He reports that about 2 weeks earlier his right knee became painful, swollen, and warm to the touch; his left knee became painful and warm 1 day later. He also had several raised red spots on the posterior aspect of his left calf that were itchy but not painful. The next day the rash progressed to his left knee, and he began to experience severe epigastric pain along with shortness of breath and lightheadedness. Later the rash progressed to involve his feet, arms, and trunk with bilateral swelling of the ankles and hands as well as worsening pain in his feet such that he was unable to stand or walk.
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