I think this can be easily photoshopped. The coloring is just two shades and the area of editing isn't so big. Because seriously...that thing...is freaking hideous.
This image is related to "やる夫がお隣のお姉さんを孕ませたようです" (Yaruo ga Otonari no Onee-san wo Haramaseta Youdesu), a popular heartwarming series of Yaruo-threads on 2ch.
'やる夫スレ' (Yaruo-thread) is a type of ascii art thread / topic starring Yaruo.