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A recent Lancet case study of a 33-year-old man with long Covid reported “rapid purple discoloration” of the patient’s legs after he would stand for 10 minutes. The patient had been experiencing this peculiar symptom for six months and other than the purple discoloration, his legs also felt heavy and itchy. The symptoms would subside and the discoloration would fade away after he would lay down.
The condition is known as acrocyanosis and occurs when there is a venous accumulation of blood in the legs. While a bluish or purplish discoloration of the hands is more common among patients with acrocyanosis, it can occur around the feet or legs after spasms of small blood vessels within that area.
In a press release, Manoj Sivan, an associate clinical professor at the University of Leeds said, “This was a striking case of acrocyanosis in a patient who had not experienced it before his COVID-19 infection.”
“Patients experiencing this may not be aware that it can be a symptom of long Covid and dysautonomia (malfunction of the autonomic nervous system that regulates blood pressure and heart rate) and may feel concerned about what they are seeing. Similarly, clinicians may not be aware of the link between acrocyanosis and Long Covid,” Sivan added. “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.”
Some of the risk factors that might make people more prone to an unusual condition like acrocyanosis is a low body mass index, neurological impairments, living in regions with cold climates, and working in more outdoors oriented professions. The exact incidence and prevalence of acrocyanosis is still unknown.
Sivan and his colleagues also diagnosed the 33-year-old male patient with postural orthostatic tachycardia syndrome (POTS). The condition is characterized by an increased heart rate shortly after an individual is sitting or lies down. Other POTS symptoms can include fainting and lightheadedness. Doctors tend to recommend POTS patients to increase their salt intake to try and combat these symptoms.
According to the National Institutes of Health, POTS is an uncommon condition and affects approximately 0.2% of the general population. In the United States, researchers estimate around 500,000 to 1,000,000 people were diagnosed with POTS. In a prior study, Sivan and colleagues reported that POTS and dysautonomia could frequently develop in individuals who have long Covid.
The Lancet study further highlights that while long Covid affects at least 10% of the general population, it is possible for uncommon conditions to develop among a few long Covid patients. Long Covid more commonly manifests in the form of severe fatigue (also known as myalgic encephalomyelitis), brain fog, sleep issues, difficulties concentrating, loss of smell and taste, and depression and anxiety.
Recent studies have found that these symptoms could persist for more than 12 months although they typically might subside after three to six months among most long Covid patients.
“We need more awareness about dysautonomia in long term conditions; more effective assessment and management approaches, and further research into the syndrome. This will enable both patients and clinicians to better manage these conditions,” Sivan further added.