Rubor, Dolor, Calor, Tumor
Blog Address:
August 13, 2010

Not where you want expect it to be

I have always hated the phrase "expect the unexpected."  Obviously if you could expect it, it would not be unexpected and since it is unexpected, how can you expect it. 

The patient is an elderly female with minimal medical problems who comes in MOSF from an apparent intraabdominal catastrophe.  She has free air, a WBC of 35K and is whisked off to the OR where she has extensive dusky small bowel.  The surgeon did Dopplers and found the vascularity of the small bowel to be fine and he judged the bowel to be viable, so she was sewn back up and sent to the ICU, with the anticipation that she would need another exploration in a day or two.

In the ER she had complained of diarrhea, and although she had been on no recent antibiotics, the ER sent a ...

Posted By: Mark Crislip  

August 9, 2010

Size Matters?

No, this is not about spam email.  The patient I saw with the CROCK, no HOCUM, with the S. oralis endocarditis was back to the ER at Outside Hospital with progressive heart failure.  No fever, no chills, no sweats.  Progressive peripheral edema and PND.

Exam is without change, maybe the murmur is a wee bit louder, b...

Posted By: Mark Crislip  

August 7, 2010

IVDA. A Bad Lifestyle Except For The Fungi

I just have a life, I am in need of a lifestyle.  I need a style, a good style, a cool style.  Not a style associated with sepsis and death.

Patient is young a young male with one of those not so good lifestyles: IVDA.  IntraVenous Drug Abuser.  I know the preferred term is IDU.  User, not abuser, but injecting drugs always seems a wee bit self-abusive to me.</p...

Posted By: Mark Crislip  

August 3, 2010

25 Years, Ain't Never Seen This Bug Before

As an ID fellow last century I devoted two years to investigating the interaction of Candida and endothelial cells.  Talk about the Peter Principle in action.  If there was ever a more incompetent lab rat than me, speak now.  Two years and nothin'. However, I did develop an appreciation for Candida species and it's c...

Posted By: Mark Crislip  

July 31, 2010

Adverse Drug Reaction?

Pregnant patients give me the willies.  They shouldn't.  But when I get called to the Ob floor for a consult, a get this vague sense of unease.  

The patient is pregnant and has the sudden onset of severe abdominal pain, starting RLQ and then moving so that she hurts all over.

Rest of her history is negative and exam shows her to be afebrile and to be very sensiti...

Posted By: Mark Crislip  

July 29, 2010

There Will Be Blood. Then an Abscess.

It is hard to infect muscle in normal people.  The rare times you see a muscle abscess is after some sort of trauma.  A young male has a 'groin pull' from diving for a basketball or lifting a heavy object, then develops fevers, pain and evaluation will show an abscess in the ileopsoas or iliacus or paraspinous muscles.  The presumption is trauma causes some bleeding into the...

Posted By: Mark Crislip  

July 27, 2010

A Turbulent Mouth

Turbulence.  Bad.  Turbulence in the heart leads to platelet/thrombin deposition.  Bacteria do not care much for endothelial cells. but platelet/thrombin is a hospitable environment where they can stick and grow.

Patient is young and has had a life long history of a murmur.  Of late he was been seeing a cardiologist who has been treating him with a beta blocker, b...

Posted By: Mark Crislip  

July 23, 2010

The Evil Betty

The patient is a middle aged male who, for a variety of reasons, stopped taking his HIV medications several years ago.  He now comes in with several months of SOB, chronic non-productive cough, and failure to thrive.

Otherwise his past medical history is unrevealing; his HIV was not notable for prior opportunistic infections.

He has a cat, lived for a while in the uppe...

Posted By: Mark Crislip  

July 21, 2010

Am I Feeling Lucky Today? Am I? TVIE.

I have  sympathy for drug users.  I have never been one myself, but there for the grace...  If I had lived a few decades earlier I suspect I would be a two pack a day smoker and look like Henry the VIII.  Coke or heroin?  I am sure that once started, I would never stop. I have enough trouble skipping the maple bars in the cafeteria.  So I am never surprised, only s...

Posted By: Mark Crislip  

July 19, 2010

Can I Ignore A Positive Blood Culture?


Back from a short vacation at the Oregon coast.  No infections there for four days.  But I  did not win Powerball. Again. So back to the daily grind.  The consult today was positive blood cultures.  A homeless person is admitted with fevers, which occur for three days. Each day he gets a set of blood cultures.

Cultures from day one. Nothing.


Posted By: Mark Crislip  

« previous 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 next »
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.
Share This
Add this blog page to your favorite Social Media site.

All material on this website is protected by copyright, Copyright © 1994-2018 by WebMD LLC. This website also contains material copyrighted by 3rd parties.