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October 25, 2009

Read the Book

First patient is a new kidney transplant with slowly progressive hypoxia over two weeks despite azithromycin, on no PJP prophylaxis, a CXR that shows a slight patchy lower lobe infiltrate but the CT shows diffuse, patchy, multi lobar involvement with tree in bud pattern.  Cough is nonproductive and the patient is totally nontoxic on exam. Labs are normal except for an LDH of 300.

The second patient has 6 months of chronic cough, bilateral infiltrates, but no hypoxia.  LDH is 225.  She has been on no immunosuppressants for the last 6 months, although she had been on prednisone for an acute case of gout about six months ago around the onset of her cough.

First patient I thought for sure had PJP.  He didn't. His bronch grew out heavy growth of a ve...

Posted By: Mark Crislip  

October 23, 2009

A Perfect Storm

H1N1 is taking off big time and to judge from the CDC site and google flu trends, the great pacific northwest is the epicenter of H1N1 activity.  Whether due to increased testing or increased cases, we have more H1N1 than anyone.

Lucky us.

Oddly, the pandemic has not affected my clinical work all that much.  Most...

Posted By: Mark Crislip  

October 21, 2009

What does the Inky Dinky Do?

More of the same

When I was an intern, tattoos were not a fashion statement, but a sure sign of sociopathy.  No so much anymore, where everyone but me has a tat.

But sometimes, well, tats may be a sign that the individual with them is not necessarily going to be a model patient. Love and hate on opposite hands is a good tip off as are tats on the face, like a tear in ...

Posted By: Mark Crislip  

October 19, 2009

Unhealthy lifestyle

I lack a lifestyle.  I have a life and I live it.  Others, it appears, do have a lifestyle, and it involves intravenous drugs.  And, to be daring and edgy, I am going to suggest that a lifestyle that involves intravenous drugs is not one that provides optimal health. There. I said it. Let the opprobrium begin.

The problem is that drugs have to be mixed into some sort o...

Posted By: Mark Crislip  

October 17, 2009

The Eyes Have It and It Gives Me the Creeps

The patient was  minding their own business, going on with the ADL's, when, bam, it felt like they were punched in the eye. Over the next 24 yours the pain in the eye became unbearable and vision went to zero.

No past medical history, no trauma, no festering infections or dental work. No prior symptoms of any kind in the weeks leading up to the eye pain.


Posted By: Mark Crislip  

October 15, 2009

Ignorance with grace and style

Often I get asked to do a consult with a question that has no answer, at least not an answer that I can get without doing the patient some serious harm.  Part of my job is to provide an answer based on my best bet, with not a lot of good data to back me up.  To be a consultant is to learn how to be ignorant with grace and style (yes, yes, yes, I know. I am ignorant, but lack grace and...

Posted By: Mark Crislip  

October 13, 2009

The oldest 730.27. Ever.

Last night I was watching the Discovery channel special on
Ardipithecus ramidus, the 4.4 million year old hominid fossil found in Ethiopia.

Ardi, as they call her,  had many interesting features: small brains, grasping feet, bipedal, lived in a forest, and had small canine teeth.  The skeleton suggests the chimp is not a direct ancestor ...

Posted By: Mark Crislip  

October 11, 2009

What's in a name? A rose by any other name would smell as sweet.

Elderly patient comes in with urosepsis and o n CT is found of have a pyleonephritis and obstruction of the ureter from a kidney stone.

Common clinical problem, the treatment is antibiotics and remove the obstruction. Usually is E. coli or Proteus and the attending doesn't bother to call me.  Occasionally more problematic organisms will rear their ugly head.


Posted By: Mark Crislip  

October 9, 2009

Who is that masked man?

Not every (any?) title can be a gem.

First, some self aggrandizement.  There is a post of mine over at on influenza vaccine efficacy.  It is excellent, but I expect nothing less from me.

Consults have been slow for the month of September and  the hospitals have taken leave of ...

Posted By: Mark Crislip  

October 7, 2009

Top Ramosus

Work is so much nicer than taking a multiple choice computer test.

A consult today was a neutropenic who had been admitted with fever. Common problem with a fairly standardized approach.

The blood cultures grew a gram positive rod in the anaerobe bottle.

Hmmm.  Anaerobes in the blood are not that common in the neutropenic, for reasons that have never unders...

Posted By: Mark Crislip  

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About This Blog

For the Benefit of Mr Kite, there will be ID tonight. Infectious Diseases! Antibiotics! Viruses and Bacteria and Fungi! Oh my! Exclamation marks!!!!!! No trampolines, nor will any band be playing at 10 to 6. And Henry the Horse died of the Strangles. Sorry. That's the problem with infections.

The endless excitement that is the daily practice of Infectious Diseases in a Portland teaching hospital! The need for meta data!

Every day I make infectious disease rounds in the hospital and see at least one cool case or learn something new. 25 years and I still do not know everything. Why be selfish and keep all of that wonder and knowledge to myself? This blog will be a mostly qod account of days events, a cool ID case, a referenced pearl, and a minimum of 1 horrible, yet ultimately feeble, attempt at humor.

While usually written in the present tense, the cases are not necessarily current and all identifying information is altered or obscured as long as it is not absolutely pertinent to the case. Can't have a female with prostate infection for example.

I write these at night or in spare moments. There is always someone who will quibble about spelling, punctuation or grammar. My response is live with it. It's a blog, not Mandel.

Read and listen to more of me at my multimedia empire linked below.

The first 2 years blog posts have been collected and edited and are available as The Puswhisperer, Volumes 1 and 2. Really. Perfect for the pus lover in your life.
Because The World Needs More Mark Crislip (tm).
Flies in the Ointment: Essays on Supplements, Complementary and Alternative Medicine (SCAM).
A carefully selected and edited compendium of my best blog posts from The sections have been edited for redundancy, updated for 2017, and classified into themes including my influenza rants.

All on Amazon.

Disclosure: Mark A. Crislip, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Pusware LLC
Have a 5% or greater equity interest in: Pusware LLC (owner)

  • Mark Crislip

    Mark Crislip, MD, has been practicing in infectious diseases in Portland, Oregon, since 1990. He is nobody from nowhere, but he has an enormous ego that leads him to think someone might care about what he has to say about infectious diseases. And so he blogs and podcasts and writes on the most endlessly fascinating specialty in all of medicine. Links to his multimedia empire of blogs, podcasts, books, apps and tweets can be found at

    Mark A. Crislip, MD, has disclosed the following relevant financial relationships: Owner, Pusware LLC. He as not talked to a drug rep in over 25 years and does not even eat the pizza provided at conferences. But he is for sale for the right price. Please. Someone. Buy me.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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