CHIEF COMPLAINT: fevers, chills, night sweats

PRESENT ILLNESS: 55M comes to the ED with chronic large scrotal and perineal
collections with persistent fevers, chills and night sweats. He
has a long-standing history of urethral strictures treated with
urethroplasties at [**Hospital6 1129**] which
subsequently failed and developed into urethral and pelvic
fistulae. Under the care of Dr. [**Last Name (STitle) 770**], the pt underwent a
diverting ileal conduit but continued to have drainage from his
native bladder. He then underwent a cystoprostatectomy. Despite
having no urinary source for a persistent fistula, he continues
to have drainage of fluid from a pinpoint opening at the bottom
of his scrotum and out of his hip and buttocks.
.
Currently, he notes that he has severe fevers (as high as 103)
when he sits for too long on his collections. In association
with his high fevers, he has chills, sweats, nausea and
vomiting. He has not had n/v for one week however. He had a
normal BM today and is passing flatus. He notes that one of the
abscess collections "burst" a month ago and continues to drain.
These drainage sites are tender/painful

MEDICAL HISTORY: PAST MEDICAL HISTORY: History of methicillin resistant
Staphylococcus aureus urinary tract infection. History of
ampicillin sensitive enterococci urinary tract infection,
diabetes mellitus type 2 on oral hypoglycemic, hepatitis C
virus status post blood transfusion at the time of his motor
vehicle accident approximately 27 years ago, T12 paraplegic
status post motor vehicle accident approximately 27 years ago
with chronic inguinal and scrotal abscesses status post
urethra and bladder surgery. Coronary artery
disease, history of one stent placed at [**Hospital1 2025**] in the past on
aspirin and Toprol,  status post back surgery due to motor
vehicle accident. At the time of his motor vehicle accident
27 years ago, the patient had a urethral disruption and
needed a surgery. Approximately five years ago is when the
scrotal abscess occurred. History of fluoroquinolone
resistant and fluoroquinolone sensitive pseudomonas of
osteomyelitis of bilateral tibias. History of osteomyelitis of
the right ischium, pelvic ramus and sacrum decubitus.

MEDICATION ON ADMISSION: glucophage 1500 qam/1000 qpm, glyburide 5 [**Hospital1 **], lipitor 20 qd,
toprol XL 25 qd, lantus 50, [**Last Name (LF) **], [**First Name3 (LF) **] 81, protonix 40, MVI, vitC

ALLERGIES: Sulfa (Sulfonamides) / Bactrim

PHYSICAL EXAM: PE: 98.9 100 134/63 16 98RA
NAD, lying in bed
CTAB
RRR, no CVAT, well-healed scar over spine
Soft, nontender, protuberant abd with reducible parastomal
hernia
Stoma is pink and functioning well.
Phallus uncirc
scrotum erythematous and tender bilaterally, purulent drainage
tract in right hemi-scrotum and right perineum
R hip with drainage tract
DRE: flat fossa, minimally tender, poor rectal tone
No sacral breakdown
Ext wnl

FAMILY HISTORY: nc

SOCIAL HISTORY: SOCIAL HISTORY: The patient was born in [**Country 4194**] and has lived
in the United States for ten plus years. He is wheelchair
bound at baseline. He has a history of tobacco use, but does
not smoke currently. He denies alcohol use. He denies any IV
drug use. He lives in [**Location 583**] with his wife.
Cellulitis and abscess of trunk,Paraplegia,Unspecified osteomyelitis, pelvic region and thigh,Other inflammatory disorders of male genital organs,Anal fistula,Unspecified local infection of skin and subcutaneous tissue,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Late effect of spinal cord injury,Late effects of motor vehicle accident,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Cellulitis of trunk,Paraplegia NOS,Osteomyelitis NOS-pelvis,Male gen inflam dis NEC,Anal fistula,Local skin infection NOS,Hypertension NOS,Crnry athrscl natve vssl,Late eff spinal cord inj,Late eff motor vehic acc,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2180-8-16**]              Discharge Date:   [**2180-8-23**]

