CHIEF COMPLAINT: Abscess of right buttock.

PRESENT ILLNESS: HPI: 24 M w/ presented to OSH 5 days prior to admission w/
abdominal pain, fever, nausea and diarrhea and was found to
havean abscess of his R buttock. Pt states he had a recent binge
of alcohol for several days and after sobering had significant
pain from the affected area and into his testicles. He was
admitted to the hospital on [**5-10**] and started on IV antibiotics
(levo/tigecycline) without resulotion of his symptoms. CT was
obtained and demonstrated an abscess which was I&D'd, but the
patient failed to improve s/p I&D. A repeat CT scan on [**5-13**]
demonstrated tracking of his fluid collection along the
peritoneum into the R abdominal rectus muscle. OSH cultures grew
group b strep. Since this admission, his testicular pain has
resolved, although he continues to have significant pain from
his buttock/I&D site. The patient was transferred to [**Hospital1 18**] for
further management of his tracking infection.  He has never had
a previous lesion like this and no immediate family members or
contacts have reported similar lesions. There is remote FH of
similar disease in his sister (years past), and he has had no
recent travel.

MEDICAL HISTORY: PMH: Substance Abuse, Depression
PSH: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
T: 97.8F BP: 120/83 HR: 73 RR: 18 SaO2: 99% RA
General: pleasant, nad
HEENT: op clear, mmm, no lesions; no cervical LAD
Neck: supple, no LAD, no thyromegaly
Cardiovascular: RRR, no MRG
Respiratory: CTA bilat w/o wheezes/rhonchi/rales
Back: no spinous process tenderness, no CVA tenderness
Gastrointestinal: +bs, soft, non-tender, non-distended.
Suprapubic drain in place, with 200mL of grayish output
Rectal: 2cm incised area at inferior margin of R inner gluteal
cleft with foul-smelling purulence. No apparent anal canal
involvement.
Musculoskeletal: No leg edema
Skin:  No rash, +tattoos, +mild erythema around left forearm PIV
Neurological: aaox3, cn 2-12

FAMILY HISTORY: 

SOCIAL HISTORY: ETOH abuse, Tobacco use, Recent episode of binge drinking.
Abscess of anal and rectal regions,Peritoneal abscess,Cellulitis and abscess of buttock,Mechanical complication due to other implant and internal device, not elsewhere classified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Leukocytosis, unspecified,Alcohol abuse, unspecified,Depressive disorder, not elsewhere classified
Anal & rectal abscess,Peritoneal abscess,Cellulitis of buttock,Malfunc oth device/graft,Abn react-procedure NEC,Streptococcus group b,Leukocytosis NOS,Alcohol abuse-unspec,Depressive disorder NEC
Admission Date:  [**2174-5-15**]              Discharge Date:   [**2174-5-24**]

Date of Birth:  [**2150-3-12**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 4659**]
Chief Complaint:
Abscess of right buttock.

Major Surgical or Invasive Procedure:
Interventional Radiology Aspiration and DrainageX2, Drain
placement X2


History of Present Illness:
HPI: 24 M w/ presented to OSH 5 days prior to admission w/
abdominal pain, fever, nausea and diarrhea and was found to
havean abscess of his R buttock. Pt states he had a recent binge
of alcohol for several days and after sobering had significant
pain from the affected area and into his testicles. He was
admitted to the hospital on [**5-10**] and started on IV antibiotics
(levo/tigecycline) without resulotion of his symptoms. CT was
obtained and demonstrated an abscess which was I&D'd, but the
patient failed to improve s/p I&D. A repeat CT scan on [**5-13**]
demonstrated tracking of his fluid collection along the
peritoneum into the R abdominal rectus muscle. OSH cultures grew
group b strep. Since this admission, his testicular pain has
resolved, although he continues to have significant pain from
his buttock/I&D site. The patient was transferred to [**Hospital1 18**] for
further management of his tracking infection.  He has never had
a previous lesion like this and no immediate family members or
contacts have reported similar lesions. There is remote FH of
similar disease in his sister (years past), and he has had no
recent travel.


Past Medical History:
PMH: Substance Abuse, Depression
PSH: None


Social History:
ETOH abuse, Tobacco use, Recent episode of binge drinking.

