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Susceptible Pseudomonas aeruginosa. A punch biopsy was performed but final results weren't instantly available. The patient was continued on levofloxacin, sulfasalazine, hydroxychloroquine, and tramadol. Following many days, granulation tissue started to form within the ulcers plus the patient was discharged with close follow-up. Final biopsy evaluation following discharge by a board-certified dermatopathologist revealed calcinosis cutis with multibacterial infection and lipodermatosclerosis. DISCUSSION: Calcinosis cutis entails the deposition of calcium and phosphorus within the skin, causing a chronic inflammatory state that damages tissue and interferes with calcification inhibitors, facilitating mineralization. On top of that, the deposits may ulcerate, extrude calcium salts, or become secondarily infected. Classically seen 8?ten years immediately after initial diagnosis in dermatomyositis and systemic sclerosis, calcinosis cutis may perhaps present in other autoimmune connective tissue illnesses (ACTDs) and may be hard to diagnose provided its variable clinical latency (2?12 months). Although calcinosis cutis is usually a rare complication of SLE/RA overlap syndrome, it really should be suspected in individuals with subcutaneous nodules that present with chronic ulcers. The delay in the patient's diagnosisJGIMABSTRACTSSCLINICAL ETHICAL DILEMMAS Plus the PRINCIPLE OF PRIMUM NON NOCERE Sagger Mawri2; Jainil Shah2; Joseph Gibbs2; Jessie Tan2; Heidi Alvey1; Najia Huda2. 1Henry Ford Overall health Method, Molecular Weight Of Jtc-801 Southgate, MI; 2Henry Ford Hospital, Detroit, MI. (Tracking ID #2199035) Mastering OBJECTIVE #1: Describe a clinical case that illustrates an ethical dilemma and discover various approaches that might be made use of to facilitate the clinical decision producing approach Learning OBJECTIVE #2: Explore the dangers and potential unintended harms of routine healthcare interventions and revisit the principle of "First, Do No Harm" (Primum Non Nocere) to ensure secure and ethical patient care CASE: A 60 year-old man with history of hypertension and diabetes mellitus form 2 was admitted for the hospital for progressive proximal muscle weakness. He was undergoing neurological work-up for suspected amyotrophic lateral sclerosis (ALS). In the basic medical floor, he was noted to possess gradual elevated work of breathing and arrangements were produced to transfer him towards the healthcare intensive care unit to acquire bilevel positive airway pressure (BPAP). Nonetheless, his transfer was delayed for many hours due to shortage of ICU beds. Upon arrival for the ICU, he was started on non-invasive 1326631 ventilation, but 24786787 24786787 didn't tolerate it well. Because of impending acute respiratory failure, he was intubated and mechanically ventilated. Following intubation, he created aspiration pneumonia and was began on Vancomycin and Piperacillin/Tazobactam. Regrettably, he developed antibiotic-induced acute interstitial nephropathy. He was switched to Moxifloxacin, but subsequently acquired clostridium difficile colitis. His ventilator settings escalated and neurology team determined that his ALS was rapidly progressive. He was fully informed of his prognosis and slim chances of getting weaned successfully off the ventilator. His renal failure progressed rapidly and he became oligouric, volume overloaded and developed electrolyte derangements. Urgent hemodialysis was necessary; having said that, at this point the patient refused any further medical interventions. After three weeks on the ventilator and subsequent tracheostomy placement with continued clinical decline, the p.