Date of Birth:  [**2125-5-5**]             Sex:   M

Service: UROLOGY

Allergies:
Sulfa (Sulfonamides) / Bactrim

Attending:[**First Name3 (LF) 824**]
Chief Complaint:
fevers, chills, night sweats

Major Surgical or Invasive Procedure:
debridement of perineum and buttocks


History of Present Illness:
55M comes to the ED with chronic large scrotal and perineal
collections with persistent fevers, chills and night sweats. He
has a long-standing history of urethral strictures treated with
urethroplasties at [**Hospital6 1129**] which
subsequently failed and developed into urethral and pelvic
fistulae. Under the care of Dr. [**Last Name (STitle) 770**], the pt underwent a
diverting ileal conduit but continued to have drainage from his
native bladder. He then underwent a cystoprostatectomy. Despite
having no urinary source for a persistent fistula, he continues
to have drainage of fluid from a pinpoint opening at the bottom
of his scrotum and out of his hip and buttocks.
.
Currently, he notes that he has severe fevers (as high as 103)
when he sits for too long on his collections. In association
with his high fevers, he has chills, sweats, nausea and
vomiting. He has not had n/v for one week however. He had a
normal BM today and is passing flatus. He notes that one of the
abscess collections "burst" a month ago and continues to drain.
These drainage sites are tender/painful

Past Medical History:
PAST MEDICAL HISTORY: History of methicillin resistant
Staphylococcus aureus urinary tract infection. History of
ampicillin sensitive enterococci urinary tract infection,
diabetes mellitus type 2 on oral hypoglycemic, hepatitis C
virus status post blood transfusion at the time of his motor
vehicle accident approximately 27 years ago, T12 paraplegic
status post motor vehicle accident approximately 27 years ago
with chronic inguinal and scrotal abscesses status post
urethra and bladder surgery. Coronary artery
disease, history of one stent placed at [**Hospital1 2025**] in the past on
aspirin and Toprol,  status post back surgery due to motor
vehicle accident. At the time of his motor vehicle accident
27 years ago, the patient had a urethral disruption and
needed a surgery. Approximately five years ago is when the
scrotal abscess occurred. History of fluoroquinolone
resistant and fluoroquinolone sensitive pseudomonas of
osteomyelitis of bilateral tibias. History of osteomyelitis of
the right ischium, pelvic ramus and sacrum decubitus.


Social History:
SOCIAL HISTORY: The patient was born in [**Country 4194**] and has lived
in the United States for ten plus years. He is wheelchair
bound at baseline. He has a history of tobacco use, but does
not smoke currently. He denies alcohol use. He denies any IV
drug use. He lives in [**Location 583**] with his wife.


Family History:
nc

Physical Exam:
PE: 98.9 100 134/63 16 98RA
NAD, lying in bed
CTAB
RRR, no CVAT, well-healed scar over spine
Soft, nontender, protuberant abd with reducible parastomal
hernia
Stoma is pink and functioning well.
Phallus uncirc
scrotum erythematous and tender bilaterally, purulent drainage
tract in right hemi-scrotum and right perineum
R hip with drainage tract
DRE: flat fossa, minimally tender, poor rectal tone
No sacral breakdown
Ext wnl


Pertinent Results:
[**2180-8-16**] 06:21PM   WBC-9.8 RBC-5.09 HGB-13.2* HCT-39.0* MCV-77*
MCH-25.8* MCHC-33.8 RDW-16.1*
[**2180-8-16**] 06:21PM   NEUTS-70.1* LYMPHS-17.2* MONOS-6.3 EOS-6.2*
BASOS-0.2
[**2180-8-16**] 06:21PM   PLT COUNT-394
[**2180-8-16**] 06:21PM   GLUCOSE-187* UREA N-15 CREAT-0.7 SODIUM-134
POTASSIUM-5.0 CHLORIDE-98 TOTAL CO2-24 ANION GAP-17
[**2180-8-16**] 06:39PM   LACTATE-2.6*

Brief Hospital Course:
Patient was admitted for bacteremia secondary to perineal
collections/abscess.  An MRI was obtained which showed the
following:
Multiple abscesses identified in the right gluteal region.  5.2
cm x 2.7
cm x 3.8 cm abscess with a draining sinus to the posterior
cutaneous surface
of the right buttock has decreased in size since previous study.
 There is
underlying loss of cortical margination and abnormal signal
within the
proximal femoral shaft/greater trochanteric region consistent
with
osteomyelitis.

