Coronary angiography causes Rumpel-Leede symptoms

Abstract

Background Rumpel Leede sign (RLS) is a clinical presentation observed at the extremities due to pressure applied externally. The appearance ranges from scattered pin-point rashes to an entire arm covered with petechial hemorrhage depending upon the severity. This phenomenon is relatively uncommon in clinical practice. Case presentation A 64 year old female patient developed a rash in the normal skin area below the compression area on the second day of single catheter coronary angiography. The patient's rash resolved without treatment after 3 days. Conclusions We report a case of hypertension and hyperlipidemia with a petechial rash on the skin under the tourniquet compressed by the radial artery after coronary angiography, which is consistent with the Rumpel-Leede phenomenon. clinicians should be watchful of these symptoms.

Rumpel-Leede phenomenon following radial artery catheterisation

“…This phenomenon describes petechiae and purpura secondary to venous compression and congestion, with its underlying aetiology involving the fragility of capillary vessels within the dermis [ 2 ] . When venous obstruction occurs, an increase in hydrostatic pressure occurs within the capillary vasculature, resulting in the compromise of the fragile capillary vessel walls and extravasation of erythrocytes into the dermis [ 1 , 3 , 4 ] . Some medical conditions can predispose an individual to develop the Rumpel-Leede phenomenon.…”

“…In addition, patients with thrombocytopenia or platelet dysfunction are predisposed to capillary haemorrhage and petechiae formation. This includes iatrogenic causes of platelet dysfunction, such as in those receiving antiplatelet therapy, or those with thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura [ 2 , 4 , 9 ] . However, in current literature, anticoagulation therapy has not been reported to increase the risk of Rumpel-Leede phenomenon.…”

“…A majority of these children do not have underlying vascular or platelet dysfunction, but the relative fragility of children's capillaries when compared to adults is the reason for its occurrence in this age group [10] . Interestingly, only five cases of this phenomenon following radial artery catheterisation have been reported [3][4][5][6][7] . In all cases, a similar mode of venous obstruction secondary to a radial compression band was noted, with some variation of presentation ranging from limited petechiae to large confluent purpura with blistering of the skin distal to the compression site.…”

“…This has also been found in systemic infection, especially in patients with scarlet fever, dengue fever and Rocky Mountain spotted fever. The usage of capillary fragility testing with tourniquet application in earlier medicine increased the risk of this phenomenon [1,[2][3][4][5][6][7][8][9] . In addition, patients with thrombocytopenia or platelet dysfunction are predisposed to capillary haemorrhage and petechiae formation.…”