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December 25, 2013

Bugs don't care.

A generic nondenominational seasonal greeting to all my readers. I worked today, Christmas, since the germs, like the honey badger, don’t care. It may be time for peace on earth and good will towards men, but as far as the bacteria are concerned, every day is an opportunity to try and kill another human.

The patient had a relatively minor fall off a moving skateboard, skinning his knee and getting banged up. Over the next several days he has increasing pain in his knee and leg. In the ER it is felt he has a traumatic infected bursa which is drained but the patient does not improve.

He is febrile, pus draining from the incisions and still has a lot of pain in his thigh so they call me. His thigh is twice norma...

Posted By: Mark Crislip  

December 23, 2013

Increasing cost and toxicity without benefiting the patient.

It is flu season. H1N1 has rearing its ever so ugly head the last last few weeks and there have been at least two deaths in young people as a result of influenza complications. Two too many. You can always tell an anti-vaccine wackaloon as they often put the adjective ‘only’ in front of some vaccine preventable death rate. Me? I have never had a death that was an ‘only.’...

Posted By: Mark Crislip  

December 18, 2013


I was initially called by the hospitalist about a psoas abscess. It was an elderly male with fevers and abdominal pain and the CT showed a right psoas abscess, on the same side he was having a diabetic foot ulcer worked on.

Should be S. aureus, I said, does he have back pain?


Check an MRI sometimes ileopsoas abscess co...

Posted By: Mark Crislip  

December 17, 2013

Record Delay

The patient had a robot prostetectomy a little over two years ago and after he never felt quite right. He had chronic dull left lower quadrant and never got his mojo back. He would try and exercise and be active but he tired easily.

Evaluation of this abdomen revealed a lymphocele, a not uncommon complication of the procedure, occurring in a fifth of patients. He had no fever, chills or...

Posted By: Mark Crislip  

December 11, 2013


The patient is admitted with exacerbation of COPD and has the usual work up and treatment, including steroids.

Everything was negative for infection on admit except an admitting WBC of 55 K. Three months ago the CBC was normal. For the next 5 days the WBC fluctuated between 55k and 66K and they called me.

There are three diseases on the short differential for a leukemoid reactio...

Posted By: Mark Crislip  

December 9, 2013

The Bird That Wasn't There.

I have mentioned in the past that ID is a lot like birding. I have a life list of diseases I have seen, and I want to see, before I retire. Unlike birding, ID is interesting. Just kidding. I almost rear ended a car recently as I saw a bald eagle flying along the Willamette. Sometimes  I think I might see a rare bird, only to be proven wrong by testing, a form of medical pareidolia where I ...

Posted By: Mark Crislip  

December 6, 2013

Double Vision

Ooh-ooh (oooh) ooh-ooh, double vision

(Oooh) I need double vision

(Oooh, double vision) it takes me out of my head, takin’ me out of my head

(Oooh, double vision) I get my double vision, woa-o...

Posted By: Mark Crislip  

December 5, 2013

How Sweet It Is

It has been a while. I like to write for the blog three times a week, MWF, but I need to be working to have grist for the mill. I spent a long Thanksgiving weekend in Minnesota with the in-laws. I hate the cold I hate the cold I hate the cold. I wish my wife was from Hawaii.  But I am back to work with some great cases and awaaay we go!

Before I left I saw an unusual case of relaps...

Posted By: Mark Crislip  

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 annoyin...

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  

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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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