{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:01:48Z","timestamp":1791576108727,"version":"4.3.4"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T00:00:00Z","timestamp":1632355200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T00:00:00Z","timestamp":1632355200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Coronavirus disease 2019 (COVID-19) has a broad spectrum from respiratory and nasopharyngeal symptoms, cerebrovascular diseases, impaired consciousness, and skeletal muscle injury. Emerging evidence has indicated the neural spread of this novel coronavirus. Restless legs syndrome (RLS) is a common neurological, sensorimotor disorder, but highly under diagnosis disorder. Restless anal syndrome as restless legs syndrome variant associated with COVID-19 has been previously not published. We report a case presenting with restless anal syndrome following COVID-19.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>Although a 77-year-old male with COVID-19 improved to normal respiratory function 21 days after admission and treatment of favipiravir 200\u00a0mg per day for 14 days and dexamethasone 6.6\u00a0mg per day for 5 days, the insomnia and anxiety symptoms remained. Several weeks after discharge, he gradually began to experience restless, deep anal discomfort, approximately 10\u00a0cm from the perineal region. The following features were observed in the anal region; urge to move is essential, with worsening with rest, improvement with exercise, and worsening at evening. Colonoscopy revealed internal haemorrhoids without other rectal lesions. Neurological findings including deep tendon reflex, perineum loss of sensory and spinal cord injury, revealed no abnormalities. Diabetes militias, kidney dysfunction and iron deficiency status were not confirmed. Family history of RLS and periodic limb movements were not observed. Clonazepam at 1.5\u00a0mg per day resulted in the alleviation restless anal discomfort.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We reported a case presenting with restless anal syndrome following affection of COVID-19 as restless legs syndrome variant. This case fulfilled 4 essential features of RLS, urge to move, worsening with rest, improvement with exercise, and worsening at evening. To date, no case of restless anal syndrome associated with COVID-19 has been previously published. This case report may reflect the associative impacts of COVID-19 on the neuropsychiatric state. The long-term outcomes of neuropsychiatric conditions should continue to be monitored.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06683-7","type":"journal-article","created":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T21:04:21Z","timestamp":1632431061000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Case report of restless anal syndrome as restless legs syndrome variant after COVID-19"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8494-1278","authenticated-orcid":false,"given":"Itaru","family":"Nakamura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Itoi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"issue":"8","key":"6683_CR1","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.1007\/s00405-020-05965-1","volume":"277","author":"JR Lechien","year":"2020","unstructured":"Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020;277(8):2251\u201361.","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"4","key":"6683_CR2","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jinf.2020.02.018","volume":"80","author":"S Tian","year":"2020","unstructured":"Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z, et al. Characteristics of COVID-19 infection in Beijing. J Infect. 2020;80(4):401\u20136.","journal-title":"J Infect"},{"issue":"6","key":"6683_CR3","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1001\/jamaneurol.2020.1127","volume":"77","author":"L Mao","year":"2020","unstructured":"Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683\u201390.","journal-title":"JAMA Neurol"},{"key":"6683_CR4","doi-asserted-by":"publisher","first-page":"102350","DOI":"10.1016\/j.ajp.2020.102350","volume":"54","author":"D Banerjee","year":"2020","unstructured":"Banerjee D, Viswanath B. Neuropsychiatric manifestations of COVID-19 and possible pathogenic mechanisms: insights from other coronaviruses. Asian J Psychiatr. 