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The ‘Pink herring’
  1. Siew Cheng Foong,
  2. May Loong Tan,
  3. Wai Cheng Foong,
  4. Jacqueline Judith Ho
  1. Department of Paediatrics, Royal College of Surgeons Ireland and University College Dublin Malaysia Campus, George Town, Malaysia
  1. Correspondence to Dr Siew Cheng Foong, Department of Paediatrics, Royal College of Surgeons Ireland and University College Dublin Malaysia Campus, George Town 10450, Malaysia; scfoong{at}

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A 3-month-old infant, exclusively fed with his mother’s expressed milk, was diagnosed with a parotid haemangioma and prescribed oral propranolol. Soon after starting propranolol, his clothes that were soiled by regurgitated milk (initially ‘milk-coloured’) mysteriously turned pink if left unwashed overnight. His mother initially thought it was because of the pink-coloured propranolol (figure 1). After 3.5 months, when the pink changes persisted despite stopping propranolol for a week, his mother brought him to our attention.

Figure 1

Picture of propranolol and stained shirt.

Physical examination of the 6.5-month-old infant revealed an involuted haemangioma. His weight and length (which was at the 15th centile from birth until 3 months of age) had dropped to the third centile. He was otherwise well and had normal development.

Question 1

Which of the following is a cause of the pink-coloured changes?

  1. Ingested blood from his mother’s breasts.

  2. Red dragon fruit his mother ate.

  3. Propranolol.

  4. Bleeding visceral haemangioma.

  5. Meckel’s diverticulum. …

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  • Contributors SCF and MLT contributed equally to this paper in the planning, conduct and reporting of the work. WCF contributed to the literature search and reports. JJH critically reviewed the paper. All authors read and approved the final manuscript.

  • 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.

  • Patient consent for publication Obtained.