CHIEF COMPLAINT: Fever

PRESENT ILLNESS: HPI: MR. [**Known lastname 6164**] is a 48 yo M with HIV/AIDS (CD4 311 [**2144-10-2**] VL
<48), Hep C, who presented to the ED with fevers for the past 2
days. He reports having headache, sore throat, nasal congestion,
cough and body aches since the start of the fevers. Of note he
admits to injecting crystal meth in his left arm on the day
prior to symptom onset, reports cleaning the area prior and
using a clean needle. He denies any history of endocarditis. He
presented to [**Hospital1 2025**] yesterday, where he had a treadmill stress test
which patient reports was normal, went 12minutes on the
treadmill. Otherwise he denies getting any other treatment. He
presented to our ED overnight when the fevers persisted and he
continued to feel poorly. Otherwise he denies nausea, vomiting,
diarrhea, dysuria, hematuria, pain at the site where he injected
drugs, abdominal pain.
.
Of note he had recent LP in [**Hospital **] clinic due to concern for
possible neurosyphillis however his CSF VDRL was negative.
.
In the ED T100.8 HR 75 BP 105/63 RR 20 100% RA. He spiked fever
up to 104 with no localizing symptoms other than neck stiffness
so he had an LP which was unremarkable. Cultures were sent and
he was started on Vancomycin and Ceftriaxone. He was also given
1gm tylenol and motrin 400mg for his fevers. He dropped his
pressure to 75/32 in the ED so he was given 3L IVF, a central
line was placed, and he was started on levophed. He was
evaluated by the ID service in the ED who agreed with the
management and also recommended droplet precautions and nasal
swab for influenza.

MEDICAL HISTORY: 1)HIV/AIDS-nadir CD4 count around 50, CMV retinitis in his right
eye, Toxo IgG neg, CMV IgG pos, only known [**Last Name (un) 10291**] was [**2-11**] and was
wild type (off therapy).
2)HCV, as above, [**Last Name (un) **] 1b, baseline VL around 4 million, Sono
[**2-12**]  with fatty infiltration ([**9-16**] HCV viral load not
detectable)
3)Chronic Sinusits
4)Depression, was followed by Dr. [**Last Name (STitle) 75205**] at [**Hospital1 2025**]
5)Hypogonadism
6)Hx of MRSA infections
7)Onychomycosis
8)Cataract and mild glaucoma in his right eye
9) +RPR s/p LP on [**2144-9-24**] to eval for neuro syphillis which was
negative

MEDICATION ON ADMISSION: CLONAZEPAM 1 mg Tablet qHS
Aranesp injections qmonth
TRUVADA - 200 mg-300 mg Tablet - 1 Tablet(s) by mouth once a day

ALLERGIES: Vancomycin

PHYSICAL EXAM: DISCHARGE PHYSICAL
VSS
Gen: NAD, pleasant
SKIN: Maculopapular, fading erythematous rash on trunk, arms,
back, groin, thighs and buttocks, coalescing into plaques,
scattered urticaria with minimal desquamation
HEENT: NC/AT, PERRL, EOMI, small erythematous patch on hard
palate, no ulcerations
Neck: supple
CV: RRR s1 s2
Lungs: CTAB
Abd: soft, NT, ND BS+ no rebound or guarding
Ext: no edema, warm, 2+ distal pulses
NEURO: a/o x3, no focal deficits
PSYCH: psychomotor agiation

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with partner [**Name (NI) **], endorses injecting crystal meth on the
day prior to symptom onset, last injection prior probably about
2 months ago, remote intranasal cocaine, no tob or etoh.
Fever, unspecified,Human immunodeficiency virus [HIV] disease,Other and unspecified coagulation defects,Hypotension, unspecified,Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Chronic hepatitis C without mention of hepatic coma,Thrombocytopenia, unspecified,Depressive disorder, not elsewhere classified
Fever NOS,Human immuno virus dis,Coagulat defect NEC/NOS,Hypotension NOS,Drug dermatitis NOS,Adv eff antibiotics NEC,Chrnc hpt C wo hpat coma,Thrombocytopenia NOS,Depressive disorder NEC
Admission Date:  [**2144-10-17**]              Discharge Date:   [**2144-10-23**]