2020;54:102350.","journal-title":"Asian J Psychiatr"},{"key":"6683_CR5","doi-asserted-by":"publisher","first-page":"588872","DOI":"10.3389\/fnagi.2020.588872","volume":"12","author":"S Alonso-Lana","year":"2020","unstructured":"Alonso-Lana S, Marqui\u00e9 M, Ruiz A, Boada M. Cognitive and neuropsychiatric manifestations of COVID-19 and effects on elderly individuals with dementia. Front Aging Neurosci. 2020;12:588872.","journal-title":"Front Aging Neurosci"},{"issue":"8","key":"6683_CR6","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1016\/j.sleep.2014.03.025","volume":"15","author":"RP Allen","year":"2014","unstructured":"Allen RP, Picchietti DL, Garcia-Borreguero D, Ondo WG, Walters AS, Winkelman JW, et al. Restless legs syndrome\/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria\u2013history, rationale, description, and significance. Sleep Med. 2014;15(8):860\u201373.","journal-title":"Sleep Med"},{"issue":"16","key":"6683_CR7","doi-asserted-by":"publisher","first-page":"2363","DOI":"10.1002\/mds.22274","volume":"23","author":"T Nomura","year":"2008","unstructured":"Nomura T, Inoue Y, Kusumi M, Uemura Y, Nakashima K. Prevalence of restless legs syndrome in a rural community in Japan. Mov Disord. 2008;23(16):2363\u20139.","journal-title":"Mov Disord"},{"issue":"8","key":"6683_CR8","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1016\/j.parkreldis.2009.02.014","volume":"15","author":"Y Tsuboi","year":"2009","unstructured":"Tsuboi Y, Imamura A, Sugimura M, Nakano S, Shirakawa S, Yamada T. Prevalence of restless legs syndrome in a Japanese elderly population. Parkinsonism Relat Disord. 2009;15(8):598\u2013601.","journal-title":"Parkinsonism Relat Disord"},{"issue":"8","key":"6683_CR9","doi-asserted-by":"publisher","first-page":"4431","DOI":"10.4103\/jfmpc.jfmpc_640_20","volume":"9","author":"S Prakash","year":"2020","unstructured":"Prakash S, Prakash A. Dopa responsive headache: Restless head syndrome or a cephalic variant of restless legs syndrome? J Family Med Prim Care. 2020;9(8):4431\u20133.","journal-title":"J Family Med Prim Care"},{"issue":"1","key":"6683_CR10","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1186\/s12883-020-01875-1","volume":"20","author":"XX Wang","year":"2020","unstructured":"Wang XX, Zhu XY, Wang Z, Dong JW, Ondo WG, Wu YC. Restless abdomen: a spectrum or a phenotype variant of restless legs syndrome? BMC Neurol. 2020;20(1):298.","journal-title":"BMC Neurol"},{"issue":"18","key":"6683_CR11","doi-asserted-by":"publisher","first-page":"2713","DOI":"10.2169\/internalmedicine.55.6815","volume":"55","author":"K Suzuki","year":"2016","unstructured":"Suzuki K, Miyamoto M, Uchiyama T, Miyamoto T, Matsubara T, Hirata K. Restless bladder in an elderly woman: an unusual feature or a variant of restless legs syndrome? Intern Med. 2016;55(18):2713\u20136.","journal-title":"Intern Med"},{"key":"6683_CR12","doi-asserted-by":"publisher","first-page":"577658","DOI":"10.1016\/j.jneuroim.2021.577658","volume":"358","author":"A Johansson","year":"2021","unstructured":"Johansson A, Mohamed MS, Moulin TC, Schi\u00f6th HB. Neurological manifestations of COVID-19: a comprehensive literature review and discussion of mechanisms. J Neuroimmunol. 2021;358:577658.","journal-title":"J Neuroimmunol"},{"key":"6683_CR13","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.bbi.2020.05.062","volume":"88","author":"B Yuan","year":"2020","unstructured":"Yuan B, Li W, Liu H, Cai X, Song S, Zhao J, et al. Correlation between immune response and self-reported depression during convalescence from COVID-19. Brain Behav Immun. 2020;88:39\u201343.","journal-title":"Brain Behav Immun"},{"issue":"11","key":"6683_CR14","doi-asserted-by":"publisher","first-page":"2221","DOI":"10.1002\/acn3.51210","volume":"7","author":"EM Liotta","year":"2020","unstructured":"Liotta EM, Batra A, Clark JR, Shlobin NA, Hoffman SC, Orban ZS, et al. Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol. 2020;7(11):2221\u201330.","journal-title":"Ann Clin Transl Neurol"},{"issue":"3","key":"6683_CR15","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1111\/j.1479-8425.2008.00349.x","volume":"6","author":"T Nomura","year":"2008","unstructured":"Nomura T, Inoue Y, Kusumi M, Oka Y, Nakashima K. Email-based epidemiological surveys on restless legs syndrome in Japan. Sleep Biological Rhythms. 2008;6(3):139\u201345.","journal-title":"Sleep Biological Rhythms"},{"issue":"4","key":"6683_CR16","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1111\/j.1440-1819.2005.01399.x","volume":"59","author":"S Mizuno","year":"2005","unstructured":"Mizuno S, Miyaoka T, Inagaki T, Horiguchi J. Prevalence of restless legs syndrome in non-institutionalized Japanese elderly. Psychiatry Clin Neurosci. 