2.  Abscess measuring up to 3.4 cm just lateral to the right
ischiorectal
fossa and infiltrating into the perineum also appears to have
decreased in
size since previous study.  There is underlying abnormal signal
and early
cortical destruction of the right ischium consistent with
osteomyelitis.

He was started on IV antibiotics (Vanco and Zosyn) and the
infectious disease team was consulted for their input.  Because
of the location of the abscesses and fistulas being near the
rectum, we did obtain a consult from General Surgery.  They did
not feel that there was any indication for the need of a
colorectal diversion at this time.  Ortho was consulted for the
osteomyelitis.  They did not feel that it needed to be debrided
at this time and suggested following up with them in the next
two weeks for further evaluation. On [**8-18**] he was taken to the OR
for debridement of his perineal abscesses and resection of the
fistula tracts.  Four incisions were made.  One in the scrotum.
Another on the lateral aspect of the right buttock, another just
medial to the anus, and a third relaxing incision over the
medial buttock.  Multiple tissue, fluid, and bone cultures were
sent for bacteria, fungal, and AFB cultures.
   Post-op he developed hyperglycemia.  His blood sugars jumped
into the 400+ range.  We tried giving large doses of fast acting
insulin but he did not appear to be responding.  For this reason
he was transferred to the ICU for possible need of an insulin
drip.  By the time he got down to the ICU his sugars had finally
started to drop.  He did not require an insulin drip and was
trans. back to the floor the next day.  Endocrine was consulted
at this point for assistance with blood sugar control.
Eventually his sugars were better controlled, but he would need
close follow-up with his endocrinologist due to the devastating
effects hyperglycemia has on his infection and vice versa.
   Plastics was consulted regarding the use of a wound vac.
However, this did not seem feasible as he had multiple small
wounds not in proximity to each other.  We therefore proceeded
with wet->dry kerlex packing twice daily.  By the time of
discharge his wounds were granulating and the packing had only
minimal pus and drainage.
  He had received a PICC line during his stay as we thought he
would need IV antibiotics to go home with.  However, ID
eventually recommended that a course of Augmentin PO x 4 weeks
would be sufficient to treat the soft tissue infection.  They
felt the osteomyelitis would ultimately require debridement in
the future.  Therefore, the wife was instructed on how to change
his packing and manage his wounds so that he could go home, as
his insurance would not cover VNA.
  By POD 5 we felt he was meeting all the criteria for discharge
and decided to send him home with appropriate teaching and
follow up.


Medications on Admission:
glucophage 1500 qam/1000 qpm, glyburide 5 [**Hospital1 **], lipitor 20 qd,
toprol XL 25 qd, lantus 50, [**Last Name (LF) **], [**First Name3 (LF) **] 81, protonix 40, MVI, vitC

Discharge Medications:
1. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. Metformin 500 mg Tablet Sig: Three (3) Tablet PO QAM (once a
day (in the morning)).
4. Metformin 500 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

7. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
8. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
10. Amoxicillin-Pot Clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 4 weeks.
Disp:*56 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
perineal fistulas and abscess


Discharge Condition:
stable


Discharge Instructions:
Call Urology office or go to your local Emergency Room if
1) Temp greater than 101
2) Nauseau and Vomitting for greater than 24 hours
3) Worsening Pain not relieved by Medications
4) Inability to Urinate
You may resume your home Medications
You may shower

Please have weekly CBC, BUN/Cr blood tests drawn and fax results
to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 1419**]

