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COVID toe another manifestation of the infection
COVID toe in Sri Lankan patients
Watch out for the ‘COVID toe’.
This is the advice from the National Eye Hospital’s Clinical Medicine Department which, amidst conducting many studies on COVID-19 related issues to help the people face the pandemic better, has come across several patients with the COVID toe.
Poring over research conducted across the world, Consultant Physician Dr. Waruna Gunathilake says that COVID-19 has brought about wide and varied clinical presentations in patients. While some of them are documented well, others are not. Everyone is still learning the effect of this viral disease on different parts of the body.
He says that the ‘COVID toe’ is described in literature flowing forth from the west and he and his team have also identified it in at least 10 Sri Lankan patients.
Explaining that this manifestation can occur in both fingers and toes, either one or many, he gives the signs as:
- Early presentation of bright red discolouration of the toes or fingers
- Later presentation of the discolouration turning purple
- Initially without pain, with the pain occurring later along with blisters and/or itching.
- There could be raised bumps or patches of rough skin but very rarely with pus in the blisters or the raised skin
He says that there is no scientific data on when this COVID condition could occur but the range of the period could be from 14 days to many months. The good news is that it is not infectious.
While urging his colleagues, especially General Practitioners (GPs) to be cognizant of this condition, Dr. Gunathilake says that it could easily be misdiagnosed as a fungal infection underneath the nail (paronychia) or an ingrown toe-nail (burrowing of the nail into the flesh of the toe).
Cautioning against incising (cutting open) the nail to drain the pus thinking that it is a possible abscess or treating with anti-fungal medication, he says that COVID toe should be considered in the current situation. A hydrocortisone (steroid) cream usually settles COVID toe.
“It may be easy to miss this diagnosis as Sri Lankans have a darker complexion, but if a patient complains of finger-tip or toe-tip pain, the red signal that needs to be taken into account is that it may be related to COVID,” he says.
How does it occur?
Dr. Gunathilake says: “The pathophysiology is that COVID-19 causes inflammation of the endothelium (the thin membrane that lines the inside of the heart and blood vessels). This is known as vasculitiswhich may be associated with abnormal blood coagulation (hardening of the blood). This, in turn, could be due to an aberrant immune reaction when the host (patient’s immune system) battles the virus.
“This may occur as a side-effect when the body switches into attack-mode to dispel the invader-virus. The immune-mediated pathology probably increases interferons(a group of signalling proteins made and released by host cells in response to the presence of viruses) causing an inflammation of cytokines (small proteins that are crucial in controlling the growth and activity of other immune system cells and blood cells).”
Referring to the patients with COVID toe that they had seen, he adds that they were Post-COVID patients, some with symptoms and others asymptomatic. But when they underwent testing for COVID-19, it was negative.
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