CHIEF COMPLAINT: Fever and neutropenia.

PRESENT ILLNESS: 67-year-old man with a history
of lymphoplasmacytic lymphoma, low-grade non-Hodgkin's
lymphoma diagnosed in 12/97.  The patient is status post
multiple courses of chemotherapy, including chlorambucil,
prednisone, CVP, fludarabine, Rituxan, adriamycin, and
Decadron.  Most recently, the patient has been on Taxol, 714X
and GSCF.  The patient had discontinued Taxol and was only on
714X, which is an experimental Canadian drug.  However, on
[**2137-9-26**], he was admitted to [**Hospital1 188**] with fever and neutropenia.  He was treated with
ceftazidime, but had no signs of infection.  His ceftazidime
was discontinued, and he had no evidence of infection despite
a thorough Infectious Disease workup, including an Infectious
Disease consult, six blood cultures which were negative,
multiple negative urine and stool cultures.  His fevers were
attributable to his non-Hodgkin's lymphoma, and he was
discharged home on [**2137-10-4**].

MEDICAL HISTORY: 1.  Non-Hodgkin's lymphoma diagnosed in [**2133-11-23**]; a
lymphoplasmacytic lymphoma status post multiple
chemotherapeutic treatments
2.  Hepatitis B
3.  Depression
4.  Osteoarthritis
5.  Oral HSV
6.  Question of benign prostatic hypertrophy
7.  Ethanol abuse some 30 years ago

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient lives with his wife and has a
remote history of tobacco and alcohol use.
Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Depressive disorder, not elsewhere classified,Acute myocardial infarction of anterolateral wall, initial episode of care,Congestive heart failure, unspecified,Bacteremia,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Arteritis, unspecified
Oth lymp unsp xtrndl org,Depressive disorder NEC,AMI anterolateral, init,CHF NOS,Bacteremia,Mth sus Stph aur els/NOS,Arteritis NOS
Admission Date:  [**2137-10-8**]       Discharge Date:  [**2137-10-15**]

Date of Birth:   [**2070-3-26**]       Sex:  M

Service:  Oncology Medicine

NOTE:  The following is a history and physical as noted by
medical house staff, Dr. [**First Name4 (NamePattern1) 402**] [**Last Name (NamePattern1) 21054**].

CHIEF COMPLAINT:  Fever and neutropenia.

HISTORY OF PRESENT ILLNESS:   67-year-old man with a history
of lymphoplasmacytic lymphoma, low-grade non-Hodgkin's
lymphoma diagnosed in 12/97.  The patient is status post
multiple courses of chemotherapy, including chlorambucil,
prednisone, CVP, fludarabine, Rituxan, adriamycin, and
Decadron.  Most recently, the patient has been on Taxol, 714X
and GSCF.  The patient had discontinued Taxol and was only on
714X, which is an experimental Canadian drug.  However, on
[**2137-9-26**], he was admitted to [**Hospital1 188**] with fever and neutropenia.  He was treated with
ceftazidime, but had no signs of infection.  His ceftazidime
was discontinued, and he had no evidence of infection despite
a thorough Infectious Disease workup, including an Infectious
Disease consult, six blood cultures which were negative,
multiple negative urine and stool cultures.  His fevers were
attributable to his non-Hodgkin's lymphoma, and he was
discharged home on [**2137-10-4**].

The patient was doing fine at home until Monday, when he had
increased weakness, increased urinary frequency, and fever
from 100 to 100.5.  He denies cough, nausea, vomiting, sore
throat, headache, or abdominal pain.  He does report a new
rash on both his arms, and diarrhea.  The patient received
Taxol chemotherapy that Thursday, [**2137-10-3**], prior to
discharge.  In the Emergency Room this time, the patient
received ceftazidime 2 grams x 1, Tylenol, Motrin and
intravenous fluids.  His vital signs at this time were a
temperature of 103.4, blood pressure 110/60 in the Emergency
Room.