Date of Birth:  [**2096-10-14**]             Sex:   M

Service: MEDICINE

Allergies:
Vancomycin

Attending:[**First Name3 (LF) 1990**]
Chief Complaint:
Fever

Major Surgical or Invasive Procedure:
none

History of Present Illness:
HPI: MR. [**Known lastname 6164**] is a 48 yo M with HIV/AIDS (CD4 311 [**2144-10-2**] VL
<48), Hep C, who presented to the ED with fevers for the past 2
days. He reports having headache, sore throat, nasal congestion,
cough and body aches since the start of the fevers. Of note he
admits to injecting crystal meth in his left arm on the day
prior to symptom onset, reports cleaning the area prior and
using a clean needle. He denies any history of endocarditis. He
presented to [**Hospital1 2025**] yesterday, where he had a treadmill stress test
which patient reports was normal, went 12minutes on the
treadmill. Otherwise he denies getting any other treatment. He
presented to our ED overnight when the fevers persisted and he
continued to feel poorly. Otherwise he denies nausea, vomiting,
diarrhea, dysuria, hematuria, pain at the site where he injected
drugs, abdominal pain.
.
Of note he had recent LP in [**Hospital **] clinic due to concern for
possible neurosyphillis however his CSF VDRL was negative.
.
In the ED T100.8 HR 75 BP 105/63 RR 20 100% RA. He spiked fever
up to 104 with no localizing symptoms other than neck stiffness
so he had an LP which was unremarkable. Cultures were sent and
he was started on Vancomycin and Ceftriaxone. He was also given
1gm tylenol and motrin 400mg for his fevers. He dropped his
pressure to 75/32 in the ED so he was given 3L IVF, a central
line was placed, and he was started on levophed. He was
evaluated by the ID service in the ED who agreed with the
management and also recommended droplet precautions and nasal
swab for influenza.

Past Medical History:
1)HIV/AIDS-nadir CD4 count around 50, CMV retinitis in his right
eye, Toxo IgG neg, CMV IgG pos, only known [**Last Name (un) 10291**] was [**2-11**] and was
wild type (off therapy).
2)HCV, as above, [**Last Name (un) **] 1b, baseline VL around 4 million, Sono
[**2-12**]  with fatty infiltration ([**9-16**] HCV viral load not
detectable)
3)Chronic Sinusits
4)Depression, was followed by Dr. [**Last Name (STitle) 75205**] at [**Hospital1 2025**]
5)Hypogonadism
6)Hx of MRSA infections
7)Onychomycosis
8)Cataract and mild glaucoma in his right eye
9) +RPR s/p LP on [**2144-9-24**] to eval for neuro syphillis which was
negative

Social History:
Lives with partner [**Name (NI) **], endorses injecting crystal meth on the
day prior to symptom onset, last injection prior probably about
2 months ago, remote intranasal cocaine, no tob or etoh.

Family History:
non-contributory

Physical Exam:
DISCHARGE PHYSICAL
VSS
Gen: NAD, pleasant
SKIN: Maculopapular, fading erythematous rash on trunk, arms,
back, groin, thighs and buttocks, coalescing into plaques,
scattered urticaria with minimal desquamation
HEENT: NC/AT, PERRL, EOMI, small erythematous patch on hard
palate, no ulcerations
Neck: supple
CV: RRR s1 s2
Lungs: CTAB
Abd: soft, NT, ND BS+ no rebound or guarding
Ext: no edema, warm, 2+ distal pulses
NEURO: a/o x3, no focal deficits
PSYCH: psychomotor agiation


