CHIEF COMPLAINT: back pain, fever

PRESENT ILLNESS: 50 yo male with history of HIV on HAART (CD4 413, VL 50 in [**5-26**])
and IVDU who complains of atraumatic acute onset low back pain
x1 week and fevers to 101 x2 days. Pain became worse last night.
Associated with nausea and loss of appetite. Denies lower
extremity weakness, numbness/tingling, urinary or bowel
incontinence, urinary retention, saddle anesthesia. Denies
abdominal pain. Denies headache, neck pain.
He was seen by Dr. [**Last Name (STitle) 724**] and could not sit comfortably in his
office secondary to pain. He has a history of IVDU with last use
in [**6-25**]. He had a routine colonoscopy last week, but was fine
until yesterday. In his office, exam was significant for Temp
100.5, SBP 98/60 (normally 120s/80s); several fractured teeth
(new); shoddy cervical adenopathy. Clear lungs; RRR s1/s2 with
soft grade 1-2 SEM LSB that's stable; abd is benign. Cannot sit;
walking difficult, cannot reproduce pain with palpation. + psoas
sign.
In the ED, initial VS: Pain 10 102 96 101/55 19 97% ra. Blood
cultures x3 were obtained. Rectal exam done noted normal tone.
CXR revealed increased interstitial markings. MRI spine prelim
read was negative for epidural abscess. UA was sent and is
pending. He was given 5mg iv morphine given for pain, ativan
given prior to mri, 1gm tylenol for temp 102.2, 650mg po tylenol
given for temp on admission, and 1gm iv vanco given. Most recent
vitals prior to transfer: Most Recent Vitals: 102.6, 97, 24,
110/72, 94%RA.
Currently, he is somnolent and unable to provide more than basic
answers to questions.

MEDICAL HISTORY: HIV diagnosed in [**2101**]; no ARVs for many years. Sees Dr. [**Last Name (STitle) 724**]
HCV+ Genotype 1 infection, not on therapy
hx b/l MRSA + buttock abscesses
Right epididymo-orchitis w/ assoc right pyocele
Hx syphills
Hx chlamydia
Hx gonorrhea
IVDU, last use [**6-25**]
Multiple prior UTI's
MEDICATIONS: per OMR
citalopram 20 mg Tablet daily with ARVs
darunavir [Prezista] 400 mg Tablet 2 Tablet(s) by mouth once
daily
emtricitabine-tenofovir [Truvada] 200 mg-300 mg Tablet daily
ritonavir [Norvir] 100 mg Tablet daily with darunavir
sildenafil [Viagra] 100 mg Tablet 0.25-0.5 prn
terbinafine 1 % Cream apply to soles of feet daily after
showering

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Citalopram 20 mg PO DAILY
2. Darunavir 800 mg PO DAILY
3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY
4. Ritonavir (Oral Solution) 100 mg PO DAILY
to be given with darunavir
5. sildenafil *NF* 25-50  Oral prn
6. Terbinafine 1% Cream 1 Appl TP DAILY showering
7. Multivitamins 1 TAB PO DAILY

ALLERGIES: Bactrim

PHYSICAL EXAM: Admission physical exam:
VS - 98.8 right 86/57 left 94/59 78 16 95% on RA 69.4kg
GENERAL - somnolent male in NAD, comfortable, only responds to
sternal rub, clear when responding
HEENT - NC/AT, dilated pupils at 6mm bilat, PERRLA, EOMI,
sclerae anicteric, MMM, OP clear
NECK - supple, neg B/K signs, no thyromegaly, shotty LAD in
right submandibular area
LUNGS - crackles right base > left base
HEART - PMI non-displaced, RRR, no MRG, nl S1, split S2
ABDOMEN - +BS, soft/NT/ND, no masses or HSM, no rebound/guarding

FAMILY HISTORY: No h/o HIV.

