A 77-year-old man, hospitalized for a mild form of Covid-19, developed a curious variant of restless legs syndrome affecting… his anal region. A unique case for the moment in the scientific literature.
More than 200 symptoms have been associated with long-term Covid-19, including double vision, voice changes, discoloration of nails and even a reduction in the size of the testicles. But the case of this Japanese patient reported in the journal BMC Infectious Diseases is completely unique: a curious version of restless legs syndromerestless legs syndromebut at the anal level.
Anal discomfort alleviated by video games
In 2020, a 77-year-old man (whom we will call M) presented to Tokyo hospital due to classic symptoms of Covid-19: sore throat, cough, low fever. After a night spent in the hospital, a PCR testPCR test confirms the diagnosis: M is indeed positive for Covid-19. Despite a slight pneumoniapneumoniathe case is classified as mild by doctors and the patient is treated with an anti-asthma medication and a antiviralantiviral.
After 21 days, M regained almost normal breathing and was sent home. A few weeks later, however, he began to feel “profound anal discomfort”, about 10 cm above the perineumperineumthe muscle located between the pubis and theanusanus. Unrelieved discomfort defecationdefecationbut which calms down when the patient walks, runs or ” play games video gamesvideo games based on the movementmovement », Report the doctors. Rest, on the other hand, aggravates symptomssymptomswho also tend to wake up in the evening, leading doctors to prescribe them sleeping tabletssleeping tablets. If the colposcopycolposcopy reveals some internal hemorrhoidsinternal hemorrhoidsno other anomalyanomaly of the bladderbladder neither erection is detected. Nothing to report at the neurological level either. Doctors then make the diagnosis of “restless anal syndrome”, a rare variant of restless legs syndrome.
Did you know ?
The four criteria for restless legs syndrome (and its variants)
- irrepressible desire to move;
- worsening at rest;
- worsening in the evening;
- relief of symptoms with exercise.
Restless legs syndrome (RLS), which affects between 4 and 10% of the population, causes an irrepressible need to move with a sort of tingling in the legs. Some variants have already been reported in the scientific literature, affecting the head and neck, the oral cavity, theabdomenabdomen or the perineum. In 2017, doctors from the Saint-Étienne University Hospital published an article on a patient suffering from “restless genital syndrome”, describing “ an excessive and persistent feeling of genital and clitoral arousal with the absence of conscious feelings of sexual desire “. The patient, who had previously been diagnosed with classic RLS, had seen her pathologypathology extend to the genital area.
Neurological complications of Covid-19
No cause for SRJ has yet been clearly identified. Scientists suggest a dysfunction at the receptor level of dopaminedopaminewith contributing factors such as deficiencydeficiency in ironirona renal failurerenal failureor one diabetesdiabetes type 2. In M’s case, doctors believe that restless anal syndrome may have been triggered by the virusvirus of Covid-19, the man having never encountered such problems before. Two similar cases of post-Covid-19 RLS have already been reported. Rare cases of Guillain-Barré syndromeGuillain-Barré syndromean autoimmune disease attacks the nervesnerves peripherals, have also been reported following Covid-19 infection, which attests to possible neurological sequelae.
In the end, M was treated with clonazepam, a drug in the class of benzodiazepinesbenzodiazepines usually precise in case of RLS: “ Ten months after starting treatment, symptoms continue to improve », conclude the doctors in their article.
