LAUSR

A 62-year-old man reported the rapid onset of acute ataxia and a pruritic, tender, mottled rash on his torso. The patient had been on two SCUBA dives a few hours earlier—as deep as 20 m, with adherence to standard ascent protocols. He denied vision changes, weakness, and shortness of breath. He texted photos of his skin findings to his doctor (Figures 1 and 2). A clinical diagnosis of decompression sickness (DCS) was made. Medics administered high flow oxygen and intravenous fluids. Hyperbaric treatment was not available. In the emergency department, his symptoms resolved within several hours. Cutaneous abnormalities, commonly known as “skin bends,” are among the most common findings in DCS. Cutis marmorata due to decompression sickness classically presents as an erythematous, pruritic rash that spreads irregularly and deepens in color to become mottled, cyanotic patches. The cause is believed to be nitrogen bubbles within tissues and vessels. DCS may result in severe complications—including spinal cord injury, pulmonary venous gas embolism, acute circulatory collapse, and stroke from paradoxical arterial embolism. The skin findings typically resolve without sequelae, but are an important, early sign of DCS and indicate the need for emergent evaluation.