16 Aug 2023 • A 33-year-old man presented with a 6-month history of rapid purple discoloration of his legs upon standing, accompanied by feelings of heaviness, tingling, itchiness, and a petechial rash occasionally appearing on his feet. His leg color and symptoms improved when lying down. He had experienced a mild SARS-CoV-2 infection 18 months prior, with a suspected second infection 6 months later. He had been diagnosed with post-COVID-19 condition (long COVID) 3 months before his visit, reporting various symptoms such as exhaustion, pain, sleep disturbance, visual issues, sexual dysfunction, and cognitive difficulties. On examination, his symptoms matched a diagnosis of postural orthostatic tachycardia syndrome (POTS), which is characterized by increased heart rate upon standing along with various associated symptoms. Laboratory tests showed no abnormalities in markers like C-reactive protein, erythrocyte sedimentation rate, and autoantibodies. The patient was diagnosed with dysautonomia secondary to SARS-CoV-2 infection, linked to his long COVID condition. The leg discoloration was attributed to venous pooling and cutaneous ischemia. Recommendations for managing POTS included increasing fluid and salt intake and engaging in muscle strengthening exercises. POTS is a specific type of dysautonomia characterized by orthostatic intolerance, elevated heart rate upon standing, and various associated symptoms like dizziness, fatigue, headache, and cognitive impairment. It can be triggered by factors like viral infections, physical trauma, or surgery and may co-occur with other conditions. Source: Lancet | Read full story