A male in his 30's he is a sailor , complains from a painful | Figure 1

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A male in his 30's he is a sailor, complains from a painful lesion on his foot, it started as itchy and raised papule then it enlarged and became painful. throughout hx . .he gets tired fast and has shortness of breath, and he has occasional bleeding from his gums and a bullous appeared on his lips.

No joint pain, no other physical findings.

Family hx of diabetes

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