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A 62-year-old man presented with a painful rash over both legs. He first experienced a problem three years prior when he developed painful erythema over his shins. Treatment for cellulitis, prescribed by the patient’s primary-care clinician, yielded only gradual improvement. Since that time, the patient had had a few more episodes of pain and erythema. He also noticed a gradual tightness of his lower legs, which had led to noticeable tenderness. The patient was a smoker; his history included hypertension and mild congestive heart failure.

What is the diagnosis?

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