SOCIAL HISTORY: Born in [**Male First Name (un) 1056**], moved to the US 29 yrs ago. Sexually active
with males, contracted HIV in [**2101**] from unprotected intercourse.
Has a HIV+ boyfriend with whom he is currently sexually active
(without protection), who may not be monogamous. Denies tobacco
use, occasional EtOH ([**4-17**] drinks/wknd) and marijuana use. Last
IVDU one month ago. Used to work in a hotel. Never been in
prison, never been homeless.
Other septicemia due to gram-negative organisms,Septic shock,Pneumonia, organism unspecified,Acute pyelonephritis without lesion of renal medullary necrosis,Other ascites,Other and unspecified coagulation defects,Severe sepsis,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic hepatitis C without mention of hepatic coma,Nausea alone,Thrombocytopenia, unspecified,Hypoxemia,Depressive disorder, not elsewhere classified,Other, mixed, or unspecified drug abuse, unspecified
Gram-neg septicemia NEC,Septic shock,Pneumonia, organism NOS,Ac pyelonephritis NOS,Ascites NEC,Coagulat defect NEC/NOS,Severe sepsis,Asymp hiv infectn status,Chrnc hpt C wo hpat coma,Nausea alone,Thrombocytopenia NOS,Hypoxemia,Depressive disorder NEC,Drug abuse NEC-unspec
Admission Date:  [**2118-7-28**]              Discharge Date:   [**2118-8-5**]

Date of Birth:  [**2067-7-28**]             Sex:   M

Service: MEDICINE

Allergies:
Bactrim

Attending:[**First Name3 (LF) 10593**]
Chief Complaint:
back pain, fever

Major Surgical or Invasive Procedure:
None

History of Present Illness:
50 yo male with history of HIV on HAART (CD4 413, VL 50 in [**5-26**])
and IVDU who complains of atraumatic acute onset low back pain
x1 week and fevers to 101 x2 days. Pain became worse last night.
Associated with nausea and loss of appetite. Denies lower
extremity weakness, numbness/tingling, urinary or bowel
incontinence, urinary retention, saddle anesthesia. Denies
abdominal pain. Denies headache, neck pain.
He was seen by Dr. [**Last Name (STitle) 724**] and could not sit comfortably in his
office secondary to pain. He has a history of IVDU with last use
in [**6-25**]. He had a routine colonoscopy last week, but was fine
until yesterday. In his office, exam was significant for Temp
100.5, SBP 98/60 (normally 120s/80s); several fractured teeth
(new); shoddy cervical adenopathy. Clear lungs; RRR s1/s2 with
soft grade 1-2 SEM LSB that's stable; abd is benign. Cannot sit;
walking difficult, cannot reproduce pain with palpation. + psoas
sign.
In the ED, initial VS: Pain 10 102 96 101/55 19 97% ra. Blood
cultures x3 were obtained. Rectal exam done noted normal tone.
CXR revealed increased interstitial markings. MRI spine prelim
read was negative for epidural abscess. UA was sent and is
pending. He was given 5mg iv morphine given for pain, ativan
given prior to mri, 1gm tylenol for temp 102.2, 650mg po tylenol
given for temp on admission, and 1gm iv vanco given. Most recent
vitals prior to transfer: Most Recent Vitals: 102.6, 97, 24,
110/72, 94%RA.
Currently, he is somnolent and unable to provide more than basic
answers to questions.

ROS: unable to obtain

Past Medical History:
HIV diagnosed in [**2101**]; no ARVs for many years. Sees Dr. [**Last Name (STitle) 724**]
HCV+ Genotype 1 infection, not on therapy
hx b/l MRSA + buttock abscesses
Right epididymo-orchitis w/ assoc right pyocele
Hx syphills
Hx chlamydia
Hx gonorrhea
IVDU, last use [**6-25**]
Multiple prior UTI's
MEDICATIONS: per OMR
citalopram 20 mg Tablet daily with ARVs
darunavir [Prezista] 400 mg Tablet 2 Tablet(s) by mouth once
daily
emtricitabine-tenofovir [Truvada] 200 mg-300 mg Tablet daily
ritonavir [Norvir] 100 mg Tablet daily with darunavir
sildenafil [Viagra] 100 mg Tablet 0.25-0.5 prn
terbinafine 1 % Cream apply to soles of feet daily after
showering