Physical Exam:
PHYSICAL EXAM:
T: 97.8F BP: 120/83 HR: 73 RR: 18 SaO2: 99% RA
General: pleasant, nad
HEENT: op clear, mmm, no lesions; no cervical LAD
Neck: supple, no LAD, no thyromegaly
Cardiovascular: RRR, no MRG
Respiratory: CTA bilat w/o wheezes/rhonchi/rales
Back: no spinous process tenderness, no CVA tenderness
Gastrointestinal: +bs, soft, non-tender, non-distended.
Suprapubic drain in place, with 200mL of grayish output
Rectal: 2cm incised area at inferior margin of R inner gluteal
cleft with foul-smelling purulence. No apparent anal canal
involvement.
Musculoskeletal: No leg edema
Skin:  No rash, +tattoos, +mild erythema around left forearm PIV
Neurological: aaox3, cn 2-12


Pertinent Results:
[**2174-5-24**] 06:15AM BLOOD WBC-7.7
[**2174-5-21**] 10:13AM BLOOD WBC-6.8 RBC-4.42* Hgb-12.9* Hct-38.3*
MCV-87 MCH-29.1 MCHC-33.6 RDW-12.4 Plt Ct-318
[**2174-5-19**] 06:47AM BLOOD WBC-7.7 RBC-4.69 Hgb-13.9* Hct-40.5
MCV-86 MCH-29.7 MCHC-34.4 RDW-12.5 Plt Ct-395
[**2174-5-18**] 06:25AM BLOOD WBC-8.3 RBC-4.77 Hgb-14.0 Hct-40.9 MCV-86
MCH-29.3 MCHC-34.3 RDW-12.5 Plt Ct-390
[**2174-5-17**] 07:50AM BLOOD WBC-9.4 RBC-4.81 Hgb-14.1 Hct-42.1 MCV-88
MCH-29.4 MCHC-33.6 RDW-12.7 Plt Ct-391
[**2174-5-16**] 05:35AM BLOOD WBC-13.5* RBC-5.12 Hgb-14.5 Hct-43.5
MCV-85 MCH-28.4 MCHC-33.4 RDW-13.1 Plt Ct-361
[**2174-5-15**] 11:32PM BLOOD WBC-12.4* RBC-5.30 Hgb-15.0 Hct-44.6
MCV-84 MCH-28.4 MCHC-33.7 RDW-13.0 Plt Ct-372
[**2174-5-15**] 11:32PM BLOOD Neuts-76.5* Lymphs-13.1* Monos-8.5
Eos-0.6 Baso-1.2
[**2174-5-23**] 09:30AM BLOOD PT-13.6* PTT-29.0 INR(PT)-1.2*
[**2174-5-21**] 10:13AM BLOOD Plt Ct-318
[**2174-5-20**] 08:45AM BLOOD PT-14.4* PTT-29.7 INR(PT)-1.2*
[**2174-5-19**] 06:47AM BLOOD Plt Ct-395
[**2174-5-18**] 01:09PM BLOOD PT-14.4* PTT-32.1 INR(PT)-1.3*
[**2174-5-18**] 06:25AM BLOOD Plt Ct-390
[**2174-5-17**] 07:50AM BLOOD Glucose-88 UreaN-13 Creat-1.0 Na-136
K-4.6 Cl-97 HCO3-32 AnGap-12
[**2174-5-16**] 05:35AM BLOOD Glucose-93 UreaN-15 Creat-0.9 Na-134
K-4.5 Cl-98 HCO3-29 AnGap-12
[**2174-5-15**] 11:32PM BLOOD Glucose-111* UreaN-14 Creat-0.7 Na-136
K-4.3 Cl-100 HCO3-27 AnGap-13
[**2174-5-15**] 11:32PM BLOOD ALT-13 AST-22 AlkPhos-69 TotBili-0.4
[**2174-5-17**] 07:50AM BLOOD Calcium-8.6 Phos-4.2 Mg-2.0
[**2174-5-16**] 05:35AM BLOOD Calcium-8.8 Phos-4.3 Mg-2.1
[**2174-5-15**] 11:32PM BLOOD Calcium-8.2* Phos-4.6* Mg-2.0
[**2174-5-23**] 05:55AM BLOOD Vanco-6.8*

CT Pelvis [**2174-4-17**]: Fluid collection extending anterior to the
bladder and involving the left rectus muscle extending
superiorly. A portion of it appears to track to the ischio-anal
fossa on the right.

CT Abd/Pelvis [**2174-5-23**]: Two percutaneous drains terminating in
the anterior pelvis are well positioned and there has been
interval decrease in size of pelvic fluid collections.


