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January 17, 2017

A minor spleen vent

To vent the spleen. I imagine putting a tube in the spleen to let off pressure. Odd phrase. 

In European medicine from the Middle Ages until the nineteenth century, the spleen was thought to be the source of the "humours" that caused the emotion of anger. Therefore one could expel anger by "venting the spleen".

I don't suppose spleen venting leads to Howell-Jolly bodies or an increased risk for purpura fulminans, so I will be safe to continue.

Both my colleagues were gone today and I had a 9 consult day.   I really do not have the energy I did when I was young.  

Posted By: Mark Crislip  

January 11, 2017

Abscess Does Not Make the Heart Grow Fonder

There are diseases that are like jumping out of an airplane without a parachute. You might think that aiming for the lake instead of the concrete will make a difference, but it won’t.

Drug addiction is like that. Unchecked/untreated it is a certain death, not if, but when. The only uncertainty is how.  OD?  Murder? Infection?

The patient is a polysubstance abuser...

Posted By: Mark Crislip  

January 10, 2017


There are typical typicals. These are diseases we know that present typically. There are typical atypicals. That is to say, there are atypical diseases that we know present typically. But there are also atypical atypicals. There are atypical diseases that present atypically. And they are a pain to diagnose.

Posted By: Mark Crislip  

January 4, 2017

No Go

The patient was on high dose prednisone, 60 mg a day, for an underlying autoimmune problem. The prednisone did nothing for the underlying problem but did lead to a steroid myopathy and a cavitary pneumonia in the RLL.

The prednisone was weaned off and the patient was treated with a Augmentin. The infiltrate/cavity maybe improved, but not enough to avoid a bronchoscopy. The gram stain sh...

Posted By: Mark Crislip  

January 2, 2017


I have been doing this blog since September 2006 and have yet to run out of curiosities. ID is the gift that keeps on giving.

I started my fellowship the year Petersdorf wrote his famous article that there were too many ID doctors being trained and not enough for them to do. That was in 1986 and probably stan...

Posted By: Mark Crislip  

December 28, 2016

Does it make a diff?

The patient had abdominal surgery for a malignancy and had, in the passive voice, an inadvertent colon enterotomy that was repaired.

He is readmitted a week later for fevers and abdominal pain and an abscess is found on CT. It is drained, enterotomy was re-repaired in the OR and the cultures of the abscess grow E. coli, C. perfringens and C. difficile.


Posted By: Mark Crislip  

December 26, 2016

Leading in a cyst.

The patient has end stage liver disease/cirrhosis and is admitted with fever and chills.

Blood cultures grow K. pneumoniae. Not a surprise.

Gram-negative bacteria were the predominant microorganisms of bacteremia (75.6%). Among them, Escherichia coli, Klebsiella pneumoniae and Aeromonas hydrophilia were the three most commonly detected microorganisms.<...

Posted By: Mark Crislip  

December 21, 2016

I don't know what to do.

The buck has stopped with me for a long time. The problem is, the longer I practice medicine, the more I encounter problems that I really have no idea what to do. The last couple of weeks have seen a series of cases that have me flummoxed. But everyone expects an answer from me.

For example.

The patient is a middle aged male from SE Asia was treated for abdominal TB in 2003. Sou...

Posted By: Mark Crislip  

December 14, 2016

I donít care what the literature says, itís still a bad idea.

That title is heresy coming from me.

The patient is a middle aged IDDM. He comes in with fevers and pleuritic chest pain.

Blood cultures grow MRSA and the CT is consistent with septic emboli although the TTE is negative for vegetations.

The next day, 24 hours into vancomycin therapy, he complains of blurry vision and eye exam shows bilateral endopthalmitis that eventuall...

Posted By: Mark Crislip  

December 12, 2016

You woke me for for THAT ?!?

I have basically been on call since 1990. Except for weekends and vacations, the beeper is on. It is one of the reasons I refuse to use my phone as my primary contact for work: I can turn off my beeper but I cannot turn off my phone and I do occasionally want to escape medicine.

I never mind getting  called because I figure there really is no such thing as a stupid question. Someon...

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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