A28-year-old male smoker presented to the emergency depart- ment with productive cough, sore throat, nausea, vomiting, and several hours of multiple joint pains, involving the right knee and shoulder. The pain started in the right shoulder and then progressed to the right wrist and knee and worsened with movement. The patient's pertinent negative history included absence of fever, rash, chills, dysuria, lower extremity swelling, or trauma. The patient was sexually involved in a monogamous relationship with a female partner but did not report using condoms. The patient's past medical history was significant for an arthrocentesis of the right knee performed 6 months prior to the current admission (further details not available). Family and travel history was not contributory.
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