An intriguing case of peripheral cyanosis

I was working late at the surgery a few months ago when a young woman came in complaining that her hands had turned blue. Dr Google had alarmed her by suggesting she may have contracted some terrible disease. On examining her deeply cyanosed hands I was starting to agree with her.

My sluggish brain, already dreaming of dinner with a nice glass of red (Margaret River Cabernet Sauvignon), was reaching frantically into the depths of its grey matter for the causes of cyanosis. Vaguely unpleasant memories surfaced of standing at the back of a white-coated crowd of would-be doctors trying to recite aloud the causes of peripheral cyanosis under the steely gaze of a consultant and his blue-palmed patient.

Then, as now, I mumbled to myself incoherently: right-to-left shunt ... um-mm ... clubbing ... vasoconstriction ... errr … Other words drifted by ... methaemoglobinaemia, acrocyanosis. Neither meant anything whatsoever. 

The pulse oximeter came to my rescue with normal oxygen saturations and I sent a very healthy looking patient with a normal pink tongue and no signs of congestive cardiac failure off to get some blood tests. 

Later, drowning my sorrows in that full-bodied noncyanotic Cabernet, my wife casually asked how my day had been. I paused, wondering whether to bother a professional musician with tales of heroic diagnoses and medical catastrophes averted. 

Against my better judgement, I recounted the tale of the blue hands – to which she immediately responded, ‘She must have bought a new pair of jeans, my hands are always blue for a few days afterwards’. 

I rang the patient. Yes, she had bought a new pair of jeans the day before. I explained that I had suddenly recalled that this might be the cause of her condition, not wanting to admit that my wife can often be the source of my cleverer diagnoses, and that she needn’t bother with the blood tests after all.

It was as well she couldn’t see the colour of my cheeks down the phone line – a deep shade of noncyanotic red! MT