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May 19, 2011

Just So

I am an Occam kind of guy.  I like to tie all the clinical pieces together in one nice package that explains everything. Good thing I am not a physicist, else I would be forever lost in string theory. My love of a theory of everything is, along with my attraction to an unusual diagnosis, the quirks I have as a diagnostician. I have to be careful that I am not coming up with Just So stories when I come up with what I think is an interesting narrative.  We all know docs with quirks, who are always finding a diagnosis that seems to be more in their mind than in the pathology of the patient.  I just hope my minimal self awareness prevents me from walking down nonexistent paths.

Like the last month. &nb...

Posted By: Mark Crislip  

May 15, 2011

Three Cuts: The Answer

The patient has had TB.  They were treated 20 years ago, relapsed or reinfected 10 years ago, and, to judge from the AFB smear, remains a cure.

All the calcium is residua from the old Tb.

The upper lobe looks to be a large mass in an old cavity and the bronch cultures are growing both Candida and Aspergillus.  While the latter is more common as a caus...

Posted By: Mark Crislip  

May 13, 2011

Three Cuts

Change of pace.

Mid 50's, male, born and raised in SE Asia, admitted with recurrent, severe, hemoptysis. That's all you get.

Here are three cuts from the CT:

Upper Lobe


Middle-ish lob

Posted By: Mark Crislip  

May 9, 2011

More Pox to Come

It starts with a sore throat.  A common enough problem in the young, but not when you are 86.  Sore throat for common reasons is less common in the elderly.  If you reach 85, you have probably been exposed to all the typical causes and should be immune.

The sore throat rapidly became severe and the patient was unable to swallow dinner.  Then fever, chills and a ...

Posted By: Mark Crislip  

May 7, 2011

Order Everything, Get Something in Return

The patient had received their first course of CHOP for non-Hodgkins lymphoma five days ago and comes in febrile, neutropenic, and a new LLL infiltrate.  He is quickly intubated and bronched for a diagnosis.

The infiltrate is espcially worrisome in a patient with neutropenia, since most of what we see on CXR with pneumonia is due to white cells, and he doesn't have any.  So...

Posted By: Mark Crislip  

May 5, 2011

Otitis Gone Bad

The patient is a young and otherwise healthy.  Unfortunately, infectious are going through the family. A mother of 4, three of the children have had ear problems, and, consequently, so has the patient.

She has had ear and sinus pain for at least a month, and received a macrolide, a penicillin, a cephalosporin and a course of steroids, all without resolution of the symptoms.


Posted By: Mark Crislip  

May 3, 2011

Dawg Bite

    The patients dog was in a fight.  If your dog is in a fight, and you see fit to break up said fight, might I suggest you not use your hand.  You may get bit, which is what happened to this patient.  Right over the first knuckle of the right index finger.

    In less than a day it became red, hot and swollen.  It was debrided and g...

Posted By: Mark Crislip  

April 27, 2011

The eyes are the window of the soul. English Proverb

I do not see many transplant patients.  For one, the hospitals I practice in only do kidney transplants.  Second, between the prophylactic protocols and the newer anti-rejection meds, patients do not get much in the way of infections.  Maybe the occasional CMV when they are finally taken off their valgangcyclovir, but that is about it.  Not like the cyclosporin and prednison...

Posted By: Mark Crislip  

April 25, 2011

Raise it up

The swollen leg so shiny and red

How quickly the erythema fades

I start giving clindamycin all the time

Was that the wrong pill to take (Raise it up)

You made a dx and now it seems you have to offer up

But will it ever be enough

(Raise it up raise it up)

It's not enough

(Raise it up raise it up)

Here I am a ce...

Posted By: Mark Crislip  

April 23, 2011

There are some things (insert gender) are not meant to know.

The purpose of this blog is to make me look like a combination of House and Mycroft Holmes.   Almost every case has a final diagnosis.  The reason is that there is more to be learned when there is an answer, since a Pubmed of the phrase "I don’t know" and "infection" yie...

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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