Rubor, Dolor, Calor, Tumor
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November 23, 2013

More Snot in the Wrong Place

The patient is elderly male with a h/o cholangiocarcinoma who presented with acute on chronic RUQ pain and dyspnea with SIRS . The WBC is 15K but his LFTs are normal.

So a CT is done and it reveals several large cavitating lung masses, there is a large liver abscess and some partial clot in the inferior vena cava.

Yet another liver abscess with normal transaminases. Very annoying. So the liver is drained and there is pus and it grows K. pneumonia as does the blood. Again.

I call the lab and yep, it is mucoid, with the snot test: when the put a loop on the culture it leaves a long sting of mucoid Klebsiella as the wire is pulled away. Looks just like snot. If you don’t believe me,

Posted By: Mark Crislip  

November 21, 2013

Life Lessons

The patient is an IVDA. Two years ago he had a mitral valve replacement due to endocarditis and, such is the power of addiction, he relapsed.

He comes to the ER for an  I&D of two large arm abscesses and, while not febrile, all four blood cultures bottle of cultures grow Corynbacterium and S. salivarious so he is admitted and they call me.

I tell ...

Posted By: Mark Crislip  

November 13, 2013


The patient had an ACD placed for recurrent ventricular fibrillation and was doing well except for a growing fluid collection over the pocket site. No constitutional symptoms, normal labs, and on exam the unit was floating in some sort of fluid, blood? pus?, but it was not the typical abscess seen with pocket infections. There was no rubor, dolor or calor.

So rather than taking it out w...

Posted By: Mark Crislip  

November 8, 2013

A Connecticut Yankee

The patient had an aortic vavle replacement 6 months ago and has been doing great until a month before admission, when he developed fevers and malaise but nothing else.

He saw his PMD who noted an change in his murmur which led to an ECHO that showed a small vegetation and probably a large ring abscess. He was was admitted and after three days his blood cultures remained negative. He we...

Posted By: Mark Crislip  

November 6, 2013

Infected Hole

About 10 days ago the patient had chest pain. For a variety of reasons it took some time for her to seek medical care and it was primarily progressive dyspnea and recurrence of chest pain that lead her to the ER. That led to the cath lab and an ECHO, both of which demonstrated there was a left ventricular pseudoanyerism. And so to the OR where at the time of repair it was noted that there was a...

Posted By: Mark Crislip  

November 5, 2013

Weight Gain

The patient is finishing up a course of vancomycin for an infected septic hip from enterococcus, resistant to ampicillin

The infected prosthesis was removed, a spacer placed and the patient has been biding his time at a nursing home. He has done quite well clinically, with no signs of infection, lab work peachy keen, but pain and a lack of a real hip has limited his activity.


Posted By: Mark Crislip  

October 30, 2013


I am not used to failure. Well, professional failure. Well, failing to kill bugs. A nice aspect about ID is that we usually cure infections or they get better on their own and I can take the credit. Long term I always fail. I always keep in the back of my mind that some day, unless I am cremated, I will be consumed by the organisms I have spent my professional life killing. For the sort term we...

Posted By: Mark Crislip  

October 28, 2013

From the Tips

I don’t charge to remove central lines. I just take tips. Nah. A variation of an old circumcision joke that doesn’t really work. They can’t all be gems.

The patient is admitted with pus around the PICC line. She has been on antibiotics for 3 weeks for recurrent MSSA bacteremia with no source identified despite an extensive workup. We are working our way towards a PET s...

Posted By: Mark Crislip  

October 25, 2013

Yet another unexpected pathogen

Common things are, course, common. It is what gets me through the day. If every case I had was something unusual or odd I would never get home, spending all my time on the Pubmeds learning about weirdness.  You young whippersnappers have no idea how good you have it with Pubmed and the Googles.  Bifocals would not help me read an Index Medicus.

Patient has a long history of in...

Posted By: Mark Crislip  

October 23, 2013

I expected more

As I have mentioned in the past, work has slowly declined over the last decade. Fewer neutropenics, no AIDS opportunistic infections, many fewer hospital acquired infections, etc etc. There is fewer infections to take care of combined with those damn hospitalists. When you have bright doctors running the inpatient service instead of clinic docs there is less fear, uncertainty and doubt and FUD ...

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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