PAST MEDICAL HISTORY:
1.  Non-Hodgkin's lymphoma diagnosed in [**2133-11-23**]; a
lymphoplasmacytic lymphoma status post multiple
chemotherapeutic treatments
2.  Hepatitis B
3.  Depression
4.  Osteoarthritis
5.  Oral HSV
6.  Question of benign prostatic hypertrophy
7.  Ethanol abuse some 30 years ago

MEDICATIONS:  Terazosin 5 mg daily at bedtime, quinine 325 mg
daily at bedtime, prednisone 4 mg once daily, GCSF 300 mg
once daily, Megace 400 mg twice a day.

ALLERGIES:   No known drug allergies.

SOCIAL HISTORY:  The patient lives with his wife and has a
remote history of tobacco and alcohol use.

FAMILY HISTORY:   Noncontributory.

PHYSICAL EXAMINATION:
Vitals:  Temperature 97.7, pulse 90, respiratory rate 20,
blood pressure 70/40, oxygen saturation 98% on room air.

General:  Awake, alert, and responding to questions.

Head, eyes, ears, nose and throat:  Pupils equal, round and
reactive to light, extraocular movements intact, anicteric,
two small mm lesions on the lower lip.

Neck:  Supple, no lymphadenopathy.

Lungs:  Clear to auscultation bilaterally.

Cardiovascular:  Regular, tachycardic, with ectopic beats.
Normal S1 and S2.

Abdomen:  Positive bowel sounds, soft, nontender,
nondistended.

Extremities:  Warm, 1+ distal pulses, no edema.

Skin:  Two mm to 1 cm black lesions with raised center.

LABORATORY DATA:  White count 0.1, hematocrit 33.2, platelets
8, differential 87 polys, 4 bands, 4 lymphs, 3 monos.  ANC
91, INR 1.2, PT 13, PTT 30.5.  Sodium 135, potassium 4.1,
chloride 102, bicarbonate 21, BUN 20, creatinine 0.9, glucose
103.  Urinalysis:  Urobilinogen 4, no red cells, no white
cells, no bacteria.  Blood cultures pending.  Urine culture
pending.  Chest x-ray:  No infiltrates, no effusion, no
lymphadenopathy, no change from prior chest x-ray.

HOSPITAL COURSE:  The following hospital course is as
observed by multiple house staff and summarized by [**Last Name (NamePattern5) 21055**],
M.D., Ph.D.  Mr. [**Known lastname 21056**] had a complicated medical course
which is summarized below.

On arrival to the floor, the patient was hypotensive with a
blood pressure of 70/palp, and therefore two large bore
intravenous lines were placed with fluids running wide open.
After several liters of fluids, the patient's blood pressure
improved to 130/70.  He was given platelet transfusions and
placed on neutropenic precautions.

Given the magnitude of the patient's temperature rise in
conjunction with his skin lesions and neutropenic state, we
were concerned about possible infectious etiology explaining
these findings.  Therefore, after panculture, the patient was
started on broad spectrum antibiotics to include
piperacillin, gentamicin and vancomycin.  Fluconazole was
also started for his hepatic lesions.  Furthermore, his GCSF
was increased to 480 mg once daily.  Throughout the first day
of admission, however, the patient became increasingly more
lethargic and difficult to arouse, with decreased blood
pressure to 80/50 and again he was treated with fluids and
platelet transfusion.  He received a total of five more
liters of normal saline before transfer to the Intensive Care
Unit.

While in the Intensive Care Unit, he was supported
hemodynamically with transfusions of two units of blood and
platelets as necessary.  Workup there revealed a
staphylococcus aureus bacteremia sensitive to oxacillin.  His
course in the Intensive Care Unit was complicated by an acute
myocardial infarction in the setting of hypotension and
sepsis.  He had an MB index of 21.2 and a troponin greater
than 50.  An echocardiogram performed during this time
revealed a decreased ejection fraction between 30 and 40%,
with an inferior and posterior hypokinesis.

The patient continued to improve from a hemodynamic and
sepsis point of view, and was stable for transfer back to the
Oncology service on [**2137-10-11**].  [**Initials (NamePattern5) **] [**Last Name (NamePattern5) **] was the medical
house staff caring for the patient during the remainder of
his hospitalization.