Social History:
Born in [**Male First Name (un) 1056**], moved to the US 29 yrs ago. Sexually active
with males, contracted HIV in [**2101**] from unprotected intercourse.
Has a HIV+ boyfriend with whom he is currently sexually active
(without protection), who may not be monogamous. Denies tobacco
use, occasional EtOH ([**4-17**] drinks/wknd) and marijuana use. Last
IVDU one month ago. Used to work in a hotel. Never been in
prison, never been homeless.

Family History:
No h/o HIV.

Physical Exam:
Admission physical exam:
VS - 98.8 right 86/57 left 94/59 78 16 95% on RA 69.4kg
GENERAL - somnolent male in NAD, comfortable, only responds to
sternal rub, clear when responding
HEENT - NC/AT, dilated pupils at 6mm bilat, PERRLA, EOMI,
sclerae anicteric, MMM, OP clear
NECK - supple, neg B/K signs, no thyromegaly, shotty LAD in
right submandibular area
LUNGS - crackles right base > left base
HEART - PMI non-displaced, RRR, no MRG, nl S1, split S2
ABDOMEN - +BS, soft/NT/ND, no masses or HSM, no rebound/guarding

EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials,
DPs), no [**Last Name (un) **] lesions or osler nodes on fingers or toes
SKIN - no rashes or lesions
BACK - marked CVA tenderness bilaterally, no tenderness over
spinous processess from cervical spine to sacrum, no abscesses
or fistulas apparent on external rectal exam
NEURO - somnolent, with sternal rub: A&Ox3, CNs II-XII grossly
intact, muscle strength 5/5 throughout

Pertinent Results:
MRI C-T-L spine
IMPRESSION:  Multilevel degenerative changes in the cervical,
thoracic and lumbar spine as described above with severe
foraminal narrowing and canal stenosis at multiple levels.  No
evidence of epidural abscess seen.
.
Renal Ultrasound:
IMPRESSION:
1. Perinephric fluid collection of unclear etiology. Correlation
with CT is recommended.
2. Pericholecystic fluid without evidence of gallbladder
dilatation or wall thickening is consistent with pericholecystic
edema secondary to impeded venous return (such as in portal
hypertension) or edema secondary to hypoproteinemia as in
anasarca.
3. Ascites.
.
CXR: [**2118-7-30**]
There is a left retrocardiac opacity and consolidation within
the left mid and lower lung fields.  There is mild improved
aeration at the right base.
Findings are most likely due to pulmonary edema as opposed to
focal
consolidation.  Left sided pleural effusion is also seen.  There
are no
pneumothoraces.
.
CXR: [**2118-7-28**]
IMPRESSION:  Increased interstitial markings most pronounced at
the lung
bases, which are nonspecific and may reflect atelectatic changes
but mild
pulmonary vascular congestion, or an atypical infection are not
excluded.  No overt pulmonary edema is seen.  A repeat
radiograph with improved inspiratory effort may be helpful for
further evaluation.
.
Chest CT [**2118-8-1**]
IMPRESSION:
1.  Multifocal pneumonia.
2.  Bilateral pleural effusions and bibasilar consolidations,
unchanged since CT abdomen and most likely reflecting areas of
atelectasis.
3.  Anasarca.
.
Echocardiogram [**2118-8-1**]
The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
diameters of aorta at the sinus, ascending and arch levels are
normal. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic stenosis or aortic
regurgitation. No masses or vegetations are seen on the aortic
valve. The mitral valve leaflets are structurally normal. No
mass or vegetation is seen on the mitral valve. Mild (1+) mitral
regurgitation is seen. The estimated pulmonary artery systolic
pressure is normal. No vegetation/mass is seen on the pulmonic
valve. There is no pericardial effusion.
.
Abd CT [**2118-7-30**]:
IMPRESSION:
1.  Bilateral pleural effusions with overlying atelectasis.
2.  The previously noted perinephric fluid actually represents
perihepatic
fluid extending anterior to the right lobe of liver and inferior
to the left
lobe of liver.  Both kidneys are normal in appearance without
evidence of
pyelonephritis.  The constellation of bilateral pleural
effusions,
intra-abdominal fluid, and anasarca suggests fluid overload.
3.  Thick-walled bladder suggestive of cystitis.
4.  Moderately enlarged prostate.
.
Renal ultrasound [**2118-7-29**]:
IMPRESSION:
1.  Small amount to right perinephric fluid, which in the
setting of ascites
could represent fluid in [**Location (un) 6813**] pouch.
2.  Findings of right pleural effusion, ascites, GB mural edema,
distended IVC
all suggestive of cardiac decompensation/third spacing.
Correlate clinically.
.
MRI C/T/L Spin [**2118-7-28**]:
FINDINGS:

