Long Covid has a wide range of symptoms, but the latest described by a team at Leeds University may be unfamiliar to many – blue legs.

A case of the disorder, known as acrocyanosis, has been detailed in The Lancet, recording a 33-year-old man whose legs turned blue when standing for several minutes.

Acrocyanosis occurs when venous, or deoxygenated, blood pools in the legs, and is pumped back up the heart slower than it should be.

In the Lancet case, the patient’s legs began first to redden after standing for one minute, then became increasingly blue. After ten minutes, the colour was more pronounced, and the patient described a heavy, itchy sensation in his legs. His original colour returned two minutes after returning to a non-standing position. 

The patient said he first experienced discolouration after a Covid-19 infection. He was diagnosed with postural orthostatic tachycardia syndrome (POTS), a condition that causes an abnormal increase in heart rate on standing and results in a reduced volume of blood being returned to the heart.

‘This was a striking case of acrocyanosis in a patient who had not experienced it before his Covid-19 infection,’ said co-author Dr Manoj Sivan, associate clinical professor and honorary consultant in rehabilitation medicine at the University of Leeds.

‘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.

‘We need to ensure that there is more awareness of dysautonomia [malfunctioning of the nervous system] in long COVID so that clinicians have the tools they need to manage patients appropriately.’

More than 200 symptoms of long Covid have been identified since the disorder arose during the pandemic, with many, such as fatigue and brain fog, affecting people’s ability to perform daily functions. The condition often affects the autonomic nervous system, which regulates blood pressure and heart rate.

Dr Sivan has previously shown both dysautonomia and POTS are frequently seen in those with long Covid.

‘We need more awareness about dysautonomia in long term conditions,’ he said. ‘More effective assessment and management approaches, and further research into the syndrome. This will enable both patients and clinicians to better manage these conditions.’

Covid cases are increasing in a number of countries, with the rise of a new strain, Eris, declared a ‘variant of interest’ by the World Health Organisation.

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