Pope Francis was seen with a significant bruise on his chin at the Vatican City. It came as he presided over a ceremony to install new cardinals without apparent problems.

The Vatican didn’t immediately respond to requests for comment about the cause of the bruise.

The pontiff, who turns 88 later this month, appeared slightly fatigued, but carried on as normal with the scheduled ceremony to create 21 new cardinals in St. Peter’s Basilica.

Francis has suffered several health problems in recent years and now uses a wheelchair due to knee and back pain.

In 2017, while on a trip to Colombia, Francis sported a black eye after he hit his head on a support bar when his popemobile stopped short.