A 45-year-old man with a history of hypertension and type 2 diabetes presents with 10 days of fevers and chills. He works as a cattle farmer in rural Indiana (Midwestern, USA) and has experienced pain in his hips and wrists in the last few days, making it difficult for him to work. He has drenching sweats that are foul smelling. Over the last 24 hours he developed swelling and pain in his scrotum which prompted presentation. He denies other symptoms and reports he is only sexually active with his wife; they do not use contraception.
At time of exam, he was afebrile with normal vitals. Exam was notable for mild splenomegaly and swelling and tenderness over scrotum consistent with epididymo-orchitis. His joint exam was unremarkable.