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February 2, 2015


Most I learn something new mostly as there is so much I do not know. Currently I have no facinomas, although I might. So many of my great diagnoses are disconfirmed by testing. The saying is when you hear hoofbeats, think horse not zebra. So often even the horse is an auditory hallucination.

Still even if I do not have a diagnosis, I have some curiosities from the last few weeks.

One. I saw a patient a while back with severe pneumonia. She was on a ventilator with diffuse infiltrates throughout the lung. On admit her LDH was 500, PJP range, but the bronch had no PJP.

When I think of high LDH with pneumonia my differential diagnosis starts and stops with PJP. Histoplasma can give a high LDH as well, but Oregon is not histoplasma territory and the patient has no tr...

Posted By: Mark Crislip  

January 30, 2015

Word Salad

The patient is a young female with 5 days of progressively severe headache. She comes to the ER for evaluation and the initial workup is negative and she was about to be discharged when she had a transient episode of word salad.

This led to an MRI (normal) and an LP: 230 lymphocytes, normal glucose and a protein of 200. Aseptic meningitis.

After admission she had one more episod...

Posted By: Mark Crislip  

January 29, 2015

Staph goes anywhere it wants

As I have said before, if I were a superhero, S. aureus would be my arch-nemesis. Like in the comics, no matter how many times it appears to be defeated, it comes back, a little harder to kill than the time before.

The patient is admitted with S. aureus bacteremia without a focus, shortness of breath and pleuritic chest pain. He has what looks to be peripheral emboli i...

Posted By: Mark Crislip  

January 26, 2015

A question but no answer.

This blog is often about the little things that pique my curiosity. I see something of interest, ask a question, and, thanks to the interwebs, I almost always find an answer. There is no question that needs to go unanswered given the ease with which information can be found. I do not miss the Index Medicus


Posted By: Mark Crislip  

January 21, 2015

Wonder Drug

The patient is admitted with aspirin overdose. Not a common reason for an ID consult, but it was fun to see a process I had not really taken care of since I was a resident back in the dark ages. He had all the classic findings: gap acidosis, hearing issues, respiratory overcompensation. It also reminded me that I am glad acid-base is now someone else s problem.

But why the aspirin overd...

Posted By: Mark Crislip  

January 19, 2015

Can't Tie It All Together

I’m missing something.  And I don't mean I am a few cards short of a full deck.

The patient is a youngish male with a long history of kidney stones who is admitted with an exacerbation of same.

As an outpatient he had fevers and cultures were done. The urine grew MRSA and Enterococcus.

The blood? Both sets grew Rothia mucilaginosa, which you probably ...

Posted By: Mark Crislip  

January 15, 2015


You may not know this, but for a year I blogged on my own. Eventually Medscape recognized my what? pathology? genius? click bait value? and asked me to blog here.

I had self-published those early essays in a volume that received good reviews by readers. 4.5 Stars on Amazon ...

Posted By: Mark Crislip  

January 14, 2015

Where did those come from?

The patient, otherwise healthy, has 2 months of gradually progressive shortness of breath. She is increasingly unable to take her garden debris a half mile down the road to the community mulch pile. No fevers, no cough, no night sweats, no weight loss. Rest of the PMH and exposure history was initially negative.

Screening labs are normal but the CXR shows patchy multilobar pneumonia.</p...

Posted By: Mark Crislip  

January 9, 2015


We all have our weak points. Dermatology is mine. I hate make making rash decisions. Wah Wah Wah.

Still. What is that rash?

The patient come in with extensive cellulitis of the leg. Common enough. There are a lot of blisters filled with clear liquid, but that doesn’t concern me. It is common with erysipelas, although there is not a...

Posted By: Mark Crislip  

January 8, 2015

Ignorance is Bliss. It is why I am so happy.

I write this blog because, like Jon Snow, I know nothing. Think about it. Everyone one of these entries, three times a week, going back to September of 2008, is written to answer questions that I did not have an answer for. That’s about 650,000 words. With my SBM blogs I have churned out well over a million words. 

Amazing. A...

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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