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August 7, 2017

Progressive Primary?

 “TB or not TB, that is the congestion. Consumption be done about it? Of cough, of cough. But it takes a lung, lung time.” Woody Allen

The patient presents to the ER with a month of consumption: fevers, malaise, weight loss, mild shortness of breath, and a nonproductive cough.

She has been on inflixamab for a decade with good control of her primary disease.

CXR leads to a CT that shows this:

Which is named after these:

Most of the ti...

Posted By: Mark Crislip  

August 2, 2017

More Myths

They, whoever they are, have long asserted that half of all that is learned in medical school will be found later to not be true. Sure. We learn, things change, medicine advances. Except in the world of alternative medicine, of course, which is as resistant to change as it is data.

One of the interesting variations on the theme is medical myths; ideas that everyone thinks are true but e...

Posted By: Mark Crislip  

July 31, 2017

Does Two a Hodgepodge Make?

No great insights today, but a hodgepodge of curiosities. But it is the curiosities that give me that frisson on joy. Or anger.

I have a patient with cryptococcal meningitis so I sent the prescription into the pharmacy for the 5 flucytosine. I warned her of sticker shock but it should be covered by the insurance. Two weeks cost $3900. In India flucytosine is 2 dollars a tab.


Posted By: Mark Crislip  

July 26, 2017

A Gamble That Paid Off

The patient had a liver abscess for no good reason beyond a prior cholecystectomy. A drain was placed and it grew Pseudomonas aeruginosa and E. coli.

The former organism is not high on my list of etiologies for liver abscess, but we see this, both following procedures and community acquired from underlying biliary issues.

Both organisms were pansensitive, so sh...

Posted By: Mark Crislip  

July 24, 2017

Blame the Medications First.

When patients ask why they have a particular infection, often the only answer I have is bad luck. And often they reply that it is so typical, that if there is going to be bad luck, it is going to happen to them. No one has ever said, that’s odd. I tend to be lucky. It is unusual for me to have bad luck.

Me? Good luck dominates. I have been lucky all my life. I work in the best hos...

Posted By: Mark Crislip  

July 17, 2017

Would you like cheese with this whine?

I switched antibiotics when your back was turned! Ha ha, you fool! You fell victim to one of the classic blunders! The most famous of which is "never get involved in a land war in Asia," but only slightly less well-known is this: "Never go in against a cefazolin when DEATH is on the line!"

The Princess Bride. Kind of.</p...

Posted By: Mark Crislip  

July 12, 2017


Those whom the Gods wish to destroy first they make smug.

I am, quelle surprise, one smug SOB. The problem with being smug is that reality has a way of catching up with you. It...

Posted By: Mark Crislip  

July 10, 2017

That's A Curbside ?!?

I get asked for a lot of curbside advice. I have been at an actual curbside only two times that I can remember. Usually I am sitting at the computer so perhaps it should be modernized to PC consult. Most of the time the questions are reasonable and I know who is asking the questions and I trust their abilities.

Interns on the first month on the wards? Maybe not so much.

I rememb...

Posted By: Mark Crislip  

July 3, 2017


For the last year I have had an unhealthy obsession with cable news.  I have noticed that pundits often start their bloviating with ‘Look’ or ‘Well, look’. It is starting to bug be.

Look. The patient is a young male with no medical problems who presents with severe chest pain, “like I was stabbed.”

One thing, as it often does, led to anot...

Posted By: Mark Crislip  

June 28, 2017

Doing Nothin'

Man is it slow.  I'm not complaining, mind you.  I am of an age where slow is better.  But I like to work when I am at worlk.  Going to the hospital when there is little clinical work (there is always no end of adminstrative work to catch up on) is mentally like putting the car in neutral and pushing down the gas petal.  

So some graphs. I like my numbers as gra...

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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