Brief Hospital Course:
The patient was admitted from the emergency department from
outside hospital. The CT Abdominal CT scan preformed at an
outside hospital [**2174-5-15**] showed progression of abscess to include
left rectus,lateral to bladder, anterior to bladder with air
fluid levels. The patients white blood cell count was elevated
to 12.4 on admission. The patient was started on Vancomycin and
Zosyn. On [**2174-5-16**] the patient was taken to interventional
radiology where CT guided drainage was preformed and a pigtail
catheter was placed, which drained approximately 400 ml of
odorous grey/light brown drainage which was sent for gram stain
and culture which showed polymorphonuclear leukocytes, gram
positive cocci in pairs, chains, and clusters as well as gram
negative rods. The MRSA screen was negative. Later these culture
showed Beta Streptococcus disease was consulted for antibiotic
and management recommendations. After drainage of this
collection the patients condition began to improved. His pain
was treated effectively on the floor with pain medications by
mouth. On [**2174-5-18**] output from pigtail drain was noted to drop
significantly which was concerning that the drain had become
blocked or misplaced. The patient was taken back to
interventional radiology on [**2174-5-20**] where a repeat CT scan was
preformed and showed persistent fluid collection and the drain
was upsized which put out a moderate amount of purulent, foul
smelling drainage. The output from the drain again slowed
despite the larger catheter size and continued fluid collection.
[**2174-5-20**] an additional pigtail drain was placed in interventional
radiology which began to effectively drain the abdominal
collection and  a repeat CT abdomen on [**2174-5-23**] showed a decrease
in the size of the abdominal fluid collection. Throughout this
time, the patient was followed closely by infectious disease who
monitored the patient's laboratory values and recommended
Vancomycin, Ceftriaxone, and [**Last Name (un) 28487**] intravenously. The patients
clinical presentation continued to improve and his wihte blood
cell count progressively decreased. Upon discharge, the patient
was sent home on an appropriate oral antibiotic regimen
recommended with ID with appropriate ID follow-up. Through out
the hospital coarse, the patient had a difficult personality and
social work was consulted for recommendations and access the
patients ability to care for himself. His report of serious
alcohol abuse pre-operatively was also very concerning. Social
work saw the patient and offered increased emotional support.
The patient was discharged home with the drains in place, and
per nursing, was able to flush and care for the drains with help
of a visiting nurse.

Medications on Admission:
None

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for pain for 7 days: Do not drink alcohol or
drive a car while taking this medication.
Disp:*56 Tablet(s)* Refills:*0*
3. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day
for 22 days: take until follow-up appointment with infectious
disease.
Disp:*22 Tablet(s)* Refills:*0*
4. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO three
times a day for 22 days: take until follow-up appointment with
infectious disease.
Disp:*66 Tablet(s)* Refills:*0*
5. Outpatient Lab Work
Please draw weekly: Chem 7, LFT, CBC, ESR, CRP and fax these
results to the [**Hospital1 18**] Infectious Disease Clinic at [**Telephone/Fax (1) 1419**]
Attention [**First Name4 (NamePattern1) 2808**] [**Last Name (NamePattern1) **] [**Name8 (MD) **], MD
6. Normal Saline Flush 0.9 % Syringe Sig: Ten (10) ml Injection
twice a day: Please flush Abdominal Drains twice daily as
instructed. Not for injection. .
Disp:*16 * Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Right Buttock Abscess Extending to Rectus Sheath


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


Discharge Instructions:
You were admitted to the hospital after developing a wound in
your buttock which turned into an abcess. This abcess became
large and infected and extended into your abdomen. This was
making you very sick and you had an elevated white blood cell
count. The fluid collection was drained in interventional
radiology and drains were placed inthis collection of fluid.
Unfortunately you required multiple visits to interventional
radiology. A CT scan of your abdomen varified that these drains
are in the correct place. These drains have been draining small
amounts of [**Doctor Last Name 352**]/brown fluid. You will return home with these
drains. It is important that you keep the area around the drains
clean and dry and change the gauze dressings as you are
instructed by the nursing team. If the drains begin to put out
blood please call the office or go ot the emergency room if
severe. It is important that you monitor the insertion sites of
these drains for signs and symptoms of infection including
increasing redness around the incertion sites, change in the
appearance of the drainage, developing an increasingly foul
odor, increased abdominal pain, or you develop a fever. Monitor
your bowel function, if you become nauseous, vomit, have
increased abdominal pain, or become constipated call the office.
You will be prescribed antibiotics which you should take exactly
as prescribed and finish the entire precription as it is
written. You will be set up with visiting nursing services at
home and they will also check these drains and help you with
flushing. The drains shoud be flushed twice daily. Please follow
their instruction exactly. You may shower with these drains. No
heavy lifting greater than 6 pounds until follow-up or otherwise
instructed by Dr. [**Last Name (STitle) **].

Please do not drink any alcohol and take it very easy until your
follow-up appointment with Dr. [**Last Name (STitle) **]. You will be taking pain
medication as needed and the antibiotic [**Last Name (un) **] so it is very
important that you do not drink any alcohol. The antibiotic
[**Last Name (un) **] will make you very nauseated and you may vomit if you
drink alcohol while taking this medication and may hurt your
liver.

You will be prescribed the pain medication hydromorphone
(Dilaudid) for you to take exactly as prescribed for pain. Do
not drink alcohol while taking this medication. Do not drive a
car while taking this medication.

