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December 13, 2012

A Ticket to the Fungal Ball

The patient has the sudden onset of unilateral painful red eye and decrease in visual acuity.

A dialysis patient due to diabetes, the patient has no bad habits or risks and is sent off to the ophthalmologist and the patient has endophthalmitis with what looks to be a small fungus ball in the back of the eye, but no involvement of the optic nerve or the vitreous.

The ophthalmologist (if he worked for Apple would he called an iDoc?) is pretty adamant that it looks like Candida, although it sure would be nice if there was a more typical risk for Candida endophthalmitis like heroin use or a recent stay in the ICU.

Otherwise the patient is stable so I suggest blood cultures (negative) and a beta glucan (modestly, but really, positive).


Posted By: Mark Crislip  

December 12, 2012

A Great Idea

The patient is an elderly-ish male with a prosthetic hip that almost never worked right.  It was slow to recover function and over the next 6 months he had increasing pain and decreasing function and a little loosening.

A tap of the hip showed WBC but cultures were negative, so off to the OR where more pus was found, it was washed out and the plastic exchanged.

Gram st...

Posted By: Mark Crislip  

December 9, 2012

Phone Call.

I'm on call this weekend, and I cover 7 hospitals, although fortunately not all hospitals have active patients.

I finish rounds, come home, go out for a burger with the family and get home to watch the end of the Blazers game.  Not looking good.  The phone rings.  I answer the page and it is a doc wanting to discuss one of the cases I am covering.

The case is a tr...

Posted By: Mark Crislip  

December 5, 2012

The Joint Ain't Jumping Any Time Soon

The joints of the pelvis are a pain.  Infection is rare and as a result the diagnosis can be missed or delayed.

If you are a shooter coming in with hip pain and a fever, first they MRI the hip. Negative. Then MRI the spine. Negative.  The fields of the MRI are too narrow and for both studies and the SI joint can be just outside the imaging.  Same can be true of ...

Posted By: Mark Crislip  

December 4, 2012

I See All The Weirdness

I have been the sole, and the soul (no, not really), doctor at 3 or 4 hospitals for the last 23 plus years so I see all the weird cases.  I think the cases were odder back in the day.  For example, in my first decade of practice I saw one each of the HACEK group causing endocarditis, but not a one this century.  It was always better in the golden past.

I have patient...

Posted By: Mark Crislip  

November 30, 2012

Half of My Favorite Quartet

The patient has HIV, in control for years with a low viral load and CD4's that hover around 260.  What medicine gives, it takes away, and a renal transplant has resulted in medications that make his immune function suspect.  He has been fine for years with both however, until this admission when he has several days of weakness and the sudden onset of a painful rapidly growing mas...

Posted By: Mark Crislip  

November 28, 2012

Then Another

When last we left our patient he was slowly improving on voriconazole for his Aspergillus pneumonia and was discharged home.

Now he returns  a week later septic-ish: still neutropenic, febrile, tachycardiac, hypotensive and some mild abdominal pain.'

He stabilizes on antibiotics and the usual ICU care and work up shows what looks to be a right sided colitis wi...

Posted By: Mark Crislip  

November 26, 2012

First One Thing...

Thanksgiving is over with minimal weight gain, although I did make my best turkey ever and my best pumpkin pie ever.  As much as I enjoy my work, it is not better than four days on the Oregon coast.  As I have mentioned before, I have yet to have a patient tell me at the end of their days, "Doc, I wish I had spent more time at work."  But if you have to work there is no more inte...

Posted By: Mark Crislip  

November 19, 2012


I go through a ton of medical articles.  For each Puscast I scan several hundred  articles, whittle them down to about 50 that I read and end up discussing maybe 25.  I have collected over 10,000 references representing 3.6 gigabytes of data.  How much of that I can actually rec...

Posted By: Mark Crislip  

November 14, 2012

Sleepy Head

The phone awakens me at 1 am.  ER calling.  They evidently have a higher opinion of my neurological function upon awakening from a deep sleep than I do.  My Dad was a cardiologist and I remember the phone ringing all night growing up.  About 6 months after retiring he became this whole new sharp energetic person, probably finally getting caught up in his sleep. Fortunately, ...

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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