CHIEF COMPLAINT: Sore throat, coryza symptoms

PRESENT ILLNESS: 51 yo male presents with 1 week history of sore throat and URI
type symptoms.  He presented to an OSH where he was noted to
have leukocytosis (WBC >70K) and given concern for hematologic
malignancy, he was transferred here for further care.
.
In the ED, initial vitals were: 98.2, 98, 138/67, 20, 94%.
Hematology evaluated the patient, and a peripheral smear was
consistent with likely AML.  Bone marrow biopsy was performed,
and the patient was then initiated on leukopheresis prior to
admission.  In the ED, he also received 3 gm hydroxyuria,
allopurinol, bicarb, as well as levofloxacin for ? PNA on his
CXR.
.
Currently, the patient feels better.  He reports brownish
productive sputum.  He saw his PCP on Wednesday, and since his
lungs were clear, he was told to continue on his OTC coricidin.
His symptoms continued to worsen which is why he presented to
the ED.  He states he's also had nightsweats for the last week.
.
On ROS, he denies fevers, chills, weight change, visual changes,
headaches, nausea, vomiting, abdominal pain, constipation,
BRBPR, melena, dysuria, hematuria, frequency, urgency, numbness,
weakness, orthopnea, PND, or lower extremity edema.  He does
report some increased dyspnea this past week as well as a few
episodes of diarrhea.

MEDICAL HISTORY: Hypertension
Seasonal Allergies

MEDICATION ON ADMISSION: HCTZ 25 mg daily
Fluticasone nasal spray

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: 101.0  124/72  85  20  96%1L
GENERAL: WDWN male, NAD, appears comfortable
HEENT: NCAT, no cervical adenopathy; mucous membranes slightly
dry
CV: RRR, no M/R/G
LUNGS: few coarse BS in R base, otherwise clear without wheezes
rales or rhonci
ABDOMEN: soft, obese, non tender.  normal BS.  could not
appreaciate HSM due to body habitus
EXTREMITIES: no C/C/E
SKIN: no rash; few petecechiae around neck
NEURO: CN 2-12 grossly intact; [**6-14**] prox/distal strength BUE/BLE
extremities. no clonus.
PSYCH: A/O x 3; mood and affect appropriate
LYMPH: no cervical, suprclavicular, or axillary lymphadenopathy
appreciated

FAMILY HISTORY: First cousin with leukemia

SOCIAL HISTORY: Occasional ETOH.  Previous smoker, none now (25pk/yr) quit 4 yrs
ago.  No illicit drug use (prior use of marijuana)- no h/o IVDU.
Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Hiccough,Acute myeloid leukemia, without mention of having achieved remission,Pneumonia, organism unspecified,Unspecified essential hypertension,Dermatitis due to drugs and medicines taken internally,Cephalosporin group causing adverse effects in therapeutic use,Accidents occurring in residential institution,Neutropenia, unspecified,Stomatitis and mucositis, unspecified,Fever presenting with conditions classified elsewhere,Personal history of tobacco use,Diarrhea,Other specified erythematous conditions,Antineoplastic chemotherapy induced anemia
Adv eff antineoplastic,Hiccough,Ac myl leuk wo achv rmsn,Pneumonia, organism NOS,Hypertension NOS,Drug dermatitis NOS,Adv eff cephalosporin,Accid in resident instit,Neutropenia NOS,Stomatitis/mucositis NOS,Fever in other diseases,History of tobacco use,Diarrhea,Erythematous cond NEC,Anemia d/t antineo chemo
Admission Date:  [**2175-8-19**]              Discharge Date:   [**2175-9-15**]

Date of Birth:  [**2124-2-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7591**]
Chief Complaint:
Sore throat, coryza symptoms

