Unusual case of 'blue legs' in long Covid patient seen: Lancet study

An unusual case of a long Covid patient's legs turning blue after 10 minutes of standing has been reported in a study published in The Lancet journal.

The study described the case of a 33-year old man who developed a condition called acrocyanosis, which refers to blood pooling in the veins of the legs.

A minute after standing, his legs began to redden and became increasingly blue over time, with the veins becoming more prominent, the study from the University of Leeds, UK, said.

The colour was seen to become much more pronounced after 10 minutes of standing, with the patient describing a heavy, itchy sensation in his legs.

However, his original colour was observed to return two minutes after he resumed a non-standing position.

The patient said he had started to experience the discolouration since his Covid-19 infection, the researchers said in the study.

"This was a striking case of acrocyanosis in a patient who had not experienced it before his Covid-19 infection," said Manoj Sivan, the study's author and associate clinical professor at the university's School of Medicine.

The patient was then diagnosed with postural orthostatic tachycardia syndrome (POTS), a condition causing an abnormal increase in heart rate upon standing.

Long Covid has been shown to affect multiple systems in the body, including the autonomic nervous system, which is responsible for regulating involuntary processes in the body such as heart rate, blood pressure, respiration, digestion, and sexual arousal.

Acrocyanosis has previously been observed in children with dysfunction of the autonomic nervous system (dysautonomia), a common symptom of post-viral syndromes.

"Patients experiencing this may not be aware that it can be a symptom of long Covid and dysautonomia and may feel concerned about what they are seeing. Similarly, clinicians may not be aware of the link between acrocyanosis and long Covid," said Sivan.

Previous research by Sivan's team has shown that both dysautonomia and POTS frequently develop in people with Long Covid.

Dysautonomia is also seen in a number of other long-term conditions such as Fibromyalgia and Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome or ME, both of which affect muscles and cause pain.

The researchers said that the patient's case highlighted the need for greater awareness of this symptom among people experiencing this condition.

"We need to ensure that there is more awareness of dysautonomia in long Covid so that clinicians have the tools they need to manage patients appropriately," said Sivan.

Long Covid includes symptoms of fatigue, brain fog, depression and anxiety among others, heavily impacting the patients' ability to perform daily activities and their quality of life, which in some cases has been found to be worse than that of advanced cancer patients.