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Case Reports
. 2023 Sep 30;53(3):285-289.
doi: 10.28920/dhm53.3.285-289.

Atypical distally distributed cutis marmorata decompression sickness associated with unconventional use of thermal protection in a diver with persistent foramen ovale

Petra Magri Gatt  1 , Emily Diacono  2   3 , Lyubisa Matity  4 , Kurt Magri  5
Affiliations
Case Reports

Atypical distally distributed cutis marmorata decompression sickness associated with unconventional use of thermal protection in a diver with persistent foramen ovale

Petra Magri Gatt et al. Diving Hyperb Med. .

Abstract

Cutis marmorata is a mottled, marbling, livedoid rash caused by vascular inflammation and congestion in cutaneous decompression sickness. It may occur during or after ascent due to the formation of bubbles from dissolved nitrogen accumulated throughout the dive. It is strongly associated with the presence of right to left shunts, particularly persistent (patent) foramen ovale (PFO). We report a case of cutis marmorata decompression sickness of an unusual pattern associated with unconventional use of thermal protection (a 'shorty' wetsuit worn over full suit) by a diver with a PFO. The patient also had neurological manifestations of decompression sickness. The distal lower limb pattern of involvement favours the hypothesis that cutis marmorata in humans is likely to be due to bubbles in the skin itself and/or adjacent tissues rather than cerebrally mediated.

Keywords: Decompression illness; Pathophysiology; Right-to-left shunt; Wetsuit.

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Conflict of interest statement

Conflict of interest and funding: nil

Figures

Figure 1
Figure 1
Dive profile data uploaded from Ratio iDive diving computer. A: Dive 1 on day 1; B: Dive 2 on day 1; C: Dive 1 on Day 2; D: Dive 2 on Day 2. msw: metres sea water
Figure 2
Figure 2
Pre-treatment; right distal thigh and knee with cutis marmorata rash visible
Figure 3
Figure 3
Pre-treatment; left shin bruise and cutis marmorata rash visible
Figure 4
Figure 4
Post-treatment; left shin bruise still visible, no further cutis marmorata rash
See this image and copyright information in PMC

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