Major Surgical or Invasive Procedure:
PICC placement
Bone Marrow Biopsy


History of Present Illness:
51 yo male presents with 1 week history of sore throat and URI
type symptoms.  He presented to an OSH where he was noted to
have leukocytosis (WBC >70K) and given concern for hematologic
malignancy, he was transferred here for further care.
.
In the ED, initial vitals were: 98.2, 98, 138/67, 20, 94%.
Hematology evaluated the patient, and a peripheral smear was
consistent with likely AML.  Bone marrow biopsy was performed,
and the patient was then initiated on leukopheresis prior to
admission.  In the ED, he also received 3 gm hydroxyuria,
allopurinol, bicarb, as well as levofloxacin for ? PNA on his
CXR.
.
Currently, the patient feels better.  He reports brownish
productive sputum.  He saw his PCP on Wednesday, and since his
lungs were clear, he was told to continue on his OTC coricidin.
His symptoms continued to worsen which is why he presented to
the ED.  He states he's also had nightsweats for the last week.
.
On ROS, he denies fevers, chills, weight change, visual changes,
headaches, nausea, vomiting, abdominal pain, constipation,
BRBPR, melena, dysuria, hematuria, frequency, urgency, numbness,
weakness, orthopnea, PND, or lower extremity edema.  He does
report some increased dyspnea this past week as well as a few
episodes of diarrhea.


Past Medical History:
Hypertension
Seasonal Allergies


Social History:
Occasional ETOH.  Previous smoker, none now (25pk/yr) quit 4 yrs
ago.  No illicit drug use (prior use of marijuana)- no h/o IVDU.

Family History:
First cousin with leukemia

Physical Exam:
VITALS: 101.0  124/72  85  20  96%1L
GENERAL: WDWN male, NAD, appears comfortable
HEENT: NCAT, no cervical adenopathy; mucous membranes slightly
dry
CV: RRR, no M/R/G
LUNGS: few coarse BS in R base, otherwise clear without wheezes
rales or rhonci
ABDOMEN: soft, obese, non tender.  normal BS.  could not
appreaciate HSM due to body habitus
EXTREMITIES: no C/C/E
SKIN: no rash; few petecechiae around neck
NEURO: CN 2-12 grossly intact; [**6-14**] prox/distal strength BUE/BLE
extremities. no clonus.
PSYCH: A/O x 3; mood and affect appropriate
LYMPH: no cervical, suprclavicular, or axillary lymphadenopathy
appreciated

At discharge: same as above except:
HEENT: MM moist
SKIN: resolving maculopapular rash w/ excoriations on trunk,
single suture at site of skin biopsy on L side of abdomen;
minimal petechiae on B/L ankles

Pertinent Results:
Admission Labs:
[**2175-8-19**] 06:15PM   WBC-70.2* RBC-3.90* HGB-13.6* HCT-36.5*
MCV-94 MCH-34.8* MCHC-37.2* RDW-15.2
[**2175-8-19**] 06:15PM   NEUTS-4* BANDS-0 LYMPHS-8* MONOS-5 EOS-1
BASOS-0 ATYPS-0 METAS-1* MYELOS-1* NUC RBCS-1* OTHER-80*
[**2175-8-19**] 06:15PM   PT-14.4* PTT-24.4 INR(PT)-1.2*
[**2175-8-19**] 06:15PM   GLUCOSE-152* LACTATE-3.1* NA+-137 K+-3.1*
CL--92* TCO2-29
[**2175-8-19**] 06:15PM   GLUCOSE-159* UREA N-13 CREAT-1.3* SODIUM-137
POTASSIUM-2.8* CHLORIDE-94* TOTAL CO2-26 ANION GAP-20
.
Discharge Labs:

.
Imaging:
ECHO [**2175-8-21**]
The left atrium is elongated. 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) are mildly thickened. There is no
valvular aortic stenosis. The increased transaortic velocity is
likely related to high cardiac output. No aortic regurgitation
is seen. The mitral valve leaflets are mildly thickened. There
is no mitral valve prolapse. Mild (1+) mitral regurgitation is
seen. The tricuspid valve leaflets are mildly thickened. The
estimated pulmonary artery systolic pressure is normal. There is
no pericardial effusion.
.
Cytogenetics [**2175-8-21**]


