Why so blue? Patient appears off colour after a fall

It all started 15 years earlier

This elderly man took his heart meds until he was blue in the face, literally.

Skin discolouration

The 81-year-old presented to an ED in Galway, Ireland, after a fall. He had a history of AF and hypertension and was taking apixaban, ramipril, bisoprolol, amlodipine and amiodarone.

Although not injured, doctors did notice a blue–grey pigmentation across his nose, cheeks and forehead, with sparing of the deep skin folds.

The patient reported that this unusual blueish hue had been longstanding.