• Avery Kopacz, Cameron Ludwig, and Michelle Tarbox.
• Texas Tech University Health Science Center School of Medicine, Lubbock, Texas, USA avery.kopacz@ttuhsc.edu.
• BMJ Case Rep. 2021 Mar 17; 14 (3).

AbstractEstablishing accurate symptomatology associated with novel diseases such as COVID-19 is a crucial component of early identification and screening. This case report identifies an adult patient with a history of clotting dysfunction presenting with rare cutaneous manifestations of COVID-19, known as 'COVID-19 toes'', previously described predominantly in children. Additionally, this patient presented with possible COVID-associated muscle spasticity of the lower limbs, as well as a prolonged and atypical timeline of COVID-19 infection. The rare occurrence of 'COVID-19 toes'' in this adult patient suggests that her medical history could have predisposed her to this symptom. This supports the coagulopathic hypothesis of this manifestation of COVID-19 and provides possible screening questions for patients with a similar history who might be exposed to the virus. Additionally, nervous system complaints associated with this disease are rare and understudied, so this novel symptom may also provide insight into this aspect of SARS-CoV-2.© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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