In a case report that will make you want to get a few extra booster shots "just to be sure", doctors have described the rare case of a man who developed "restless anal syndrome" following falling ill with COVID-19.
The 77-year-old man presented to the Tokyo Medical University Hospital with fairly typical COVID-19 symptoms, including a cough and a mild fever, after which he tested positive for the disease. For the next ten days, he was kept in hospital for monitoring, and to treat the mild pneumonia he had developed, doctors write in the journal BMC Infectious Diseases.
Despite the hospitalization, his case was classed as "mild", and he did not require oxygen. However, other details about his case were unusual, and perhaps unique, mainly in the region of his anus.
"Before affecting COVID-19, he had never experienced anal restless and discomfort," the team write, ominously foreshadowing the anal restlessness to come. "However, several weeks after discharge, he gradually began to experience restless, deep anal discomfort, approximately 10 cm [4 inches] from the perineal region."
You may not have heard of restless anal syndrome (as it's possibly unique in the medical literature), but it is, as you'd imagine, the evil twin of restless leg syndrome. With restless leg syndrome, you get the overwhelming urge to move your legs and sometimes an "unpleasant crawling or creeping sensation in the feet, calves and thighs".
The man had a constant urge to poop, which wasn't alleviated by pooping. Like in restless leg syndrome, the discomfort deep within his anus improved when he exercised, though upon rest his symptoms would get worse once more. His restless anus became worse at night, though he was able to sleep through the use of sleeping pills. A colonoscopy found there was nothing wrong with the man's rectum aside from internal hemorrhoids, which wouldn't explain his unique symptoms. Eventually, they diagnosed him with what is essentially restless leg syndrome of the anus, given the similarity between the two conditions.
"Various other parts of the body than legs can be involved [in restless leg syndrome] from arms, abdomens, face, head, oral cavity, bladder and [the] genital area," the team wrote in their report.
"Because he had never experienced anal restless and discomfort before affecting COVID-19 and the anal restless symptom developed after COVID-19, we considered that these anal restless symptoms were [related to] COVID-19."
The team cited many other reported cases of neuropsychiatric manifestations in patients following the disease, though ultimately they advise that they can't claim causation based on a single case report. It's perfectly possible the man had bad luck, developing COVID-19 and then an entirely separate case of restless leg syndrome of the anus a few days later, via an unrelated cause.
"Because neuropsychiatric sequelae require longitudinal observation, the long-term outcomes of neuropsychiatric conditions should continue to be monitored. COVID-19 related RLS or RLS variant may be underdiagnosed and we should pay attention to similar cases in order to clarify [the] relation between COVID-19 and RLS."