CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 38 year-old male with
a history of HIV last CD4 count 134, last viral load greater
then 200,000 found to have a temperature of 102.6 while at
hemodialysis today.  The patient complained at hemodialysis
of a headache, which began concurrently with a fever.
Vancomycin was empirically begun.  The patient reports that
he was in his usual state of health until hemodialysis on the
28th.  He states that he also had mild low back pain,
although he denies any low back pain, denies any photophobia
and was transferred to the Emergency Room for further workup.
 In the Emergency Room his temperature was found to be 102.7,
pulse 88, blood pressure 104/58 and respiratory rate of 28
with an O2 sat of 97% on room air.  He received Ceftriaxone 1
gram intravenous in addition to the Vancomycin he previously
received and was noted to have further decline and his blood
pressure down to systolic of between 70 and 80 associated
with mild lightheadedness.  He was given 500 cc of normal
saline bolus times two and a further 200 cc of normal saline
bolus times one for a total of 1200 of normal saline with
transient improvement, but then blood pressures returned to
the 70s.  A Dopamine drip was started in the Emergency Room.

MEDICAL HISTORY: 1.  HIV, the patient was diagnosed in [**2116**] and was started on
HAART in [**2117**], which he continued until he self discontinued
his regimen one year prior to admission.  He has had
shingles, but has otherwise had on opportunistic infections.
2.  Hepatitis C positive.
3.  History of shingles.
4.  End stage renal disease.  He has been hemodialysis
dependent times six years.  This is thought to be secondary
to HIV nephropathy.
5.  PPD positive received INH times nine months.

MEDICATION ON ADMISSION: 1.  Trazodone 100 mg po q.h.s.
2.  Erythropoietin alpha 6000 units subq three times a week
with dialysis.
3.  Nephrocaps one po q day.
4.  Nystatin oral suspension 5 ml po q.i.d.
5.  Oxycodone Acetaminophen one tab po q 4 to 6 prn.
6.  Gabapentin 600 mg po b.i.d.
7.  Testosterone 5 mg patch 1 patch q day.
8.  Bactrim double strength one tab po q.o.d. Monday,
Wednesday and Friday.
9.  Protonix 40 mg q 24 hours.
10.  Clonazepam 1 mg po b.i.d.
11.  PhosLo 4000 and 2 mg po t.i.d. with meals.

ALLERGIES: Penicillin, Amoxicillin and Ativan and to
Compazine.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: He formerly worked at [**Hospital3 2576**] [**Hospital3 **]
until approximately a year ago.  He lives alone and denies
any tobacco history, occasional use of ethanol.
Unspecified septicemia,Human immunodeficiency virus [HIV] disease,Abscess of anal and rectal regions,Infection and inflammatory reaction due to other vascular device, implant, and graft,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute hepatitis C without mention of hepatic coma,Other and unspecified coagulation defects,Anal fistula
Septicemia NOS,Human immuno virus dis,Anal & rectal abscess,React-oth vasc dev/graft,Hyp kid NOS w cr kid V,Hpt C acute wo hpat coma,Coagulat defect NEC/NOS,Anal fistula
Admission Date:  [**2123-11-9**]     Discharge Date:  [**2123-11-12**]

Date of Birth:   [**2085-8-17**]     Sex:  M

Service:  [**Hospital1 **]

HISTORY OF PRESENT ILLNESS:  This is a 38 year-old male with
a history of HIV last CD4 count 134, last viral load greater
then 200,000 found to have a temperature of 102.6 while at
hemodialysis today.  The patient complained at hemodialysis
of a headache, which began concurrently with a fever.
Vancomycin was empirically begun.  The patient reports that
he was in his usual state of health until hemodialysis on the
28th.  He states that he also had mild low back pain,
although he denies any low back pain, denies any photophobia
and was transferred to the Emergency Room for further workup.
 In the Emergency Room his temperature was found to be 102.7,
pulse 88, blood pressure 104/58 and respiratory rate of 28
with an O2 sat of 97% on room air.  He received Ceftriaxone 1
gram intravenous in addition to the Vancomycin he previously
received and was noted to have further decline and his blood
pressure down to systolic of between 70 and 80 associated
with mild lightheadedness.  He was given 500 cc of normal
saline bolus times two and a further 200 cc of normal saline
bolus times one for a total of 1200 of normal saline with
transient improvement, but then blood pressures returned to
the 70s.  A Dopamine drip was started in the Emergency Room.

REVIEW OF SYSTEMS:  Notable for diarrhea times one day in the
absence of bright red blood per rectum, melena, abdominal
pain, dysuria, flank pain or vomiting.

PAST MEDICAL HISTORY:
1.  HIV, the patient was diagnosed in [**2116**] and was started on
HAART in [**2117**], which he continued until he self discontinued
his regimen one year prior to admission.  He has had
shingles, but has otherwise had on opportunistic infections.
2.  Hepatitis C positive.
3.  History of shingles.
4.  End stage renal disease.  He has been hemodialysis
dependent times six years.  This is thought to be secondary
to HIV nephropathy.
5.  PPD positive received INH times nine months.

