Leeds University doctor warns of Long Covid symptom after 33-year-old man's legs turn blue

Doctors raised the alarm following the case of a Long Covid patient’s legs turning blue after 10 minutes of standing. They say it highlights the need for greater awareness of the "blue legs" symptom among people with the debilitating condition.

The paper, published in The Lancet, focuses on the case of a 33-year British man who developed acrocyanosis – venous pooling of blood in the legs.

Dr Manoj Sivan, of the University of Leeds, explained that, a minute after standing, the patient’s legs began to redden and became increasingly blue over time, with veins becoming more prominent.

He sad that after 10 minutes the colour was much more "pronounced" - with the patient describing a heavy, itchy sensation in his legs. His original colour returned two minutes after he returned to a non-standing position.

The patient said he had started to experience the discolouration since catching Covid. He was diagnosed with postural orthostatic tachycardia syndrome (POTS), a condition that causes an abnormal increase in heart rate on standing.

Dr Sivan 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 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 in Long Covid so that clinicians have the tools they need to manage patients appropriately.”

Long Covid affects several systems in the body and has a variety of symptoms, affecting patients’ ability to perform daily activities. Dr Sivian said the condition also affects the autonomic nervous system, which is responsible for regulating blood pressure and heart rate.

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

Previous research by Dr Sivan’s team has shown that both dysautonomia and POTS frequently develop in people with Long Covid. Dysautonomia is also seen in other long-term conditions such as Fibromyalgia and Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome or ME.

Dr Sivan, Associate Clinical Professor and Honorary Consultant in Rehabilitation Medicine at Leeds’ School of Medicine, added: “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.”