Tokyo Medical University Hospital, Tokyo, Japan.
Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
BMC Infect Dis. 2021 Sep 23;21(1):993. doi: 10.1186/s12879-021-06683-7.
Coronavirus disease 2019 (COVID-19) has a broad spectrum from respiratory and nasopharyngeal symptoms, cerebrovascular diseases, impaired consciousness, and skeletal muscle injury. Emerging evidence has indicated the neural spread of this novel coronavirus. Restless legs syndrome (RLS) is a common neurological, sensorimotor disorder, but highly under diagnosis disorder. Restless anal syndrome as restless legs syndrome variant associated with COVID-19 has been previously not published. We report a case presenting with restless anal syndrome following COVID-19.
Although a 77-year-old male with COVID-19 improved to normal respiratory function 21 days after admission and treatment of favipiravir 200 mg per day for 14 days and dexamethasone 6.6 mg per day for 5 days, the insomnia and anxiety symptoms remained. Several weeks after discharge, he gradually began to experience restless, deep anal discomfort, approximately 10 cm from the perineal region. The following features were observed in the anal region; urge to move is essential, with worsening with rest, improvement with exercise, and worsening at evening. Colonoscopy revealed internal haemorrhoids without other rectal lesions. Neurological findings including deep tendon reflex, perineum loss of sensory and spinal cord injury, revealed no abnormalities. Diabetes militias, kidney dysfunction and iron deficiency status were not confirmed. Family history of RLS and periodic limb movements were not observed. Clonazepam at 1.5 mg per day resulted in the alleviation restless anal discomfort.
We reported a case presenting with restless anal syndrome following affection of COVID-19 as restless legs syndrome variant. This case fulfilled 4 essential features of RLS, urge to move, worsening with rest, improvement with exercise, and worsening at evening. To date, no case of restless anal syndrome associated with COVID-19 has been previously published. This case report may reflect the associative impacts of COVID-19 on the neuropsychiatric state. The long-term outcomes of neuropsychiatric conditions should continue to be monitored.
2019 年冠状病毒病（COVID-19）的症状范围广泛，包括呼吸道和鼻咽症状、脑血管疾病、意识障碍和骨骼肌损伤。新出现的证据表明这种新型冠状病毒具有神经传播性。不宁腿综合征（RLS）是一种常见的神经感觉运动障碍，但高度漏诊的疾病。COVID-19 相关的不宁肛综合征作为不宁腿综合征的变异型以前尚未发表过。我们报告了一例 COVID-19 后出现不宁肛综合征的病例。
尽管一名 77 岁男性患有 COVID-19，在入院后 21 天，接受了每天 200mg 奈玛特韦利托那韦片和 14 天，以及每天 6.6mg 地塞米松和 5 天的治疗后，呼吸功能恢复正常，但仍存在失眠和焦虑症状。出院后几周，他逐渐开始感到不安，深部肛门不适，距离会阴部约 10cm。肛门区域观察到以下特征；移动的冲动是必不可少的，休息时会加重，运动时会减轻，晚上会加重。结肠镜检查显示内痔，无其他直肠病变。神经学检查包括深腱反射、会阴部感觉丧失和脊髓损伤，均无异常。未确诊糖尿病、肾功能不全和缺铁状态。未观察到 RLS 和周期性肢体运动的家族史。每天 1.5mg 氯硝西泮可缓解不安的肛门不适。
我们报告了一例 COVID-19 后出现不安肛综合征的病例，作为不宁腿综合征的变异型。该病例符合 RLS 的 4 个基本特征，即移动的冲动、休息时加重、运动时减轻和晚上加重。迄今为止，尚未有 COVID-19 相关不安肛综合征的病例报告。该病例报告可能反映了 COVID-19 对神经精神状态的关联影响。应继续监测神经精神状况的长期结局。
