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CHALLENGING CLINICAL CASE NO. 06/2001

A 52 year old previously well man who has had hoarseness as well as intermittent pain and swelling in his right knee and left foot over the past few months presents now because of pain and swelling in both ears. On examination he has conjunctivitis and beefy red skin over the ears and bridge of the nose, although the earlobes appear  normal. His most likely diagnosis is

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