The ‘Pink herring’

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. 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. …