Pertinent Results:
[**2144-10-17**] 12:50AM BLOOD WBC-4.2 RBC-3.34* Hgb-11.0* Hct-32.0*
MCV-96 MCH-33.0* MCHC-34.5 RDW-17.7* Plt Ct-79*
[**2144-10-17**] 12:50AM BLOOD Neuts-56.6 Lymphs-36.3 Monos-6.4 Eos-0.2
Baso-0.4
[**2144-10-17**] 12:50AM BLOOD PT-14.6* PTT-42.5* INR(PT)-1.3*
[**2144-10-17**] 05:05PM BLOOD Fibrino-309
[**2144-10-17**] 05:05PM BLOOD FDP-0-10
[**2144-10-17**] 12:50AM BLOOD Glucose-100 UreaN-21* Creat-1.2 Na-138
K-3.9 Cl-106 HCO3-23 AnGap-13
[**2144-10-17**] 12:50AM BLOOD ALT-72* AST-79* AlkPhos-65 TotBili-0.9
[**2144-10-17**] 10:58AM BLOOD Calcium-7.0* Phos-1.5* Mg-1.7
[**2144-10-18**] 03:00PM BLOOD Cortsol-12.2
[**2144-10-18**] 03:35PM BLOOD Cortsol-32.1*
[**2144-10-17**] 10:58AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2144-10-17**] 02:19AM CEREBROSPINAL FLUID (CSF) WBC-4 RBC-1* Polys-0
Lymphs-79 Monos-0 Macroph-21
[**2144-10-17**] 02:19AM CEREBROSPINAL FLUID (CSF) TotProt-37 Glucose-58
.
Cultures:
Blood cultures: No growth
Urine cultures: No growth
RPR negative
Lyme serology: positive by EIA. negative by Western Blot
CSF culture: No growth, no organisms seen on gram stain
.
Head CT [**2144-10-17**]:
1. No acute intracranial process including no hemorrhage, mass
or edema. MRI is more sensitive for evaluation of acute ischemia
or meningeal abnormalities.
2. Stable mild parenchymal volume loss in the frontal and
parietal lobes.
.
Chest X-ray [**2144-10-17**]: No acute cardiopulmonary process identified
.
Echocardiogram [**2144-10-19**]: The left atrium is mildly dilated. The
right atrial pressure is indeterminate. Left ventricular wall
thickness, cavity size and regional/global systolic function are
normal (LVEF >55%). The estimated cardiac index is high
(>4.0L/min/m2). Transmitral and tissue Doppler imaging suggests
normal diastolic function, and a normal left ventricular filling
pressure (PCWP<12mmHg). Right ventricular chamber size and free
wall motion are normal. The aortic root is mildly dilated at the
sinus level. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic regurgitation.
No masses or vegetations are seen on the aortic valve. The
mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. No mass or
vegetation is seen on the mitral valve. The tricuspid valve
leaflets are mildly thickened. There is moderate pulmonary
artery systolic hypertension. No vegetation/mass is seen on the
pulmonic valve. There is no pericardial effusion.
Compared with the prior study (images reviewed) of [**2144-8-13**],
moderate pulmonary hypertension is now identified. No
vegetations identified.
.
MICROBIOLOGY:
Stool: negative for C. diff, camphylobacter, salmonella, e.coli,

Blood: NGTD
Urine: CX negative, urine legionella negative
Line tip cx: negative

Brief Hospital Course:
48 yo M with PMH of HIV last CD4 311 in [**9-16**] admitted with 2
days of fever, recevied IV abx including vacnomycin and
ceftriazone in the ED and developed hypotension requiring MICU
admission and pressors.  His vancomycin was changed to
daptomycin after he developed a maculopapular rash which was
suspected to be a drug rash by dermatology consult Infectious
disease was consulted. He was pan-cultured to look for course of
infection but all cultures returned negative.  He has a possible
history of vancomycin allergy and a known red man syndrome with
rapid vancomycin infusion.  He was weaned off pressors in the
MICU and transferred to the floor after being afebrile for 24
hours.  He remained on the floor for observation and was stable
during this time.  He was discharged in stable condition with
close infecious diease follwo up with Dr. [**First Name (STitle) **].
.
MICU COURSE:
Mr. [**Known lastname 6164**] was admitted to the MICU on pressors due to
hypotension with concern for sepsis.  He was started initially
on Vancomycin to cover gram positives associated with IV drug
use and Zosyn for 24 hours which was then stopped.  He was
briefly treated with Clindamycin which was stopped on [**2144-10-19**].
The ID service was consulted.  He had a prior history of red man
syndrome associated with Vancomycin.  His Vancomycin was changed
to Daptomycin due to a maculopapular rash which the patient
developed on the day after admission.  Dermatology was consulted
and recommended supportive care with hydoxyzine, triamcinolone
cream and sarna lotion.  He was still requiring Levophed for
blood pressure support and underwent [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 104**] stim test on
11/90/08 to which he responded appropriately.  A TTE was
negative for valve vegetations.  He was able to be weaned from
Levophed on [**2144-10-20**].  He had received several liters of IV
fluids.  Blood pressures were in the 90s/50s but he experienced
no end-organ ischemia and was beleived to have low blood
pressure at baseline.  He was started on Azithromycin for
atypicals on [**2144-10-19**].  He continued to have persistent fevers
for the first 3 days of his admission.  Interferon and Ribaviron
were held per primary ID physician [**Last Name (NamePattern4) **]. [**First Name (STitle) **] and will be
restarted at her discretion.  A social work consult was obtained
for substance abuse.
.
All blood, sputum and urine cultures were negative, CXR was
clear, LP was without evidence of meningitis.  He was continued
on his antiretroviral medications.  He was transferred to the
floor on [**2144-10-21**].
.
FLOOR COURSE:
On transfer to the floor, antibiotics were discontinued as
cultures were all negative.  It was felt that patient may have
had a viral URI that was the cause of his initial fever.  Per
the ED notes, hypotension developed only after the
administration of vancomycin and ceftriaxone.  Unclear whether
or not this represented an anaphylactiod reaction particularly
given the subsequent development of drug rash and resolution of
hypotension after vancomycin was discontinued.  Patient should
not received vancomyin in the future given possibility of true
allergy.

