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Madison Keys signalled that she was feeling ill as she avoided shaking hands with Amanda Anisimova after her defeat to her fellow American at the WTA Finals.

Keys, the Australian Open champion, is now out of the WTA Finals after defeats to Iga Swiatek and Anisimova in her first two matches in Riyadh.

Anisimova and Keys both struggled throughout the match, which was their first meeting. Anisimova was visibly upset as she trailed by a set and a break but recovered to win 4-6 6-3 6-2.

After Anisimova sealed victory, Keys made a gesture to Anisimova that she was dealing with an illness and didn’t want to pass it on – pointing towards her chest and stomach area.

Anisimova appeared to laugh it off, with both players instead returning to the side of the court after a brief conversation across the net. Keys also chose not to shake hands with the umpire.

Jasmine Paolini is reportedly also struggling with illness at the WTA Finals, while Keys may decide to withdraw from the tournament ahead of her dead-rubber against Elena Rybakina.

Rybakina is already through as the group winner while Anisimova and Swiatek will meet on Wednesday to determine who go advances as the runner-up.

There was another comeback in the earlier match as Rybakina won 12 of the final 13 games against Swiatek to beat the World No 2, winning 3-6 6-1 6-0.

Swiatek beat Anisimova 6-0 6-0 in the Wimbledon final in July, with the American getting revenge when they met in the US Open quarter-finals a few weeks later.