Rumpel-Leede phenomenon: A rare consequence of repeated non-invasive blood pressure monitoring

Images in MedicineRumpel-Leede phenomenon: A rare consequence of repeated non-invasive blood pressure monitoring A 59-year-old woman with hypertension and diabetes presented to the emergency department following a fall at home.She had weakness of her lower body and became silent following the fall.Her Glasgow coma scale (GCS) score was E3V2M5 which further declined, necessitating endotracheal intubation the following day.Her blood pressure (BP) was 140/80 mmHg, heart rate was 90 beats/minute, and respiration rate was12 breaths/minute.Cardiac examination was normal.The lungs also showed equal bilateral air entry and right-sided basal crepitus.A computed tomography (CT) scan showed a severe contusion on the right side of her brain.She underwent emergency craniotomy, clot evacuation, and cranioplasty.In the intensive care unit, it was noted that her left upper extremity was severely enlarged and was accompanied by clearly defined, non-blanching rashes that extended from just below her elbow where the lower border of the blood pressure cuff rested (Fig. 1a).Her platelet count and coagulation profile were normal.Over the next 3 days, the oedema and rash gradually subsided (Fig. 1b) without active treatment.We made a diagnosis of Rumpel-Leede phenomenon, also known as acute capillary rupture illness.The Rumpel-Leede phenomenon arises when microscopic cutaneous capillaries rupture due to local pressure from a tourniquet or blood pressure cuff.It causes a petechial rash below the compressive device's position.People with underlying vascular disorders, hypertension, or thrombocytopenia are thought to be more vulnerable to the condition. 1,2The condition is often innocuous and rarely causes discomfort other than moderate pain.There is no specific treatment.