Painful legs moving toes as an atypical neurological manifestation of SARS CoV2 infection

Summary of observations:

A 62 year-old woman with history of hypertension and modified Rankin Scale: 0 who was admitted at emergency department because of cough, fever and malaise for 5 days. Chest x-rays revealed periphery infiltrates in ground glass in both lungs consistent with COVID infection, which was confirmed by PCR. During her stay at inpatient clinic she complained of pain in both legs even when she felt light touches. On general examination, painful legs were noticed and this sign was also accompanied by jerking feet and erratic movements of toes. Based on this finding we diagnosed painful legs moving toes syndrome (PLMT) associated to SARS-CoV 2 infection. Spinal cord, celiac disease and peripheral nerve disorders were discarded. Coincidentally, she at the same time presented respiratory impairment and methylprednisolone was used to stabilize the clinical picture. Strikingly, “erratic movements of toes” as well as dyspnea improved after corticoesteroids. At time of submitting this report, she has been discharged from the hospital due to a remarkable respiratory improvement. On other hand, the painful legs and moving toes also had a greater improvement in spite of jerking feet still remains but with less intensity and frequency. She is not receiving any specific treatment for this movement disorders and her general condition is stable. We hypothesize PLMT may be a rare and atypical symptom of SARS CoV2 infection and can improve with steroids treatment.

Patient video: