Review Question - QID 213396

A 55-year-old man presents to the emergency department with chest pain. He states that his symptoms started a few days ago and have been gradually worsening. The patient admits to drinking alcohol recently and has been vomiting frequently. The patient has a past medical history of alcohol abuse and regularly presents to the emergency department. His temperature is 102°F (38.9°C), blood pressure is 107/65 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for foul-smelling breath and poor dentition with erythema and edema of the patient’s gums. Pain is elicited when the patient swallows and the patient complains that his voice has sounded different recently. Crepitus is palpated in the submandibular region. Dermatologic exam reveals the finding in Figure A. The patient’s ECG demonstrates a left bundle branch block which is consistent with previous ECGs. Which of the following is the most likely diagnosis?