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June 5, 2015

Rash Treatments

Toxic shock? Septic shock? I am not certain at first. The patient certainly is in shock and has a necrotizing Group A streptococcal soft tissue infection.

The rash? Not present on admission but he is hypotensive and on buckets of pressors. I had a patient who did not manifest their TSS rash until after they were off pressors. I assume he was too clamped down to get red skin. That was the best explanation I had at the time. Maybe the same process is occurring in this patient.

The palms and soles became red 48 hours into the course, but the eyes are not hyperemic and the tongue does not look like a strawberry. So I am leaning towards septic shock. Also the creatinine and calcium are normal; the former should be up and the latter down if it is TSS.

Streptococci cert...

Posted By: Mark Crislip  

June 3, 2015

Cheap and Easy

The patient has endocarditis with lots of emboli: CNS on MRI and legs by exam. Curiously, none in the eyes. Usually when they have CNS emboli you see them in the conjunctiva. His creatinine is markedly elevated, I presumed from emboli as well, although there was no hematuria. We did not go looking because he didn’t need the dye load.

Until today. His fevers resolved over a week as...

Posted By: Mark Crislip  

May 29, 2015

Metastatic complications

The patient has three days of sustained Staphylococcal bacteremia. That’s endocarditis. It turns out to be MSSA, so after three days of vancomycin the patient is placed on nafcillin.

He had some curious neurologic symptoms on admission. Shoulder tingling and thigh numbness but the muscles and reflexes were normal.

A pan-MRI of the spine showed a C4 herniated disc, but no e...

Posted By: Mark Crislip  

May 27, 2015

Drugs Don't Stay Put

Bad outcomes make an impression. I remember complications and failures far more clearly than my successes.

The patient is a elderly female with a chronic entero-cutaneous fistula and abscess as a complication of a necrotic gallbladder as well as on dialysis from diabetic renal disease. For a variety of reasons the patient is not a good surgical candidate, so the abscess has had a few dr...

Posted By: Mark Crislip  

May 20, 2015

More Fleas and Lice

The patient is on high dose prednisone and rituxan for an autoimmune disease.

She comes in with some mild shortness of breath and a CT that has multiple nodules all throughout the lung. They are solid, the biggest about a centimeter, none are cavitary. She has no risk factors by travel etc for an odd infection.

The bronch is unimpressive for pus, negative for PJP by DFA, galacto...

Posted By: Mark Crislip  

May 18, 2015

Lack a Bacillus? Nope.

Any bug can infect any organ given a perfect storm of bad luck. It is what makes ID interesting and drives this blog.

The patient is an elderly male getting his first round of chemo for his Hodgkins. At baseline he is not high functioning and the chemotherapy renders him mostly bed bound.

He is in the hospital for neutropenic fevers. He is placed in standard antibiotics. His fev...

Posted By: Mark Crislip  

May 13, 2015

Nailed It

As I have said before, as a rule the physical examination is more for entertainment. It is interesting to find pathology, but it is rare to make a diagnosis on the basis of the physical exam alone as opposed to the history and cultures.  At least for me.  Your milage may vary

Part of the problem of the exam is actually seeing what you are examining. It is easy not to note the ...

Posted By: Mark Crislip  

May 11, 2015

Another Rash I Do Not Recognise

I hate rashes, mostly because I am not good at visuals. In med school histology almost did me in. All I saw was purple and red on the slides. I never could figure out the portal triad. It is why I rely on the history for making diagnosis. I am much more verbally oriented.

The patient is a middle aged male, just back from a vacation in the Caribbean, who has a rash.

Not only on t...

Posted By: Mark Crislip  

May 8, 2015

Time for a fish boil.

The patient is an elderly female, on methotrexate for rheumatoid arthritis, who presents with a cluster of nodules on the calf. They do not get better and are eventually biopsied.

They grow M. marinum, the cause of aquarium granuloma. And she does have an aquarium that she maintains. Thing is, she doesn’t maintain it with her legs. It is not like she is making fish wine, ...

Posted By: Mark Crislip  

May 6, 2015


This is mostly an infectious disease blog, but occasionally I like to wander off and winge about aspects of medicine that annoy me. But I can still tie in infections to ANYTHING.

I don’t watch medical shows on TV. They irritate me too much. I found House unwatchable from a medical point of view, even though I love Hugh Laurie and remain of the opinion that

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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