The Rumpel-Leede (R-L) phenomenon represents acutely developing purpuric macules that often occur after rupture of dermal capillaries caused by proximal compressive forces and may sometimes appear as petechiae following the application of vascular pressure. In this context, the present report describes a woman who developed this phenomenon related to non-invasive blood pressure (NIBP) monitoring during electroconvulsive therapy (ECT). The patient, a 53-year-old woman, was admitted to the psychosomatic ward of a general university hospital in northern Iran in November 2023 due to a severe episode of major depressive disorder and non-compliance with pharmacological and nonpharmacological treatments. . During the sixth ECT session, her blood pressure transiently increased from 120/80 mmHg to 140/90 mmHg and returned to 120/70 mmHg post-procedure. At the end of this session, purpuric lesions were observed on her right forearm distal to the tourniquet site, these lesions faded and completely resolved within 48 h. This case is notable for the combination of ECT, an uncontrolled depressive episode, and metabolic comorbidities, in the absence of chemotherapy or other known high-risk factors. Physicians, anesthesiologists, and psychiatrists should be aware of acute dermal capillary rupture following tourniquet or cuff pressure during ECT, particularly in patients with a history of DM or chronic hypertension. This case underscores the importance of clinician awareness of the R-L phenomenon during ECT to prevent unnecessary investigations.
Elyasi et al. (Thu,) studied this question.