{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T20:10:20Z","timestamp":1756325420005,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,3,5]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>Establishing 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 \u2018COVID-19 toes\u2019', 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 \u2018COVID-19 toes\u2019' 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.<\/jats:p>","DOI":"10.1136\/bcr-2020-241410","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T12:21:48Z","timestamp":1615983708000},"page":"e241410","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Atypical cutaneous and musculoskeletal manifestation of SARS-CoV-2: \u2018COVID-19 toes\u2019 and spasticity in a 48-year-old woman"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8470-7761","authenticated-orcid":false,"given":"Avery","family":"Kopacz","sequence":"first","affiliation":[{"name":"Texas Tech University Health Science Center School of Medicine, Lubbock, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Science Center School of Medicine, Lubbock, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Tarbox","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Science Center School of Medicine, Lubbock, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"2025082712284758000_14.3.e241410.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30558-4"},{"key":"2025082712284758000_14.3.e241410.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2020.100618"},{"key":"2025082712284758000_14.3.e241410.3","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0968-3"},{"key":"2025082712284758000_14.3.e241410.4","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1007\/s42399-020-00417-7","article-title":"Coronavirus disease 2019 (COVID-19) as a Multi-Systemic disease and its impact in low- and middle-income countries (LMICs)","volume":"2","author":"Temgoua","year":"2020","journal-title":"SN Compr Clin Med"},{"key":"2025082712284758000_14.3.e241410.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13047-020-00408-w","article-title":"The mystery of the COVID toes - turning evidence-based medicine on its head","volume":"13","author":"Bristow","year":"2020","journal-title":"J Foot Ankle Res"},{"key":"2025082712284758000_14.3.e241410.6","doi-asserted-by":"crossref","unstructured":"Colmenero I , Santonja C , Alonso\u2010Ria\u00f1o M . SARS\u2010CoV\u20102 endothelial infection causes COVID\u201019 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases. 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