This is pathetic, more pathetic than the ESRB and rating companies in general usually are. The ESRB recently deemed the cover of Risen 2, a M-rated game, to be too graphic. As you can see in the image above, the change is both glaring, and unneeded. Not to mention hideous.
The original cover depicted with a red paint was determined to be equal to blood by the ESRB, and went against their marketing guidelines. The cover was changed to a rather foul teal/cyan color in order to appease them.
The artwork change only applies to North America as the ESRB have no power anywhere else. I swear, ESRB, publishers, sponsors, they really need to learn their place, which is either at the bottom of a ladder or in quicksand.