You will see Dr. [**Last Name (STitle) **] on Monday [**2174-5-30**] as described below.
You will have a CT scan of you abdomen which has been sched for
you and will take place Monday [**2174-5-30**] t 9:30am. You should not
eat or drink after midnight prior to the scan. It is important
to have this done before seeing Dr. [**Last Name (STitle) **]. She will look at
this study to determine your progress.

Please take care of yourself. You will be followed closely by
infectious disease. You will need to have your laboratory values
drawn weekly and these should be faxed to the infectious disease
clinic at the fax number [**Telephone/Fax (1) 1419**]. These will be drawn at
the [**Hospital6 733**] Primary Care Clinic here at [**Hospital1 18**] at
your appointment next week and should be done weekly until you
are seen by infectious disease.

You have been set up with an appointment to be seen by a Primary
Care Provider at the [**Hospital6 733**] Clinic here at
[**Hospital1 18**]. It is located in the [**Hospital Ward Name 23**] building. You will be seen
Monday [**2174-5-30**] at the time listed below, be sure to keep this
appointment and bring all paper work from your discharge with
you.

Followup Instructions:
Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2174-5-30**] 9:30,
[**Hospital Unit Name 1825**] [**Location (un) 470**] [**Hospital1 18**], do not eat or drink after
midnight prior to this study.

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11917**] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2174-5-30**] 2:15, [**Hospital6 733**] [**Hospital1 18**] for blood
draw and PCP [**Name Initial (PRE) 648**].

You have a Follow-up appointment with Dr. [**Last Name (STitle) **] to evaluate
your drains on Monday [**2174-5-30**] at 415pm you will recieve a letter
describing the location of the office and what you are to bring,
you must have the CT scan prior to this appointment. Call ([**Telephone/Fax (1) 6219**] with any questions. Her office is at [**Street Address(2) 1126**]
[**Location (un) **], MA.

Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name12 (NameIs) **] ID WEST (SB) Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2174-6-14**] 10:30, Infectious Disease follow-up for
antibiotic therapy.


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **] MD, [**MD Number(3) 4661**]

Completed by:[**2174-5-24**]
{'Abscess of anal and rectal regions,Peritoneal abscess,Cellulitis and abscess of buttock,Mechanical complication due to other implant and internal device, not elsewhere classified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Leukocytosis, unspecified,Alcohol abuse, unspecified,Depressive disorder, not elsewhere classified'}


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: Abscess of right buttock.

PRESENT ILLNESS: HPI: 24 M w/ presented to OSH 5 days prior to admission w/
abdominal pain, fever, nausea and diarrhea and was found to
havean abscess of his R buttock. Pt states he had a recent binge
of alcohol for several days and after sobering had significant
pain from the affected area and into his testicles. He was
admitted to the hospital on [**5-10**] and started on IV antibiotics
(levo/tigecycline) without resulotion of his symptoms. CT was
obtained and demonstrated an abscess which was I&D'd, but the
patient failed to improve s/p I&D. A repeat CT scan on [**5-13**]
demonstrated tracking of his fluid collection along the
peritoneum into the R abdominal rectus muscle. OSH cultures grew
group b strep. Since this admission, his testicular pain has
resolved, although he continues to have significant pain from
his buttock/I&D site. The patient was transferred to [**Hospital1 18**] for
further management of his tracking infection.  He has never had
a previous lesion like this and no immediate family members or
contacts have reported similar lesions. There is remote FH of
similar disease in his sister (years past), and he has had no
recent travel.

MEDICAL HISTORY: PMH: Substance Abuse, Depression
PSH: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
T: 97.8F BP: 120/83 HR: 73 RR: 18 SaO2: 99% RA
General: pleasant, nad
HEENT: op clear, mmm, no lesions; no cervical LAD
Neck: supple, no LAD, no thyromegaly
Cardiovascular: RRR, no MRG
Respiratory: CTA bilat w/o wheezes/rhonchi/rales
Back: no spinous process tenderness, no CVA tenderness
Gastrointestinal: +bs, soft, non-tender, non-distended.
Suprapubic drain in place, with 200mL of grayish output
Rectal: 2cm incised area at inferior margin of R inner gluteal
cleft with foul-smelling purulence. No apparent anal canal
involvement.
Musculoskeletal: No leg edema
Skin:  No rash, +tattoos, +mild erythema around left forearm PIV
Neurological: aaox3, cn 2-12

FAMILY HISTORY: 

SOCIAL HISTORY: ETOH abuse, Tobacco use, Recent episode of binge drinking. 

### Response:
{'Abscess of anal and rectal regions,Peritoneal abscess,Cellulitis and abscess of buttock,Mechanical complication due to other implant and internal device, not elsewhere classified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Leukocytosis, unspecified,Alcohol abuse, unspecified,Depressive disorder, not elsewhere classified'}