MEDICATIONS ON ADMISSION:
1.  Trazodone 100 mg po q.h.s.
2.  Erythropoietin alpha 6000 units subq three times a week
with dialysis.
3.  Nephrocaps one po q day.
4.  Nystatin oral suspension 5 ml po q.i.d.
5.  Oxycodone Acetaminophen one tab po q 4 to 6 prn.
6.  Gabapentin 600 mg po b.i.d.
7.  Testosterone 5 mg patch 1 patch q day.
8.  Bactrim double strength one tab po q.o.d. Monday,
Wednesday and Friday.
9.  Protonix 40 mg q 24 hours.
10.  Clonazepam 1 mg po b.i.d.
11.  PhosLo 4000 and 2 mg po t.i.d. with meals.

ALLERGIES:  Penicillin, Amoxicillin and Ativan and to
Compazine.

SOCIAL HISTORY:  He formerly worked at [**Hospital3 2576**] [**Hospital3 **]
until approximately a year ago.  He lives alone and denies
any tobacco history, occasional use of ethanol.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature 97.9.  Pulse
67.  Blood pressure 91/60.  Respiratory rate 16.  Room air
sat of 96%.  In general, the patient was awake, alert and
oriented times three.  Moving all four extremities in no
acute distress.  HEENT pupils 2 mm bilateral and reactive.
Extraocular movements intact.  Sclera anicteric.  Conjunctiva
are injected.  Mucous membranes are moist.  No white plaque
is present on the patient's tongue.  Neck supple without any
meningismus.  Full range of motion is present.  No JVD.  No
lymphadenopathy.  Cardiovascular regular rate and rhythm.
Normal S1 and S2.  No murmurs, rubs or gallops.  Chest is
clear to auscultation bilaterally.  No erythema at the HD
catheter site.  Abdomen is soft.  The patient has mild right
upper quadrant tenderness to palpation, but no rebound or
guarding.  Extremities notable for no rash and no edema.
Neurological examination mental status examination is normal.
Strength 5+ in the upper extremities and lower extremities.
Sensory examination is normal.  Reflexes are 2+ in the
triceps, biceps, patellar and ankle jerks.  Toes are
downgoing.  Cerebellar examination is normal.

LABORATORIES ON ADMISSION:  White blood cell count is 6.3
with 75 neutrophils and 1 band.  Hematocrit 37, platelets
288, sodium 140, potassium 5.1, chloride 100, bicarb 31, BUN
61, creatinine 12.7 and glucose of 67.  A chest film revealed
no cardiomegaly and no acute cardiopulmonary processes.  LP
was performed and tube number two had 54 glucose, 39 protein.
Tube number three had 2 white blood cells, no red blood
cells.  A CT of the abdomen was obtained and demonstrated a
perirectal abscess with fistulization to the left side of the
rectum, multiple abdominal and pelvic lymph nodes, all of
which were subcentimeter in size were present.

HOSPITAL COURSE:  The patient was admitted briefly to the
Medical Intensive Care Unit for pressor therapy.  The patient
was continued on empiric antibiotics and was successfully
weaned of Dopamine.  A transthoracic echocardiogram was
obtained and demonstrated left ventricular wall thickness
that was borderline hypertrophied with LVEF greater then 55%,
normal right ventricular chamber size and free wall motion
and without any evidence of valvular abnormalities other then
trivial mitral regurgitation.  In particular, no valvular
vegetations were seen and there was no pericardial effusion.
The patient was transferred from the MICU to the general
medical team for further treatment.  Surgical consult was
obtained and the patient underwent ultrasound guided drainage
of his perirectal abscess on the [**10-12**].
Approximately 10 cc of purulent material was drained.  Gram
stain was notable for 4+ gram positive rods, 3+ gram positive
cocci in pairs and clusters, 2+ gram negative rods and 1+
budding yeast.  Culture of the drain material revealed mixed
bacterial type with greater then three colony types present
and was notable for gram negative rods of two distinct colony
morphologies and the anaerobic culture was notable for mixed
bacterial flora.  The patient's antibiotics were switched
from Vancomycin, Gentamycin and Flagyl to Ciprofloxacin and
Flagyl given the patient's allergies to Penicillin and
Amoxicillin.  The patient defervesced and remained afebrile
for 24 hours prior to discharge.

DISCHARGE CONDITION:  Stable.

DISCHARGE DIAGNOSES:
1.  Perirectal abscess.
2.  HIV.
3.  End stage renal disease.
4.  Hepatitis C.
5.  Hypertension.
6.  Fever.

DISCHARGE MEDICATIONS:  Same as those prior to admission as
well as Ciprofloxacin 500 mg q day for a two week course,
Metronidazole 500 mg by mouth t.i.d. for a total of a two
week course and Colace 100 mg b.i.d.

