reaction (acute dyspnea, angioedema, hypotension):
Methylprednisolone, Benadryl, epinephrine, famotidine
.
Ensure that the above medicines are AVAILABLE ON THE FLOOR in
which this patient is staying and are clearly labelled.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 2222**] - [**Location (un) 538**]

Discharge Diagnosis:
Penicillin allergy
Neurosyphilis


Discharge Condition:
Good


Discharge Instructions:
Ms [**Known lastname **] has been admitted for penicillin desensitization
(had penicillin allergy, will only be able to tolerate pencillin
if kept on constant dosing) and penicillin administration for
asymptomatic neurosyphilis.
.
The dosing schedule for penicillin MUST BE FOLLOWED EXACTLY BY
FACILITY STAFF. Failure to adhere to the schedule of every four
hour penicillin dosing could lead to the development of an
anaphylactic reaction, severe airway compromise and possibly
death. Her drug level must be kept constant; if it is not, she
risks re-developing her allergic reaction to penicillin when it
is next given. See instructions given on prescription and order
sheets for more details.
.
On discharge, Ms [**Known lastname **] should follow up with her
appointments, as shown below, and any other medical appointments
she may have outside the [**Hospital1 18**].

Followup Instructions:
Provider: [**Name Initial (NameIs) 11595**] (RHEUM LMOB) [**Doctor Last Name 11596**] Phone:[**Telephone/Fax (1) 2226**]
Date/Time:[**2118-7-18**] 3:00
Provider: [**First Name11 (Name Pattern1) 278**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 394**], O.D. Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2118-12-15**] 1:00
{'Neurosyphilis, unspecified,Arthropathy, unspecified, site unspecified,Other specified disorders of circulatory system'}


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: Allergy to penicillin, asymptomatic neurosyphilis

PRESENT ILLNESS: Ms. [**Known lastname **] is a 52yo female with PMH significant for
neurosyphillis who is being admitted to the MICU for penicillin
desensitization therapy. Per patient, she was diagnosed in
[**4-/2116**] when she was tested for HIV and other STDs. She had
routine bloodwork which revealed an elevated syphilis titer
(1:128) which was then confirmed with a spinal tap. She denies
any history of fevers, chills, headaches, rashes, or chancre
prior to being diagnosed. Per patient, she was started on
Doxycycline (given PCN allergy) but did not complete treatment
since she traveled to [**Country 2560**] for personal reasons. She
returned in [**2117**] but it has been difficult for her to receive
treatment due to her immigration status. Recently, with the help
of her ID physician she will be able to start treatment at
[**Hospital1 18**].

MEDICAL HISTORY: 1)Inflammatory arthropathy
2)Neurosyphillis
3)Migraines

MEDICATION ON ADMISSION: Prilosec 20mg PO QHS
Plaquenil 200mg PO BID
.
ALLERGIES: Penicillin-Given at 6 months of age and within 24
hours developed swelling of her entire body. At 12 yo she was
given Pantomicina (trade name for erythromycin) for tonsillitis.
About 2 days later she developed nephritis and developed
swelling of lower legs, dark urine.

ALLERGIES: Penicillins

PHYSICAL EXAM: vitals T 98.4 BP 109/73 AR 84 RR 18 O2 sat 96 RA
Gen: Pleasant female, well appearing
HEENT: MMM
Heart: RRR, no m,r,g
Lungs: CTAB
Abdomen: Soft, NT/ND, +BS
Extremities: No edema, 2+ DP/PT pulses bilaterally; no rashes on
palms and soles

FAMILY HISTORY: Mother died at age 72 due to a cardiopulmonary illness. Father
died at 70 with cirrhosis.

SOCIAL HISTORY: She lives in [**Location (un) 538**]. She is married and lives with
husband. [**Name (NI) **] one son. Denies tobacco, alcohol, or IVDA. 

### Response:
{'Neurosyphilis, unspecified,Arthropathy, unspecified, site unspecified,Other specified disorders of circulatory system'}
