A 45 year old man presents with left foot pain, mostly at the metatarsophalangeal joint shown above. He noticed disabling pain, redness, swelling, and inability to move the toe about 16 hours ago and it's becoming progressively worse. He can't really walk anymore. Past medical history is significant for obesity and hypertension. Social history is significant for drinking several drinks a night.
When you ask about medications, he says, "Here's the problem, doc. I think I swapped my wife's and my medications. When I took my pills yesterday, I got severe flushing. There was also some itchiness, tingling, and nausea." He can't recall what diseases his wife has, but he says, "she has all the common stuff, but nothing weird."
Challenge: The offending drug is shown above; you make sure to check LFTs because another common side effect is hepatotoxicity. What drug is it?
1. What's the clinical diagnosis?
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