Rubor, Dolor, Calor, Tumor
Blog Address: http://blogs.medscape.com/rdct
February 10, 2015

Take That.

It’s baaaaaaaack.

The patient is admitted with an altered mental status and is discovered to have MRSA in both sets of blood cultures as well as a lower extremity (leg for you non-medical readers) cellulitis.

She had been hospitalized twice before at Outside Hospital with the same issue: MRSA bacteremia, but no cellulitis. The first time was six months ago when she was treated with 6 weeks of vancomycin, the second was three months ago with a 6 week course of ceftaroline.

Diabetes with triopathy and smoking are her main medical problems.

So is this a relapse or reinfection?

She never had a vegetation on ECHO on all three admissions and I cannot imagine endocarditis with MRSA being sil...

Posted By: Mark Crislip  

February 6, 2015

Little Things Matter

At least in ID I am fascinated by the little things, the factoids and curiosities that may or may not make a difference.

The patient is an elderly female with a complex urinary tract, a neobladder and obstructing kidney stones who has an MSSA perinephric abscess that erodes/spreads into the right lobe of the liver.

The perinephric abscess is percutaneously drained and, since it ...

Posted By: Mark Crislip  

February 3, 2015

Curiosities

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.

<...

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

How...

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 20, 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 16, 2015

Self-aggrandizing

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 15, 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  

 
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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 sciencebasedmedicine.org. 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 www.edgydoc.com

    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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