PML at 15q22


RARA at 17q21.1


ETO at 8q22


AML1 at 21q22


CBFB 5' at 16q22


CBFB 3' at 16q22
.
CXR [**2175-8-21**]: IMPRESSIONS: Unchanged bibasilar opacities.
.
CT Chest [**2175-8-24**]
IMPRESSIONS:

1. Diffuse right pleural thickening with sparing of the medial
pleural
surface together with tiny right pleural effusion likely account
for the CXR appearance. Together with shift of the mediastinum
towards the right,
fibrothorax is a possibility, especially if the patient has had
prior pleural disease. Comparison with older imaging may be
helpful in establishing chronicity. Otherwise, follow up CT in 3
months may be helpful to ensure stability.

2. Diffuse ground-glass attenuation of the lungs with smooth
septal
thickening can be seen in hydrostatic edema, but also in
atypical infections such as viral or pneumocystis pneumonia.

3. Borderline enlarged mediastinal and hilar lymph nodes may be
reactive
but attention at follow up CT suggested.

4. Splenomegaly with splenic infarct.

5. Possible left renal hypodensity, which may represent either
renal lesion or renal infarct. This could be evaluated by renal
US if warranted clinically.
.
CT sinus [**2175-8-26**]
IMPRESSION:
1. Mucosal thickening involving maxillary sinuses and sphenoid
sinus,
consistent with mucosal sinus disease.
2. No evidence of soft tissue infection or osseous erosion.
.
CXR [**2175-9-8**]
Cardiac size is normal. Bibasilar opacity is new on the left,
could be
atelectasis but superimposed infection cannot be totally
excluded. There is no pneumothorax or pleural effusion. Right
central catheters remain in place.
.
CXR [**2175-9-10**]
Cardiomediastinal contours are normal. Aside from minimal
atelectasis in the right base, the lungs are clear. Opacity in
the left lower lobe is no longer visualized. There is no
evidence of pneumonia, pneumothorax or pleural effusions.
Moderate degenerative changes are in the thoracic spine. Two
right central catheters remain in place.
.
[**9-11**] SKIN BIOPSY PATHOLOGY REPORT:
Superficial dermal hemorrhage associated with small vessel
thrombi and superficial to mid dermal perivascular lymphocytic
infiltrate (see microscopic description and comment).
No herpes virus identified (routine and immunostains).
Microscopic description. Sections show intact epidermis with
occasional dyskeratotic cells. No vesiculation is identified in
the multiple tissue levels examined. There is an area of red
blood cell extravasation in the superficial dermis which is
associated with thrombi in small  vessels. No vasculitis is
seen. In addition, there is relatively [**Name2 (NI) 15410**] superficial to mid
dermal perivascular and predominantly lymphocytic infiltrate,
with some admixed histiocytes. No herpes virus cytopathic effect
is seen on routine stains. No immunoreactivity for herpes
simplex or varicella zoster is seen on specific immunostains. No
bacterial or fungal organisms are identified on Gram or GMS
stains, respectively.
Comment.  No infectious agents are identified in this sample on
routine or infectious stains, and specifically, no herpes viral
cytopathic effect is seen. If there is continuing clinical
concern for herpes virus, culture may prove more sensitive than
tissue based stains. The combined findings of apparently
localized superficial dermal hemorrhage, small vessel thrombi
and perivascular mononuclear cell infiltration are unusual and
are not specifically diagnostic in this biopsy. The histologic
differential diagnosis includes trauma, an adjacent lesion or
excoriation, a hypersensitivity reaction, and possibly an
occlusive vasculopathy. Clinical correlation is necessary



Brief Hospital Course:
The patient is a 51-year-old man with newly diagnosed AML who
was hospitalized to undergo 7+3 induction