FOLLOW UP:  The patient will follow up with his primary care
physician [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on Thursday the [**9-18**] at
2:00 p.m.  In addition, he will return to the [**Hospital1 346**] for a repeat ultrasound study to
monitor resolution of the perirectal abscess on the [**9-30**] at 1:30 p.m. and he will then see Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
on the [**10-2**] at 10:45 a.m.  The patient will also
follow up with his nephrologist at [**Hospital1 2025**] regarding removal of
his line as discussed with the patient.






                          [**First Name11 (Name Pattern1) 2515**] [**Last Name (NamePattern4) 4517**], M.D.  [**MD Number(1) 4521**]

Dictated By:[**Last Name (NamePattern1) 30756**]

MEDQUIST36

D:  [**2123-11-13**]  08:46
T:  [**2123-11-15**]  12:15
JOB#:  [**Job Number 30757**]


Name:  [**Known lastname 5359**], [**Known firstname **]                      Unit No:  [**Numeric Identifier 5360**]

Admission Date:  [**2123-11-9**]     Discharge Date:  [**2123-11-12**]

Date of Birth:   [**2085-8-17**]     Sex:  M

Service:  [**Hospital1 248**]

The patient presented with symptoms of sepsis.  The source of
the sepsis was most likely his perirectal abscess, but a
superimposed line infection may also have been the source of
the sepsis, but it is not possible to rule out a superimposed
line infection.




                          [**First Name11 (Name Pattern1) 520**] [**Last Name (NamePattern4) 521**], M.D.  [**MD Number(1) 522**]

Dictated By:[**Last Name (NamePattern1) 5361**]

MEDQUIST36

D:  [**2123-11-24**]  17:25
T:  [**2123-11-24**]  19:38
JOB#:  [**Job Number 5362**]
{'Unspecified septicemia,Human immunodeficiency virus [HIV] disease,Abscess of anal and rectal regions,Infection and inflammatory reaction due to other vascular device, implant, and graft,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute hepatitis C without mention of hepatic coma,Other and unspecified coagulation defects,Anal fistula'}


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: 

PRESENT ILLNESS: This is a 38 year-old male with
a history of HIV last CD4 count 134, last viral load greater
then 200,000 found to have a temperature of 102.6 while at
hemodialysis today.  The patient complained at hemodialysis
of a headache, which began concurrently with a fever.
Vancomycin was empirically begun.  The patient reports that
he was in his usual state of health until hemodialysis on the
28th.  He states that he also had mild low back pain,
although he denies any low back pain, denies any photophobia
and was transferred to the Emergency Room for further workup.
 In the Emergency Room his temperature was found to be 102.7,
pulse 88, blood pressure 104/58 and respiratory rate of 28
with an O2 sat of 97% on room air.  He received Ceftriaxone 1
gram intravenous in addition to the Vancomycin he previously
received and was noted to have further decline and his blood
pressure down to systolic of between 70 and 80 associated
with mild lightheadedness.  He was given 500 cc of normal
saline bolus times two and a further 200 cc of normal saline
bolus times one for a total of 1200 of normal saline with
transient improvement, but then blood pressures returned to
the 70s.  A Dopamine drip was started in the Emergency Room.

MEDICAL HISTORY: 1.  HIV, the patient was diagnosed in [**2116**] and was started on
HAART in [**2117**], which he continued until he self discontinued
his regimen one year prior to admission.  He has had
shingles, but has otherwise had on opportunistic infections.
2.  Hepatitis C positive.
3.  History of shingles.
4.  End stage renal disease.  He has been hemodialysis
dependent times six years.  This is thought to be secondary
to HIV nephropathy.
5.  PPD positive received INH times nine months.

MEDICATION ON ADMISSION: 1.  Trazodone 100 mg po q.h.s.
2.  Erythropoietin alpha 6000 units subq three times a week
with dialysis.
3.  Nephrocaps one po q day.
4.  Nystatin oral suspension 5 ml po q.i.d.
5.  Oxycodone Acetaminophen one tab po q 4 to 6 prn.
6.  Gabapentin 600 mg po b.i.d.
7.  Testosterone 5 mg patch 1 patch q day.
8.  Bactrim double strength one tab po q.o.d. Monday,
Wednesday and Friday.
9.  Protonix 40 mg q 24 hours.
10.  Clonazepam 1 mg po b.i.d.
11.  PhosLo 4000 and 2 mg po t.i.d. with meals.

ALLERGIES: Penicillin, Amoxicillin and Ativan and to
Compazine.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: He formerly worked at [**Hospital3 2576**] [**Hospital3 **]
until approximately a year ago.  He lives alone and denies
any tobacco history, occasional use of ethanol. 

### Response:
{'Unspecified septicemia,Human immunodeficiency virus [HIV] disease,Abscess of anal and rectal regions,Infection and inflammatory reaction due to other vascular device, implant, and graft,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute hepatitis C without mention of hepatic coma,Other and unspecified coagulation defects,Anal fistula'}