2005;59(4):461\u20135.","journal-title":"Psychiatry Clin Neurosci"},{"key":"6683_CR17","first-page":"318","volume":"38","author":"O Mohiuddin","year":"2021","unstructured":"Mohiuddin O, Khan AA, Shah SMI, Malick MDZ, Memon SF, Jalees S, et al. New-onset restless leg syndrome in a COVID-19 patient: a case report with literature review. Pan Afr Med J. 2021;38:318.","journal-title":"Pan Afr Med J"},{"key":"6683_CR18","doi-asserted-by":"publisher","first-page":"100057","DOI":"10.1016\/j.nbscr.2020.100057","volume":"9","author":"AA Tony","year":"2020","unstructured":"Tony AA, Tony EA, Ali SB, Ezzeldin AM, Mahmoud AA. COVID-19-associated sleep disorders: a case report. Neurobiol Sleep Circadian Rhythms. 2020;9:100057.","journal-title":"Neurobiol Sleep Circadian Rhythms"},{"issue":"5","key":"6683_CR19","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1111\/nmo.12520","volume":"27","author":"SS Rao","year":"2015","unstructured":"Rao SS, Benninga MA, Bharucha AE, Chiarioni G, Di Lorenzo C, Whitehead WE. ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders. Neurogastroenterol Motil. 2015;27(5):594\u2013609.","journal-title":"Neurogastroenterol Motil"},{"key":"6683_CR20","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.smrv.2017.03.007","volume":"38","author":"A Turrini","year":"2018","unstructured":"Turrini A, Raggi A, Calandra-Buonaura G, Martinelli P, Ferri R, Provini F. Not only limbs in atypical restless legs syndrome. Sleep Med Rev. 2018;38:50\u20135.","journal-title":"Sleep Med Rev"},{"issue":"1\u20132","key":"6683_CR21","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.jns.2012.07.007","volume":"320","author":"S Prakash","year":"2012","unstructured":"Prakash S, Ahuja S, Rathod C. Dopa responsive burning mouth syndrome: restless mouth syndrome or oral variant of restless legs syndrome? J Neurol Sci. 2012;320(1\u20132):156\u201360.","journal-title":"J Neurol Sci"},{"issue":"3","key":"6683_CR22","doi-asserted-by":"publisher","first-page":"e240686","DOI":"10.1136\/bcr-2020-240686","volume":"14","author":"S Prakash","year":"2021","unstructured":"Prakash S, Prakash A. Dopa responsive irritable bowel syndrome: restless bowel syndrome or a gastrointestinal variant of restless legs syndrome? BMJ Case Rep. 2021;14(3):e240686.","journal-title":"BMJ Case Rep."},{"issue":"19","key":"6683_CR23","doi-asserted-by":"publisher","first-page":"4969","DOI":"10.12998\/wjcc.v9.i19.4969","volume":"9","author":"LG Fang","year":"2021","unstructured":"Fang LG, Zhou Q. Remarkable gastrointestinal and liver manifestations of COVID-19: a clinical and radiologic overview. World J Clin Cases. 2021;9(19):4969\u201379.","journal-title":"World J Clin Cases"},{"issue":"Suppl 18","key":"6683_CR24","first-page":"401-8","volume":"22","author":"H Benes","year":"2007","unstructured":"Benes H, Walters AS, Allen RP, Hening WA, Kohnen R. Definition of restless legs syndrome, how to diagnose it, and how to differentiate it from RLS mimics. Mov Disord. 2007;22(Suppl 18):401-8.","journal-title":"Mov Disord"},{"issue":"9","key":"6683_CR25","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1016\/j.sleep.2008.09.015","volume":"10","author":"WA Hening","year":"2009","unstructured":"Hening WA, Allen RP, Washburn M, Lesage SR, Earley CJ. The four diagnostic criteria for Restless Legs Syndrome are unable to exclude confounding conditions (\u201cmimics\u201d). Sleep Med. 2009;10(9):976\u201381.","journal-title":"Sleep Med"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06683-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-021-06683-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06683-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,23]],"date-time":"2021-09-23T21:08:21Z","timestamp":1632431301000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-021-06683-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,23]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6683"],"URL":"https:\/\/doi.org\/10.1186\/s12879-021-06683-7","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,23]]},"assertion":[{"value":"20 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethical Committee of Tokyo Medical University (approval number: T2020-0078). Written informed consent was obtained from the patient for publication of this case report.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"993"}}