1. AML
Patient underwent 7+3 induction and tolerated the chemotherapy
well. On [**2175-9-1**], the patient's bone marrow demonstrated
"Markedly hypocellular marrow with chemoablation effects. No
morphological evidence of residual leukemia is seen." Pt.
underwent repeat bone marrow biopsy on day of discharge ([**2175-9-15**])
w/ aspirate taken but unable to obtain core sample. Acyclovir
started for prophylaxis.
.
2. Febrile neutropenia
Following a fever on [**2175-8-20**], the patient was started on
cefepime on [**2175-8-21**] and vancomycin on [**2175-8-23**]. Micafungin and
levofloxacin were added on [**2175-8-25**] after CT chest showed ground
glass attentuation. He was also ordered for CT sinus (pt uses
fluticasone at home). The patient developed a non-pruritic
maculopapular rash on his upper right arm. Derm was consulted,
since rash appeared concomitantly with fever, and were very much
convinced that the rash is a drug rash. For pruritus treatment,
Derm recommended clobetasone. Cefepime was changed to meropenem
on [**2175-8-26**] due to likely drug hypersensitivity.  The patient
also has an intertriginous rash on his right groin; has
miconazole powder to use. On [**9-1**], with the patient having more
itching and rash, meropenem was switched to aztreonam and
flagyl.
On [**2175-9-7**], the patient again began to have fevers. CXR showed
perhaps a new opacity at base of left lung. Patient was
continued on an antibiotic regimen of aztreonam, flagyl,
vancomycin, and micafungin. Repeat CXR showed no evidence of
PNA. His fevers resolved on this regimen and flagyl, vancomycin,
micafungin d/c'ed on [**2175-9-14**]. Aztreonam d/c'ed on [**2175-9-15**]. ANC
improved from 0 to 2647 on day of discharge.
.
3. Rash, likely hypersensitivity reaction to drug
Patient has maculopapular rash that developed on extremities and
torso. Cefepime and meropenem were both stopped following
outbreak of rashes. Patient received sarna and diphenhydramine
for pruritus. The rash persisted after discontinuation of
antibiotics and derm was consulted for possible viral
etiologies. A punch biopsy was obtained and sent for pathology
which showed superficial dermal hemorrhage associated with small
vessel thrombi and superficial to mid dermal perivascular
lymphocytic infiltrate with no evidence of HSV or VZV. The
patient had a suture at the site of biopsy in place at time of
discharge with instructions to remove around [**9-26**]. He was
discharged with Sarna and clobetasol creams prn.
.
-f/u w/ Dr. [**Last Name (STitle) 410**] in clinic on [**2175-9-19**] at 11am
-f/u BM aspirate results
-Skin biopsy suture should be removed around [**9-26**]



Medications on Admission:
HCTZ 25 mg daily
Fluticasone nasal spray

Discharge Medications:
1. Sarna Anti-Itch 0.5-0.5 % Lotion Sig: One (1) application
Topical four times a day as needed for itching.
Disp:*1 bottle* Refills:*0*
2. Acyclovir 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
Disp:*90 Tablet(s)* Refills:*0*
3. Clobetasol 0.05 % Ointment Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day).
Disp:*1 tube* Refills:*0*
4. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
puff each nostril Nasal once a day.
5. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
6. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain for 20 doses.
Disp:*20 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
PRIMARY:
Acute myelogenous leukemia

