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August 22, 2015

Close. But no cigar.

Not that I smoke. But so often I have a great diagnosis that is ruined by negative tests. If the Secret were true I would be awash in great pathology, wishing making it so. No such luck.

The patient has had a prolonged chemotherapy induced neutropenia for large B cell lymphoma and is admitted for fevers and respiratory failure.

The diagnosis of PJP was made, he was started on tmp/sulfa and his WBC returned. Boy did it return.

45,000. And it stayed up. So they called me.

The only other interesting abnormality was an increasing alkaline phosphatase. I thought for sure this was going to be hepatosplenic Candida. The beta-d-glucan is 450, but he has PJP so that doesn’t count. It was, I said, textbook. Get a...

Posted By: Mark Crislip  

August 17, 2015

Save Some Money

I have seen the patient on and off over the years. He has chronic lymphedema and is occasionally admitted with cellulitis. The last time I saw the patient in clinic we had discussed prevention options, but he has well documented allergies to any of the antibiotics I would consider using for long term prevention of Group A streptococcus infections.

I told him that there was no reason to ...

Posted By: Mark Crislip  

August 14, 2015

Playing it Safe

The patient is admitted with back pain. He as long standing osteoporosis from prior steroid use and CT shows a mid-thoracic compression fracture. Man those look painful.

Thirty six hours into the admission he has a fever. He denies any fevers prior to admission and no constitutional symptoms except he demands a short sleeve short, something about the right to bare arms.  Constituti...

Posted By: Mark Crislip  

August 12, 2015


It has been crazy busy for most of August. Weird. As I have mentioned, the service is historically dead in the water this time of year and mentally I join it. Who wants to work during August in Oregon?

Sometimes it is the little things that peak my curiosity as I am working up a patient.

It is a middle age male with a complicated urinary history. They call me because the blood g...

Posted By: Mark Crislip  

August 7, 2015

As If I Know

It turns out that MTW of this week the link was broken for my beeper on the work intranet.  After filling out the form and hitting submit page, nothing happened.  A homeopathic page.  What was worrisome after I discovered the problem, many docs said, "Oh, we just figured it out without you."  I do not not want to to think they do not need me.

I occasionally get a con...

Posted By: Mark Crislip  

August 5, 2015


April is the cruellest month. Perhaps. Maybe it is the showers, stirring dull roots with spring rain. I don’t find ole TS’s explanation for the cruelty to be all that compelling

August is, from an ID perspective, the dullest month. Work is always slow when the weather is good and everyone, patients and doctors, are on...

Posted By: Mark Crislip  

July 31, 2015


The patient has had HIV for decades, having been diagnosed with PJP in the early nineties and meningitis about 8 years ago on the east coast. The records of that meningitis are not available and the patient does not remember the etiology. He has been undetectable for years and his CD4 counts hover around 200.

He has had a progressive headache for 6 months and he gets an evaluation. CSF ...

Posted By: Mark Crislip  

July 29, 2015

Does he or doesn’t he? No hairdresser to ask.

The patient, an otherwise healthy and vigorous middle-aged male, has had several years of intermittent fevers, sweats and a general failure to thrive.

Work up by his PCP is negative and he eventually ends up in my office.

Everything is reasonably normal except for the intermittent fevers. Routine labs (while between episodes) is negative.

The only striking thing is he ha...

Posted By: Mark Crislip  

July 27, 2015

Do I know what I think I know?

There is what I know and what I think I know.

I see a lot of disease. Common diseases for me, such as endocarditis or epidural abscesses, are rare for other physicians. It is what I get for being the only ID doc at three hospitals. All the odd stuff goes through me.  And I'm not talking gi tract here.

When I see an unusual bug in what is for me a common diseases, I tend to ...

Posted By: Mark Crislip  

July 24, 2015

Five Year Fester

The history is everything, right? You have to trust the history. But sometimes the story can be kind of odd.

5 years ago the patient had her gallbladder out. At the time it was noted on the CT that there was a thick walled cyst in the liver, maybe an abscess.

Nothing was done about it at the time for reasons I can’t glean from the EMR and the patient was lost to follow up....

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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