A Startling Case of “Blue Legs” Raises Concerns Over Long Covid’s Unexplored Symptoms

Long COVID ‘Blue Legs’ Symptom

From left: Patient standing at 0 minutes; 2 minutes, and 10 minutes. Credit: University of Leeds

Recent research presents a unique case of a Long Covid patient whose legs turned blue after standing, highlighting the need for increased awareness of acrocyanosis. The study also emphasizes the connection between Long Covid, dysautonomia, and conditions like Fibromyalgia, contributing to advancements in autonomic medicine.

An unusual case of a Long Covid patient whose legs turned blue after 10 minutes of standing underscores the need for increased awareness of this symptom among those with the condition, according to new research published in The Lancet.

The paper, authored by Dr. Manoj Sivan at the University of Leeds, examines the case of a 33-year-old man who developed acrocyanosis, a phenomenon where venous blood pools in the legs.

Patient’s Experience

A minute after standing, the patient’s legs began to redden and increasingly turned blue over time, while the veins became more prominent. After 10 minutes, the color was much more pronounced, and the patient described a heavy, itchy sensation in his legs. The original color returned two minutes after he resumed a non-standing position.

The patient revealed that he had started to experience this discoloration since his COVID-19 infection. He was diagnosed with postural orthostatic tachycardia syndrome (POTS), a condition characterized by an abnormal increase in heart rate upon standing.

Expert Insights

Dr. Sivan, Associate Clinical Professor and Honorary Consultant in Rehabilitation Medicine at the University of Leeds’ School of Medicine, 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 and Related Conditions

Long Covid affects multiple systems in the body and has an array of symptoms, affecting patients’ ability to perform daily activities. The condition also affects the autonomic nervous system, which is responsible for regulating blood pressure and heart rate.

Acrocyanosis has previously been observed 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 a number of other long-term conditions such as Fibromyalgia and Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome or ME.


Dr. Sivan emphasized: “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.”

The research is the latest work by the team in the field of autonomic medicine. Other developments include a home test for people with symptoms of autonomic dysfunction in conditions such as long COVID, chronic fatigue syndrome, fibromyalgia, and diabetes 1 and 2, where people experience dizziness or blackouts.

Reference: “Venous insufficiency and acrocyanosis in long COVID: dysautonomia” by Nafi Iftekhar and Manoj Sivan, FRCP Edin, 12 August 2023, The Lancet.
DOI: 10.1016/S0140-6736(23)01461-7

2 Comments on "A Startling Case of “Blue Legs” Raises Concerns Over Long Covid’s Unexplored Symptoms"

  1. ElephantInDaRoom | August 14, 2023 at 2:45 am | Reply

    long covid or long vaxx?

  2. Real Problem, False Label.

Leave a comment

Email address is optional. If provided, your email will not be published or shared.