SECONDARY:
Neutropenic fever
Rash, likely in reaction to cefepime


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 with a sore throat and
symptoms of an upper respiratory infection. You were found to
have a high white blood cell count and were diagnosed with acute
myelogenous leukemia. You had multiple bone marrow biopsies. You
underwent induction chemotherapy which you tolerated well. Your
counts went down as expected and you developed a fever which was
treated with antibiotics. Your fevers resolved and your counts
have gone back up. You also developed a rash which may have been
related to antibiotics and it was determined that there was no
virus causing the rash. The rash improved prior to discharge.
.
Some of your medications were changed during this admission:
START Acyclovir
START Oxycodone as needed for pain
.
You should continue to take your other home medications as
prescribed.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 3749**], MD Phone:[**Telephone/Fax (1) 3241**]
Date/Time:[**2175-9-19**] 11:00 [**Hospital Ward Name **] [**Location (un) **]
{'Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Hiccough,Acute myeloid leukemia, without mention of having achieved remission,Pneumonia, organism unspecified,Unspecified essential hypertension,Dermatitis due to drugs and medicines taken internally,Cephalosporin group causing adverse effects in therapeutic use,Accidents occurring in residential institution,Neutropenia, unspecified,Stomatitis and mucositis, unspecified,Fever presenting with conditions classified elsewhere,Personal history of tobacco use,Diarrhea,Other specified erythematous conditions,Antineoplastic chemotherapy induced anemia'}


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: Sore throat, coryza symptoms

PRESENT ILLNESS: 51 yo male presents with 1 week history of sore throat and URI
type symptoms.  He presented to an OSH where he was noted to
have leukocytosis (WBC >70K) and given concern for hematologic
malignancy, he was transferred here for further care.
.
In the ED, initial vitals were: 98.2, 98, 138/67, 20, 94%.
Hematology evaluated the patient, and a peripheral smear was
consistent with likely AML.  Bone marrow biopsy was performed,
and the patient was then initiated on leukopheresis prior to
admission.  In the ED, he also received 3 gm hydroxyuria,
allopurinol, bicarb, as well as levofloxacin for ? PNA on his
CXR.
.
Currently, the patient feels better.  He reports brownish
productive sputum.  He saw his PCP on Wednesday, and since his
lungs were clear, he was told to continue on his OTC coricidin.
His symptoms continued to worsen which is why he presented to
the ED.  He states he's also had nightsweats for the last week.
.
On ROS, he denies fevers, chills, weight change, visual changes,
headaches, nausea, vomiting, abdominal pain, constipation,
BRBPR, melena, dysuria, hematuria, frequency, urgency, numbness,
weakness, orthopnea, PND, or lower extremity edema.  He does
report some increased dyspnea this past week as well as a few
episodes of diarrhea.

MEDICAL HISTORY: Hypertension
Seasonal Allergies

MEDICATION ON ADMISSION: HCTZ 25 mg daily
Fluticasone nasal spray

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: 101.0  124/72  85  20  96%1L
GENERAL: WDWN male, NAD, appears comfortable
HEENT: NCAT, no cervical adenopathy; mucous membranes slightly
dry
CV: RRR, no M/R/G
LUNGS: few coarse BS in R base, otherwise clear without wheezes
rales or rhonci
ABDOMEN: soft, obese, non tender.  normal BS.  could not
appreaciate HSM due to body habitus
EXTREMITIES: no C/C/E
SKIN: no rash; few petecechiae around neck
NEURO: CN 2-12 grossly intact; [**6-14**] prox/distal strength BUE/BLE
extremities. no clonus.
PSYCH: A/O x 3; mood and affect appropriate
LYMPH: no cervical, suprclavicular, or axillary lymphadenopathy
appreciated

FAMILY HISTORY: First cousin with leukemia

SOCIAL HISTORY: Occasional ETOH.  Previous smoker, none now (25pk/yr) quit 4 yrs
ago.  No illicit drug use (prior use of marijuana)- no h/o IVDU. 

### Response:
{'Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Hiccough,Acute myeloid leukemia, without mention of having achieved remission,Pneumonia, organism unspecified,Unspecified essential hypertension,Dermatitis due to drugs and medicines taken internally,Cephalosporin group causing adverse effects in therapeutic use,Accidents occurring in residential institution,Neutropenia, unspecified,Stomatitis and mucositis, unspecified,Fever presenting with conditions classified elsewhere,Personal history of tobacco use,Diarrhea,Other specified erythematous conditions,Antineoplastic chemotherapy induced anemia'}
