Sanjeev Bhat, Dharminder Kumar, Aditi Parimoo

A 14-year-old male was presented to our cardiology department with complaints of bluish discolouration of both hands (Figure 1) and feet and easy fatigability for past 2 years. This peripheral cyanosis was first perceived by his parents 2 years ago and it did not advance since then. A brief history elicited no other symptoms like shortness of breath, chest pain, fever, cough, generalized swelling of body, numbness or paraesthesia, decreased level of consciousness, abnormality in body movement, visual or auditory deficits, gastrointestinal complaints, bone and joint pain or genitourinary symptoms. There was no history of weight loss or diminished appetite. His birth history was also unremarkable and had achieved all the developmental milestones timely. There was no history of any failure to thrive, feeding difficulties or recurrent chest infections in his childhood. He was a student and did not report any exposure to chemicals or drugs prior to the onset of symptoms. He did not use any tobacco, illicit drugs or alcohol. There was no significant medical history in the past. He lived in the city and never travelled outside the state. A general physical examination revealed no abnormality other than the cyanosis of the extremities and the lips. His blood pressure was normal (110/70 mmHg) and pulse rate was 75 beats per minute. Oxygen