Acrocyanosis, a rare and shocking symptom of long COVID

Long Covid patient’s legs turn blue when standing up due to a nervous system disorder, study reveals.
Rizwan Choudhury
Photographs of the patient's legs 0 min (A), 2 min (B), and 10 min (C) after standing.
Photographs of the patient's legs 0 min (A), 2 min (B), and 10 min (C) after standing.

Credits: Manoj Sivan,Lancet  

A 33-year-old man who suffered from Long Covid had a shocking symptom: his legs turned blue whenever he stood up. A new study in the Lancet reveals how this rare condition, called acrocyanosis, is linked to a disorder of the nervous system that affects the heart rate and blood pressure.


The study, led by Dr Manoj Sivan from the University of Leeds, describes the case of a man who developed acrocyanosis after getting infected with COVID-19. Acrocyanosis is a condition where blood pools in the veins of the legs, causing them to change color.

The man noticed that his legs became red and then blue within a minute of standing up. The colour became darker and his veins more visible as time passed. He also felt a heavy and itchy sensation in his legs. The color returned to normal two minutes after he sat down.

He was diagnosed with postural orthostatic tachycardia syndrome (POTS), a condition where the heart rate increases abnormally when standing up. POTS is one of the symptoms of dysautonomia, a dysfunction of the autonomic nervous system that regulates vital functions such as heart rate and blood pressure.

Dr Sivan, who is an 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

Long Covid is a condition where people experience various symptoms for months after recovering from COVID-19. It can affect multiple systems in the body and impair daily activities. Dysautonomia is a common feature of Long Covid, as well as other post-viral syndromes.

Acrocyanosis has been seen before in children with dysautonomia, but this is the first case reported in an adult with Long Covid. Previous research by Dr Sivan’s team has shown that dysautonomia and POTS are frequent complications of Long Covid.

Dysautonomia is also associated with other long-term conditions such as Fibromyalgia and Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome or ME.  

Dr Sivan said: “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 study is part of the ongoing research by Dr Sivan’s team on autonomic medicine. They have also developed 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.

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