MR CERVICAL SPINE:  Cervical vertebrae appear normal in height,
marrow signal
intensity and alignment.  Craniocervical junction appears
normal.  There are
discogenic endplate changes seen at multiple levels, most
prominent at C4-C5.
The cervical spinal cord shows normal morphology and signal
intensity.

At C2-C3, there is no disc herniation, spinal canal or neural
foraminal
narrowing.

At C3-C4, there is posterior disc osteophyte complex indenting
the thecal sac
without significant spinal canal narrowing.  There is mild
bilateral neural
foraminal narrowing from uncovertebral and facet joint
osteophytes.

At C4-C5, there is posterior disc osteophyte complex effacing
the thecal sac
and remodeling the cervical spinal cord without focal cord
signal abnormality.
Uncovertebral and facet joint osteophytes result in moderate
right and mild
left neural foraminal narrowing.

At C5-C6, posterior disc osteophyte complex indenting the thecal
sac but no
significant canal narrowing is seen.  Uncovertebral and facet
joint
osteophytes result in moderate right and mild left neural
foraminal narrowing.

At C6-C7, posterior disc osteophyte complex is effacing the
thecal sac and
remodeling the cervical spinal cord causing mild canal
narrowing.
Uncovertebral and facet joint osteophytes result in moderate
bilateral neural
foraminal narrowing.

At C7-T1, there is no disc herniation, spinal canal or neural
foraminal
narrowing.

Visualized pre- and para-vertebral soft tissues appear
unremarkable.  There is
no abnormal enhancement concerning for epidural abscess.

MRI THORACIC SPINE:  Thoracic vertebrae appear normal in height,
marrow signal
intensity and alignment.  The thoracic spinal cord shows normal
morphology and
signal intensity.  There is no abnormal enhancement seen in the
thoracic spine
concerning for epidural abscess.  There are disc protrusions
seen at multiple
levels in the thoracic spine, most prominent at T6-T7 and T8-T9
levels with
indentation of the thoracic cord, but no cord signal abnormality
is seen.
There is no significant neural foraminal narrowing seen.

MRI LUMBAR SPINE:  Lumbar vertebrae are normal in height, marrow
signal
intensity and alignment.  Discogenic endplate marrow changes are
seen at L3-L4
level.  The spinal cord terminates at mid L1 level.  Conus
medullaris and
cauda equina have normal morphology and signal intensities.

At L2-L3, there is disc bulge, ligamentum flavum thickening and
facet joint
osteophytes causing mild spinal canal narrowing.  Combination of
disc bulge
and facet joint osteophytes results in moderate left neural
foraminal
narrowing.

At L3-L4, there is disc bulge, ligamentum flavum and bilateral
facet joint
osteophytes resulting in mild canal stenosis.  Disc bulge and
facet joint
osteophytes result in moderate-to-severe left neural foraminal
narrowing.

