Rumpel-Leede Phenomenon

Rumpel-Leede phenomenon also known as Rumpel-Leede sign or acute capillary rupture syndrome, is a rare clinical entity characterized by the acute development of non-blanchable purpuric macules that are caused by dermal capillaries being ruptured in response to a proximal compressive force, such as a blood pressure cuff or tourniquet ¹, ². Rumpel-Leede phenomenon results in a self-limiting nonpurpuric rash that resolves spontaneously without intervention. Most cases resolved spontaneously within two weeks without any specific treatment. Rumpel-Leede phenomenon prevalence remains unknown, with rarely reported cases in the literature ³. The condition was first described in 1909 in a patient with scarlet fever who had petechiae on the arm distal to the tourniquet area for blood pressure monitoring ¹. The term was originally coined from the Rumpel–Leede Capillary-Fragility Test, also known as the tourniquet test, which is used for capillary fragility assessment and to assess patients for thrombocytopenia ⁴. Today, the Rumpel–Leede sign may be observed iatrogenically in the context of continuous blood-pressure monitoring, particularly in patients with bleeding diatheses (an increased susceptibility to bleeding or bruising).

The Rumpel-Leede phenomenon has been previously described under various conditions with diabetes mellitus, diabetes insipidus, hypertension, chronic renal failure, collagen vascular diseases like systemic lupus erythematosus (SLE), nutritional deficiencies such as scurvy, liver disease, leukemia, use of antiplatelets or anticoagulants, long-term steroid use and thrombocytopenia having been demonstrated to be associated with Rumpel-Leede phenomenon ⁵, ³, ², ⁶, ⁷, ⁸.

Figure 1. Rumpel-Leede sign

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Figure 2. Rumpel-Leede phenomenon

Footnote: Purpuric rash, nonpalpable and nonblanching with pressure

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Figure 3. Rumpel-Leede phenomenon

Footnote: Multiple non-blanchable erythematous macules and patches on both dorsa of feet.

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The Rumpel-Leede phenomenon is commonly reported to occur after iatrogenic events, especially continuous blood pressure monitoring. The majority of cases were women, all of whom demonstrated a non-blanchable, petechial, or purpuric rash, distributed distally to the device band or cuff. The sphygmomanometer was the most commonly used device ¹⁰, ¹¹, ¹². Others included the tourniquet ², radial arterial wristband ⁹, peritoneal insufflation during laparoscopic abdominal surgery ¹³, knee stocking ¹⁴, cloth material ¹⁵ and car seat ¹⁶. All cases showed spontaneously improved after discontinuing the causative device, and there were no long-term complications ³.

The diagnosis of Rumpel-Leede phenomenon is based on patient history, clinical findings, and a self-limiting course after removal of the causative device.

Recognition of Rumpel-Leede phenomenon could help avoid unnecessary investigations and invasive diagnostic procedures. However, there is no specific treatment for Rumpel-Leede phenomenon. Cessation of the causative device, along with reassurance of the patient, are recommended.

References

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