Followup Instructions:
Follow up with Infectious Disease on [**9-19**]
Follow up with your Endocrinologist as soon as possible (by next
week)
Follow up with Dr. [**Last Name (STitle) **] (orthopedics) in [**12-25**] weeks for
evaluation of your osteomyelitis
Follow up with Urology in clinic in 2 weeks for evaluation of
your wound [**Telephone/Fax (1) 164**]
{'Cellulitis and abscess of trunk,Paraplegia,Unspecified osteomyelitis, pelvic region and thigh,Other inflammatory disorders of male genital organs,Anal fistula,Unspecified local infection of skin and subcutaneous tissue,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Late effect of spinal cord injury,Late effects of motor vehicle accident,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: fevers, chills, night sweats

PRESENT ILLNESS: 55M comes to the ED with chronic large scrotal and perineal
collections with persistent fevers, chills and night sweats. He
has a long-standing history of urethral strictures treated with
urethroplasties at [**Hospital6 1129**] which
subsequently failed and developed into urethral and pelvic
fistulae. Under the care of Dr. [**Last Name (STitle) 770**], the pt underwent a
diverting ileal conduit but continued to have drainage from his
native bladder. He then underwent a cystoprostatectomy. Despite
having no urinary source for a persistent fistula, he continues
to have drainage of fluid from a pinpoint opening at the bottom
of his scrotum and out of his hip and buttocks.
.
Currently, he notes that he has severe fevers (as high as 103)
when he sits for too long on his collections. In association
with his high fevers, he has chills, sweats, nausea and
vomiting. He has not had n/v for one week however. He had a
normal BM today and is passing flatus. He notes that one of the
abscess collections "burst" a month ago and continues to drain.
These drainage sites are tender/painful

MEDICAL HISTORY: PAST MEDICAL HISTORY: History of methicillin resistant
Staphylococcus aureus urinary tract infection. History of
ampicillin sensitive enterococci urinary tract infection,
diabetes mellitus type 2 on oral hypoglycemic, hepatitis C
virus status post blood transfusion at the time of his motor
vehicle accident approximately 27 years ago, T12 paraplegic
status post motor vehicle accident approximately 27 years ago
with chronic inguinal and scrotal abscesses status post
urethra and bladder surgery. Coronary artery
disease, history of one stent placed at [**Hospital1 2025**] in the past on
aspirin and Toprol,  status post back surgery due to motor
vehicle accident. At the time of his motor vehicle accident
27 years ago, the patient had a urethral disruption and
needed a surgery. Approximately five years ago is when the
scrotal abscess occurred. History of fluoroquinolone
resistant and fluoroquinolone sensitive pseudomonas of
osteomyelitis of bilateral tibias. History of osteomyelitis of
the right ischium, pelvic ramus and sacrum decubitus.

MEDICATION ON ADMISSION: glucophage 1500 qam/1000 qpm, glyburide 5 [**Hospital1 **], lipitor 20 qd,
toprol XL 25 qd, lantus 50, [**Last Name (LF) **], [**First Name3 (LF) **] 81, protonix 40, MVI, vitC

ALLERGIES: Sulfa (Sulfonamides) / Bactrim

PHYSICAL EXAM: PE: 98.9 100 134/63 16 98RA
NAD, lying in bed
CTAB
RRR, no CVAT, well-healed scar over spine
Soft, nontender, protuberant abd with reducible parastomal
hernia
Stoma is pink and functioning well.
Phallus uncirc
scrotum erythematous and tender bilaterally, purulent drainage
tract in right hemi-scrotum and right perineum
R hip with drainage tract
DRE: flat fossa, minimally tender, poor rectal tone
No sacral breakdown
Ext wnl

FAMILY HISTORY: nc

SOCIAL HISTORY: SOCIAL HISTORY: The patient was born in [**Country 4194**] and has lived
in the United States for ten plus years. He is wheelchair
bound at baseline. He has a history of tobacco use, but does
not smoke currently. He denies alcohol use. He denies any IV
drug use. He lives in [**Location 583**] with his wife. 

### Response:
{'Cellulitis and abscess of trunk,Paraplegia,Unspecified osteomyelitis, pelvic region and thigh,Other inflammatory disorders of male genital organs,Anal fistula,Unspecified local infection of skin and subcutaneous tissue,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Late effect of spinal cord injury,Late effects of motor vehicle accident,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
