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It is all blue!
  1. Zak Azeez,
  2. Pramodh Vallabhaneni
  1. Child Health, Swansea Bay University Health Board, Port Talbot, UK
  1. Correspondence to Dr Pramodh Vallabhaneni, Child Health, Swansea Bay University Health Board, Port Talbot, UK; Pramodh.vallabhaneni{at}

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A 9-month-old ex-premature (33+4) boy presented with episodes of blue discolouration of his arms and legs (figure 1). Episodes last 30 min, and recovery is spontaneous (figure 2). There is no blue discolouration of the lips or tongue and no associated pain. No other symptoms were reported, and he was not on any regular medication. There was a bluish-purple discolouration of the extremities and perioral area on examination. Lips and tongue were clear. Examination was unremarkable, with no murmurs heard and palpable femoral pulses. Family history of sudden cardiac death was reported on the maternal side.

Figure 1

Bluish discolouration of both lower limbs.

Figure 2

Post resolution of discolouration.


  1. What is the most likely diagnosis for his blue limbs?

    1. Primary acrocyanosis

    2. Erythromelalgia

    3. Hypoxia

    4. Secondary acrocyanosis

    5. Methemoglobinaemia

  2. What would be the …

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  • Contributors ZA wrote the first draft of the manuscript. PV conceived the idea, mentored ZA and authored the final version of the manuscript incorporating the reviewer’s suggestions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.