Patient was discharged home in stable condition.  He has plans
to obtain substance abuse counseling at [**Hospital 882**] Hospital.

Medications on Admission:
CLONAZEPAM 1 mg Tablet qHS
Aranesp injections qmonth
TRUVADA - 200 mg-300 mg Tablet - 1 Tablet(s) by mouth once a day

FOLIC ACID - 1 mg Tablet - 3 Tablet(s) by mouth once a day
KALETRA - 50 mg-200 mg Tablet - 2 Tablet(s)by mouth twice a day

MUPIROCIN - 2 % Ointment - use as directed twice a day
PEGINTERFERON ALFA-2A q week
RIBAVIRIN - 200 mg Capsule 3 capsules in the am and 2 pm
TESTOSTERONE [ANDROGEL] - 1.25 gram per Actuation (1%) Gel in
Metered-dose Pump - 4 pumps once a day
VARDENAFIL [LEVITRA] - 5 mg Tablet - 1/2-1 Tablet(s) by mouth
every three days as needed
Trazodone 2 tabs qhs

Discharge Medications:
1. Emtricitabine-Tenofovir 200-300 mg Tablet Sig: One (1) Tablet
PO DAILY (Daily).
2. Lopinavir-Ritonavir 200-50 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
TID (3 times a day) as needed.
Disp:*1 bottle* Refills:*0*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Triamcinolone Acetonide 0.1 % Cream Sig: One (1) Appl Topical
[**Hospital1 **] (2 times a day) for 14 days.
Disp:*1 tube* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Fever
Hypotension
Drug Rash
.
.
Secondary:
HIV
H/o CMV retinitis in R eye
Hepatitis C genotype 1b
Chronic Sinusits
Depression
Hypogonadism
Hx of MRSA infections s/p partial R lobectomy
Cataract and mild glaucoma in his right eye


Discharge Condition:
Good, vital signs stable


Discharge Instructions:
You were admitted with fever and low blood pressure.  This low
blood pressure was severe and required medication to treat it
while you were in the intensive care unit.  Your fever was
treated with several antibiotics and cultures were taken to
determine the source of your fever.  All of the cultures that
were taken have been negative suggesting a non-infectious cause
of the fever.  You also had a rash which was likely related to
one of the antibiotics you received while you were here.  You
will be given a prescription for the topical steroid cream to
treat it at home.
.
Additionally, you were not give your hepatitis C medication
(Interferon and Ribaviron) because of your fever, low blood
pressure and rash.  Dr. [**First Name (STitle) **] will follow you out-patient and
will decide when to restart those medications.
.
No other medication changes were made.  You should resume all
your other home medications as directed.
.
You saw social work and as you had previously arranged, you
spoke about going to the [**Hospital1 882**] out-patient addicition
program.  You should follow up with them directly.
.
Finally, you had lab tests in [**Month (only) 359**] that showed that your
thyroid wasn't making enough thyroid hormone.  You should talk
with Dr. [**First Name (STitle) **] about this and see endocrinology.
If you have fever higher than 100.5, chills, shortness of
breath, chest pain, severe abdominal pain, dizziness or any
other concerning symptom, please seek medical care immediately.

