Rubor, Dolor, Calor, Tumor
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November 3, 2014


We all bring biases to the table. When I was a kid if my chores were not done to the satisfaction of my fathe he referred to the work as 'half-assed'. It has since been my goal to be full-assed in all my work. While I will argue that there are no such thing as 'strong', 'big gun', or 'powerful' antibiotics, I do think there are half-assed antibiotics.

The patient has a femoral pseudoaneurysm from injection drug use that ruptures. It happens. I am reminded of one of my fellow interns (not me, really) who could not get blood out of an IVDA and the patient grabbed the syringe from him and stuck her femoral vein to get the sample. Boy did he get chewed out for that.

The aneurysm is repaired and is grossly infected in the OR. The patient is put on vancomycin and piperacillin/...

Posted By: Mark Crislip  

October 27, 2014

Journey or Destination

They say it is the journey that is important, not the destination. I suppose that is true if you are Steve Perry. Both are important in medicine. How you get to the diagnosis can be as interesting as the final diagnosis, but there is little in life as satisfying as coming up with an unusual diagnosis and being proven right. Most of the time the unusual di...

Posted By: Mark Crislip  

October 24, 2014

Lots of Back Pain

Back pain is not a large part of my practice. Except.

There is, of course, the IVDA who presents with fevers and severe back pain. I had a pair of these this week. Both had MRI's that showed discitis with the adjacent end plates involved. It is always infection with that pattern on MRI, probably one of only four things...

Posted By: Mark Crislip  

October 22, 2014

Look. But Do Not Touch.

When I was a medical student in the early 80's (1980's, BTW. I'm not that old) a dermatologist at my medical school enthusiastically encouraged us to touch rashes.

Feel them, she should say, get a sense of them. You can learn a lot by how a rash feels.

She was evidently not trained in ID and this was long before we worried about blood and body fluid exposures.

Fast forwa...

Posted By: Mark Crislip  

October 20, 2014

Mazel tov

Thanks to technology I get to know the names of bacteria more often.

The patient has known bicuspid aortic valve and comes in with fevers and night sweats followed by progressive shortness of breath. All his blood cultures are positive, the ECHO shows a vegetation and after stabilization for a few days of antibiotics his valve is replaced.

Everything, including the vegetation, ...

Posted By: Mark Crislip  

October 17, 2014

What's Going On?

The patient is an elderly female who, as part of a unilateral deafness evaluation, had syphilis serology. It was kind of positive: 2 plus FTA but a negative RPR.

History you ask?

One lifetime male partner, serology negative.

Has had but one infection in her life and has never, to her knowledge, had a course of antibiotics.

5 children, all healthy.

She is ...

Posted By: Mark Crislip  

October 15, 2014


There is a British term gobsmacked. I am adding a new term to the lexicon: Ebola-smacked. You will see why. Since getting back from ID Week I have been spending a lot of time preparing for a potential Ebola case. I think that it is unlikely that we will see a case of Ebola here in Portland, the backwaters of the Pacific Northwest, since the...

Posted By: Mark Crislip  

October 6, 2014

Budget of Dumb Asses. 2014 Edition.

I am off to ID Week, to sit in a cold room in Philadelphia while my betters read me PowerPoint slides. I can’t wait. Last time I was in Philadelphia I was disappointed with the cheese steaks. Perhaps this time I will be more fortunate. Since I will be preoccupied with learnin’ and not seeing patients, I will have no clinical material to write about, so instead I give you, slightly ...

Posted By: Mark Crislip  

October 3, 2014

Bowel to Aorta or Aorta to Bowel?

This will be the 7th year of this blog, having started September 7, 2008. It still amazes me that I can write an entry 2 or 3 times a week and have probably well over 1000 blog entries. I have yet to run out of material or repeat myself (that would be the clinical material, not the 'humor'). Everyday I wonder what I am going to discuss and it is rare that the universe doesn't serve up an ID cur...

Posted By: Mark Crislip  

October 1, 2014


Rules in medicine are almost never 100%. I only know of four that have no exception.*

Cellulitis is never chronic and never bilateral. Never. Ever.

Saw yet another patient in clinic who had a case of cellulitis (fevers and erythroderma of the leg) that did not go away after multiple courses of antibiotics. I cured it by raising the leg higher than the heart.  The redness va...

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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