At L4-L5, there is a disc bulge with broad-based posterior
central and right
paracentral and foraminal disc protrusion causing severe
narrowing of the
subarticular recess, impinging the traversing right L5 nerve
root.
Combination of disc bulge and ligamentum flavum thickening
resulting in
moderate spinal canal stenosis.

At L5-S1, there is disc bulge which along with ligamentous
thickening results
in severe narrowing of the right subarticular recess impinging
the traversing
right S1 nerve root.  Combination of disc bulge and ligamentum
flavum
thickening and facet joint osteophytes resulting in narrowing of
the left
neural foramen.

IMPRESSION:  Multilevel degenerative changes in the cervical,
thoracic and
lumbar spine as described above with severe foraminal narrowing
and canal
stenosis at multiple levels.  No evidence of epidural abscess
seen.



Brief Hospital Course:
PRIMARY REASON FOR HOSPITALIZATION:
====================================
Mr. [**Known lastname 26958**] is a 51M w/ HIV on HAART (last cd4 410 on [**2118-5-26**],
hep C (not treated), and IVDU (active) who presented with sepsis
from pyelonephritis and who then developed hypoxia and was found
to have multifocal pneumonia.  Infectious Diseases followed him
during this admission.

ACTIVE ISSUES:
=======================
# Klebsiella Sepsis/UTI: Patient was admitted to the general
medicine floor for pyelonephritis and IV antibiotics. The
patient subsequently had Klebsiella growing in [**5-18**] bottles and
was transferred to the MICU twice in the setting of hypotension
and hypoxemia. He was briefly on pressors. He was covered
broadly with Cefepime while in the MICU but cultures later
returned as pansensitive and he was narrowed to ciprofloxacin.
- Patient will receive 7 more days of ciprofloxacin PO after
discharge to complete a 2 week course of antibiotics from first
negative blood culture ([**2118-7-29**])
- consider outpatient workup for why patient has recurrent UTIs.

- Patient advised to wear condoms every time

# Multifocal pneumonia: During the hospitalization the patient
developed worsening respiratory status. He subsequently had a CT
of his chest which showed multifocal pneumonia. He was covered
for Community Acquired pneumonia pathogens with 7 days of
cefepime and 5 days of azithromycin. He does has HIV, although
his last CD4 count was in the 400s in [**Month (only) 547**] (and 637 during this
admission) so felt to be unlikely to have PCP or other
opportunistic infection.

# Low back pain: Patient has chronic low back pain worse on the
left lumbar area, mildly tender to touch. No neurologic
deficits. Because of fevers and severe back pain at time of
admission the patient underwent MRI of spine. It did not show
any acute process but showed degenerative changes in the
cervical, thoracic and lumbar spine with severe foraminal
narrowing and canal stenosis at multiple levels.
- Outpatient follow-up for chronic back pain

# Substance Abuse: admission urine tox positive for amphetamines
and opioids. Patient reports actively using crystal meth prior
to admission.
- patient given information on drug treatment facilities

# Ascites seen on U/S: Unclear if patient has cirrhosis but does
have history of hepC which has not been treated. Recent
hepascore done outpatient was 0.96 which puts him at 54% of
cirrhosis. Patient had evidence of anasarca on CT which may have
been the cause. Patient also has portosystemic shunt in liver
segment seen on imaging since [**2116**] of uncertain significance.
- will follow-up with ID after discharge to consider treatment
for hepC

RESOLVED ISSUES:
=======================
# Thrombocytopenia: likely was secondary to sepsis as it
normalized as patient improved.

# Coagulopathy: Most likely nutritional given that INR improved
from 1.5 to 1.1 with vitamin K. Patient might also have early
cirrhosis as discussed above.

