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September 27, 2010

Ribs are back.

Any organism can infect any organ in any person at any time.  Thank goodness, as it gives me a career.  Still, there are patterns.  Certain organisms have a propensity for some organs over others.

The patient is a young IV drug user who presents first with back pain, then with chest pain.  The back pain has been present for about six weeks, and is right over his scapula.

The chest pain, there for a week,  is centered over is anterior chest just below the clavicle.

He denies fevers or chills.

The rest of his aich and pea is negative.  While tender to touch with slight swelling over the chest, it is not red or hot, and there is nothing on the back.

His CBC, comp, and BC are negative and his MRI I'd he chest show a ...

Posted By: Mark Crislip  

September 25, 2010


Worms are usually a disappointment.  Most patients do not really have worm when they show up in clinic.  Either they have misidentified material that is not a worm or the are worried that they might of acquired a worm with travel or they have delusions of parasitism.  True worms are unusual.  Once an earthworm fell out of a patients pocket after gardening and he thought he h...

Posted By: Mark Crislip  

September 23, 2010

Look at it yourself

I do not know how many of you reading this are young whippersnappers in training.  I am occasionally curious about the demographics of my readers.  The only thing I know with certainty is that you are a human of rare taste and intelligence. And no, that doesn't make you look fat at all. I can pander with the best of them.

But, as a crotchety old fart, I occasion...

Posted By: Mark Crislip  

September 21, 2010

Sometimes what looks to be unimportant isn't.

In January I took care of a diabetic patient with S. aureus bacteremia and discitis as a complication of dialysis.  He did fine with a long course of antibiotics and as best I can tell he is a cure.  In January he had, when his PICC line was placed, a small, not even really an infiltrate, in the RML.  It looked like scar or atelectasis but it did not look like anything i...

Posted By: Mark Crislip  

September 19, 2010

Same bug, different sites

I am often unreasonably confidant in my pronouncements.  Diseases have patterns, and if you pay attention to the pattern, odds are in your favor that you will be right.  Of course, you obtain cultures, and every now and then the patient's infection decides to pay you no mind, and grow something you don’t expect. Words are best et with A1 sauce.

The first patient com...

Posted By: Mark Crislip  

September 17, 2010

My motto: Frequently in Error, Never in Doubt.

My Dad told me that there are four 'A's to being a consultant: availability, affability, appearance and ability. Three out of four ain't bad.  The other trick for being a consultant is pointing to left field, and hitting the ball out of the field. Most of the time you will be wrong, a swing and a miss, and no one will remember, but the rare times you connect, those are remembered.&nbs...

Posted By: Mark Crislip  

September 15, 2010

Do the Eyes Have It?

Two types of consults make me nervous.  The first is a call from the Ob service; I am discomforted at treating pregnant females. Pregnant males do not bother me.  The other is eye infections, in large part as I often do not get the diagnosis, just the suggestion of the diagnosis.

Patient is a young male from Africa.  6 years ago he was treated for scrofula in Kenya (...

Posted By: Mark Crislip  

September 14, 2010


I consult at 4 hospitals, when my partner is gone its 6, and on the weekend a whopping 8.  So I get to see a lot of neat cases, being the sole common pathway for infectious diseases consultation.  My title says I am Chief of Infectious Diseases, but it is easy to be King in a country with a population of 2. 

Patient is a 78 year old female who comes in with two days ...

Posted By: Mark Crislip  

September 8, 2010

Fe Man

Middle aged male with a day of fevers, teeth chattering rigors, and a drenching sweat.   He says he gets these on occasion over the years, but they never last, so he ignores them.  This time, however, he develops severe shoulder pain.  So severe he cannot move his shoulder, so off to the ER when a tap, with no cell count or crystals,  shows poly's but no organisms. &nbs...

Posted By: Mark Crislip  

September 4, 2010

Common, Critical, or Cool

After you see a patient, you generate a differential diagnosis, a list of things that patient may have. In addition, I like to generate a list of three: what the patient probably has, what I do not want to miss (the disease that could kill or maim the patient), and the cool case: the odd or unusual disease I have not yet to see.  Most of the time it isn't the cool diagnosis, I that do...

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 on Amazon as The Puswhisperer, Volumes 1 and 2. Really. Perfect for the pus lover in your life.
Because The World Needs More Mark Crislip (tm).

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.

    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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