What Is the Cause of This Infant's Mottled Appearance?

AUTHORS:
Carly Guss, MD
Dr Guss is a pediatric resident at the Alpert School of Medicine at Brown University located at Hasbro Children’s Hospital in Providence, Rhode Island.

Kirk Barber, MD, FRCPC––Series Editor
Dr Barber is a consultant dermatologist at Alberta Children’s Hospital and clinical associate professor of medicine and community health sciences at the University of Calgary in Alberta.

CITATION:
Guss C. What is the cause of this infant's mottled appearance? Consultant Pediatr. 2013;12(7):296,298.

A 1-month-old full-term girl was admitted to a hospital’s pediatrics floor with worsening respiratory distress resulting from bronchiolitis. At the time of evaluation by the rapid response team on the floor, the infant was tachypneic, and the skin of her right lower extremity was noted as having a mottled appearance (Figure). She was given a 20-mL/kg bolus of intravenous normal saline, but her leg continued to have the same mottled appearance. A second bolus of saline was administered. Aside from the bronchiolitis and reticulated appearance of the skin, the rest of the examination findings were unremarkable.

Her increased respiratory rate necessitated transfer to the pediatric intensive care unit (PICU) for closer monitoring. Upon examination and history-taking in the PICU, her parents stated that the girl’s skin had looked like that since birth, and that her pediatrician had told them that the marbled appearance was normal.

What is the cause of this infant’s mottled appearance?

(Answer and discussion on next page