.
It was a pleasure meeting you and participating in your care.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 1037**] [**Last Name (NamePattern4) 2335**], MD Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2144-10-27**] 2:00
.
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1387**]
Date/Time:[**2144-11-24**] 4:00
.
Please follow up with endocrinology about your thyroid tests.
{'Fever, unspecified,Human immunodeficiency virus [HIV] disease,Other and unspecified coagulation defects,Hypotension, unspecified,Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Chronic hepatitis C without mention of hepatic coma,Thrombocytopenia, 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: Fever

PRESENT ILLNESS: HPI: MR. [**Known lastname 6164**] is a 48 yo M with HIV/AIDS (CD4 311 [**2144-10-2**] VL
<48), Hep C, who presented to the ED with fevers for the past 2
days. He reports having headache, sore throat, nasal congestion,
cough and body aches since the start of the fevers. Of note he
admits to injecting crystal meth in his left arm on the day
prior to symptom onset, reports cleaning the area prior and
using a clean needle. He denies any history of endocarditis. He
presented to [**Hospital1 2025**] yesterday, where he had a treadmill stress test
which patient reports was normal, went 12minutes on the
treadmill. Otherwise he denies getting any other treatment. He
presented to our ED overnight when the fevers persisted and he
continued to feel poorly. Otherwise he denies nausea, vomiting,
diarrhea, dysuria, hematuria, pain at the site where he injected
drugs, abdominal pain.
.
Of note he had recent LP in [**Hospital **] clinic due to concern for
possible neurosyphillis however his CSF VDRL was negative.
.
In the ED T100.8 HR 75 BP 105/63 RR 20 100% RA. He spiked fever
up to 104 with no localizing symptoms other than neck stiffness
so he had an LP which was unremarkable. Cultures were sent and
he was started on Vancomycin and Ceftriaxone. He was also given
1gm tylenol and motrin 400mg for his fevers. He dropped his
pressure to 75/32 in the ED so he was given 3L IVF, a central
line was placed, and he was started on levophed. He was
evaluated by the ID service in the ED who agreed with the
management and also recommended droplet precautions and nasal
swab for influenza.

MEDICAL HISTORY: 1)HIV/AIDS-nadir CD4 count around 50, CMV retinitis in his right
eye, Toxo IgG neg, CMV IgG pos, only known [**Last Name (un) 10291**] was [**2-11**] and was
wild type (off therapy).
2)HCV, as above, [**Last Name (un) **] 1b, baseline VL around 4 million, Sono
[**2-12**]  with fatty infiltration ([**9-16**] HCV viral load not
detectable)
3)Chronic Sinusits
4)Depression, was followed by Dr. [**Last Name (STitle) 75205**] at [**Hospital1 2025**]
5)Hypogonadism
6)Hx of MRSA infections
7)Onychomycosis
8)Cataract and mild glaucoma in his right eye
9) +RPR s/p LP on [**2144-9-24**] to eval for neuro syphillis which was
negative

MEDICATION ON ADMISSION: CLONAZEPAM 1 mg Tablet qHS
Aranesp injections qmonth
TRUVADA - 200 mg-300 mg Tablet - 1 Tablet(s) by mouth once a day

ALLERGIES: Vancomycin

PHYSICAL EXAM: DISCHARGE PHYSICAL
VSS
Gen: NAD, pleasant
SKIN: Maculopapular, fading erythematous rash on trunk, arms,
back, groin, thighs and buttocks, coalescing into plaques,
scattered urticaria with minimal desquamation
HEENT: NC/AT, PERRL, EOMI, small erythematous patch on hard
palate, no ulcerations
Neck: supple
CV: RRR s1 s2
Lungs: CTAB
Abd: soft, NT, ND BS+ no rebound or guarding
Ext: no edema, warm, 2+ distal pulses
NEURO: a/o x3, no focal deficits
PSYCH: psychomotor agiation

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with partner [**Name (NI) **], endorses injecting crystal meth on the
day prior to symptom onset, last injection prior probably about
2 months ago, remote intranasal cocaine, no tob or etoh. 

### Response:
{'Fever, unspecified,Human immunodeficiency virus [HIV] disease,Other and unspecified coagulation defects,Hypotension, unspecified,Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Chronic hepatitis C without mention of hepatic coma,Thrombocytopenia, unspecified,Depressive disorder, not elsewhere classified'}