CHRONIC ISSUES:
=======================
# Depression:
- continued citalopram

# HIV:
- continue emcitritabine-tenofovir, darunavir, ritonavir
- f/u with Dr. [**Last Name (STitle) 724**]

# Hep C: currently not treated
- outpatient follow-up with Dr. [**Last Name (STitle) 724**]


TRANSITIONAL ISSUES:
==========================
# CODE STATUS: confirmed full
# CONTACT: Former Partner [**First Name8 (NamePattern2) **] [**Name2 (NI) **] designated as
HCP([**Telephone/Fax (1) 26959**]
# Notable labs on last check here: Hct 34.1, Retics 0.4, Albumin
2.4, CD4 637 on [**2118-8-1**]. These can be followed as an outpatient
after discharge.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Citalopram 20 mg PO DAILY
2. Darunavir 800 mg PO DAILY
3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY
4. Ritonavir (Oral Solution) 100 mg PO DAILY
to be given with darunavir
5. sildenafil *NF* 25-50  Oral prn
6. Terbinafine 1% Cream 1 Appl TP DAILY showering
7. Multivitamins 1 TAB PO DAILY


Discharge Medications:
1. Citalopram 20 mg PO DAILY
2. Darunavir 800 mg PO DAILY
3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY
4. Ritonavir (Oral Solution) 100 mg PO DAILY
to be given with darunavir
5. Sildenafil *NF* 25-50 mg ORAL PRN  erectile dysfunction
6. Terbinafine 1% Cream 1 Appl TP DAILY showering
7. Ciprofloxacin HCl 500 mg PO Q12H
RX *Cipro 500 mg 1 Tablet(s) by mouth twice a day Disp #*14
Tablet Refills:*0
8. Multivitamins 1 TAB PO DAILY


Discharge Disposition:
Home

Discharge Diagnosis:
PRIMARY DIAGNOSIS:
Pyelonephritis
Multifocal Pneumonia
Severe sepsis

SECONDARY DIANOGSIS:
HIV
Hepatitis C

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

Discharge Instructions:
Mr. [**Known lastname 26958**], it was a pleasure taking care of you here at [**Hospital1 1535**].

You were hospitalized with an infection in your blood, kidney,
and lungs. You were seriously ill and required intensive care.
You improved with treatment with antibiotics.

You will need to take a few more days of antibiotics after you
leave to be sure you get rid of the infection completely.

It is VERY important for your health that you stop using drugs.

Followup Instructions:
Name: [**Last Name (LF) 724**], [**Name8 (MD) **] MD
Location: [**Hospital 3578**] COMMUNITY HEALTH CENTER
Address: [**Hospital1 3579**], [**Location (un) **],[**Numeric Identifier 18406**]
Phone: [**Telephone/Fax (1) 3581**]
When: Thursday, [**2116-9-9**]:30 AM
{'Other septicemia due to gram-negative organisms,Septic shock,Pneumonia, organism unspecified,Acute pyelonephritis without lesion of renal medullary necrosis,Other ascites,Other and unspecified coagulation defects,Severe sepsis,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic hepatitis C without mention of hepatic coma,Nausea alone,Thrombocytopenia, unspecified,Hypoxemia,Depressive disorder, not elsewhere classified,Other, mixed, or unspecified drug abuse, unspecified'}