Mr. [**Known lastname 21057**] post-Intensive Care Unit course was uneventful,
with clinical improvement and eventual discharge home.  Given
the patient's methicillin-sensitive staphylococcus aureus
bacteremia without a clear source, in the setting of
neutropenia, Infectious Disease was contact[**Name (NI) **] with regards to
antibiotic duration recommendations.  They recommended a six
week course of intravenous oxacillin.  Therefore, the patient
received a PICC line to complete a six week course of
oxacillin at home.

With regard to the patient's myocardial infarction in the
setting of hypotension, he was started on a beta blocker and
ACE inhibitor, as these have been shown to be myocardial
protective.  It should be noted that he will benefit from an
outpatient stress test, but this will be reconsidered by his
primary physicians once his acute issues have resolved.

From a dermatology perspective, you recall his skin lesions.
Dermatology was consulted during this hospitalization for
biopsy, which revealed a pathology consistent with septic
vasculitis and therefore treated with oxacillin as above.

On the day of discharge, the patient was found to be stable
and clinically improved for discharge home with services.

DISCHARGE CONDITION:  Markedly improved.

DISCHARGE STATUS:  Discharged home with services.

DISCHARGE DIAGNOSIS:
1.  Staphylococcus aureus (MSSA) bacteremia with sepsis
2.  Acute myocardial infarction in the setting of sepsis
3.  Neutropenia  (It should be noted that the patient's
neutropenia resolved during the hospitalization, and his GCSF
was discontinued at this time.)
4.  Non-Hodgkin's lymphoma
5.  Oral candidiasis
6.  History of benign prostatic hypertrophy

DISCHARGE MEDICATIONS:
1.  Terazosin 5 mg daily at bedtime
2.  Megace 400 mg twice a day
3.  Lisinopril 10 mg by mouth once daily
4.  Lopressor 12.5 mg by mouth twice a day
5.  Oxacillin 1 gram every four hours to complete a six week
course

FOLLOW UP:  The patient is to follow up with his oncology
fellow and oncologist, Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 3274**] the Friday of
discharge at 2:15 P.M.

Thank you for the opportunity to participate in the care of
this very pleasant gentleman.




                            [**Name (STitle) 251**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 3282**]

Dictated By:[**Last Name (NamePattern4) 21058**]
MEDQUIST36

D:  [**2138-6-3**]  04:14
T:  [**2138-6-3**]  04:32
JOB#:  [**Job Number 21059**]
{'Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Depressive disorder, not elsewhere classified,Acute myocardial infarction of anterolateral wall, initial episode of care,Congestive heart failure, unspecified,Bacteremia,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Arteritis, 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: Fever and neutropenia.

PRESENT ILLNESS: 67-year-old man with a history
of lymphoplasmacytic lymphoma, low-grade non-Hodgkin's
lymphoma diagnosed in 12/97.  The patient is status post
multiple courses of chemotherapy, including chlorambucil,
prednisone, CVP, fludarabine, Rituxan, adriamycin, and
Decadron.  Most recently, the patient has been on Taxol, 714X
and GSCF.  The patient had discontinued Taxol and was only on
714X, which is an experimental Canadian drug.  However, on
[**2137-9-26**], he was admitted to [**Hospital1 188**] with fever and neutropenia.  He was treated with
ceftazidime, but had no signs of infection.  His ceftazidime
was discontinued, and he had no evidence of infection despite
a thorough Infectious Disease workup, including an Infectious
Disease consult, six blood cultures which were negative,
multiple negative urine and stool cultures.  His fevers were
attributable to his non-Hodgkin's lymphoma, and he was
discharged home on [**2137-10-4**].

MEDICAL HISTORY: 1.  Non-Hodgkin's lymphoma diagnosed in [**2133-11-23**]; a
lymphoplasmacytic lymphoma status post multiple
chemotherapeutic treatments
2.  Hepatitis B
3.  Depression
4.  Osteoarthritis
5.  Oral HSV
6.  Question of benign prostatic hypertrophy
7.  Ethanol abuse some 30 years ago

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient lives with his wife and has a
remote history of tobacco and alcohol use. 

### Response:
{'Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Depressive disorder, not elsewhere classified,Acute myocardial infarction of anterolateral wall, initial episode of care,Congestive heart failure, unspecified,Bacteremia,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Arteritis, unspecified'}