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: back pain, fever

PRESENT ILLNESS: 50 yo male with history of HIV on HAART (CD4 413, VL 50 in [**5-26**])
and IVDU who complains of atraumatic acute onset low back pain
x1 week and fevers to 101 x2 days. Pain became worse last night.
Associated with nausea and loss of appetite. Denies lower
extremity weakness, numbness/tingling, urinary or bowel
incontinence, urinary retention, saddle anesthesia. Denies
abdominal pain. Denies headache, neck pain.
He was seen by Dr. [**Last Name (STitle) 724**] and could not sit comfortably in his
office secondary to pain. He has a history of IVDU with last use
in [**6-25**]. He had a routine colonoscopy last week, but was fine
until yesterday. In his office, exam was significant for Temp
100.5, SBP 98/60 (normally 120s/80s); several fractured teeth
(new); shoddy cervical adenopathy. Clear lungs; RRR s1/s2 with
soft grade 1-2 SEM LSB that's stable; abd is benign. Cannot sit;
walking difficult, cannot reproduce pain with palpation. + psoas
sign.
In the ED, initial VS: Pain 10 102 96 101/55 19 97% ra. Blood
cultures x3 were obtained. Rectal exam done noted normal tone.
CXR revealed increased interstitial markings. MRI spine prelim
read was negative for epidural abscess. UA was sent and is
pending. He was given 5mg iv morphine given for pain, ativan
given prior to mri, 1gm tylenol for temp 102.2, 650mg po tylenol
given for temp on admission, and 1gm iv vanco given. Most recent
vitals prior to transfer: Most Recent Vitals: 102.6, 97, 24,
110/72, 94%RA.
Currently, he is somnolent and unable to provide more than basic
answers to questions.

MEDICAL HISTORY: HIV diagnosed in [**2101**]; no ARVs for many years. Sees Dr. [**Last Name (STitle) 724**]
HCV+ Genotype 1 infection, not on therapy
hx b/l MRSA + buttock abscesses
Right epididymo-orchitis w/ assoc right pyocele
Hx syphills
Hx chlamydia
Hx gonorrhea
IVDU, last use [**6-25**]
Multiple prior UTI's
MEDICATIONS: per OMR
citalopram 20 mg Tablet daily with ARVs
darunavir [Prezista] 400 mg Tablet 2 Tablet(s) by mouth once
daily
emtricitabine-tenofovir [Truvada] 200 mg-300 mg Tablet daily
ritonavir [Norvir] 100 mg Tablet daily with darunavir
sildenafil [Viagra] 100 mg Tablet 0.25-0.5 prn
terbinafine 1 % Cream apply to soles of feet daily after
showering

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Citalopram 20 mg PO DAILY
2. Darunavir 800 mg PO DAILY
3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY
4. Ritonavir (Oral Solution) 100 mg PO DAILY
to be given with darunavir
5. sildenafil *NF* 25-50  Oral prn
6. Terbinafine 1% Cream 1 Appl TP DAILY showering
7. Multivitamins 1 TAB PO DAILY

ALLERGIES: Bactrim

PHYSICAL EXAM: Admission physical exam:
VS - 98.8 right 86/57 left 94/59 78 16 95% on RA 69.4kg
GENERAL - somnolent male in NAD, comfortable, only responds to
sternal rub, clear when responding
HEENT - NC/AT, dilated pupils at 6mm bilat, PERRLA, EOMI,
sclerae anicteric, MMM, OP clear
NECK - supple, neg B/K signs, no thyromegaly, shotty LAD in
right submandibular area
LUNGS - crackles right base > left base
HEART - PMI non-displaced, RRR, no MRG, nl S1, split S2
ABDOMEN - +BS, soft/NT/ND, no masses or HSM, no rebound/guarding

FAMILY HISTORY: No h/o HIV.

SOCIAL HISTORY: Born in [**Male First Name (un) 1056**], moved to the US 29 yrs ago. Sexually active
with males, contracted HIV in [**2101**] from unprotected intercourse.
Has a HIV+ boyfriend with whom he is currently sexually active
(without protection), who may not be monogamous. Denies tobacco
use, occasional EtOH ([**4-17**] drinks/wknd) and marijuana use. Last
IVDU one month ago. Used to work in a hotel. Never been in
prison, never been homeless. 

### Response:
{'Other septicemia due to gram-negative organisms,Septic shock,Pneumonia, organism unspecified,Acute pyelonephritis without lesion of renal medullary necrosis,Other ascites,Other and unspecified coagulation defects,Severe sepsis,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic hepatitis C without mention of hepatic coma,Nausea alone,Thrombocytopenia, unspecified,Hypoxemia,Depressive disorder, not elsewhere classified,Other, mixed, or unspecified drug abuse, unspecified'}
