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CORRESPONDENCE |
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| Year : 2022 | Volume
: 67
| Issue : 6 | Page : 752-753 |
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| Rumpel-leede phenomenon in a COVID-19 patient |
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Pratapaneni V K Chaitanya, Sivaranjini Ramassamy
Dermatology and STD, Jawaharlal Institute of Postgraduate and Medical Education and Research (JIPMER), Puducherry, India
| Date of Web Publication | 23-Feb-2023 |
Correspondence Address:
Sivaranjini Ramassamy
Dermatology and STD, Jawaharlal Institute of Postgraduate and Medical Education and Research (JIPMER), Puducherry
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_490_21
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How to cite this article:
K Chaitanya PV, Ramassamy S. Rumpel-leede phenomenon in a COVID-19 patient. Indian J Dermatol 2022;67:752-3 |
Sir,
SARS-CoV-2 viral infection is associated with many cutaneous manifestations as a part of the immune response to the viral infection or vasculopathy. There are reports of petechial rashes in COVID-19 in the form of widespread eruption mimicking dengue fever, unilateral purpuric rash confined to the inguinal region, and isolated palmoplantar involvement.[1],[2],[3] Here, we present a case with SARS-CoV-2 infection demonstrating the Rumpel-Leede phenomenon with petechiae over the forearms.
A 45-year-old male, a known diabetic for 5 years, was admitted elsewhere to manage SARS-CoV-2 infection, diagnosed using RT-PCR test from the nasopharyngeal swab. He had moderate disease with fever, cough, and breathlessness then. He received methylprednisolone 40 mg, enoxaparin 60 mg, and azithromycin 500 mg for 5 days. After a week of hospital stay, with worsening sensorium, he was diagnosed with diabetic ketoacidosis and referred to our center. He received fluid support and insulin infusion for his medical condition. The medical team sought a dermatology referral for the rash on his trunk and upper limbs on the second day of admission. He had multiple discrete [Figure 1]a as well as confluent petechiae [Figure 1]b over both the lower third of the arms, antecubital fossae, forearms, and discrete discoid purpura over the left side of his chest. The location of the petechiae was distal to the application of compression devices like blood pressure cuff and tourniquet used for blood sampling during the hospital stay. The purpura on the chest wall corresponded to the electrocardiogram leads used at admission. His SpO2 was 96% in room air. His platelet counts were normal (3.48 lakhs/μL). The rash disappeared spontaneously over the next 4 days. | Figure 1: (a and b) Photographs showing petechiae suggestive of the Rumpel-Leede phenomenon of the left upper limb and right upper limb, respectively
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The Rumpel-Leede phenomenon refers to the appearance of petechiae distal to the area of application of pressure on vessels, such as the sphygmomanometer cuff. It occurs in patients with thrombocytopenia or capillary fragility. In the absence of thrombocytopenia, conditions like diabetes mellitus, hypertension, chronic steroid use, and infections like dengue, chikungunya, and parvovirus B19 are associated with this phenomenon.[4] In the present case, with platelet count being normal, the possible reasons for this phenomenon could be a state of capillary fragility induced by the SARS-CoV-2 or diabetes-related microangiopathy. Steroids given for managing his COVID-19 moderate disease were for a too short duration to be ascribed to the phenomenon directly. On the other hand, the patient had suction purpura on the chest due to the negative pressure exerted by the electrocardiogram leads. This form of mechanical purpura does not involve disease of the blood vessels or blood constituents pathogenetically.
Histology of purpuric rashes in COVID-19 revealed impairment in endothelial structure and function, causing increased vessel permeability and erythrocyte extravasation.[5] We observed evidence of capillary fragility in COVID-19 infection in the form of petechiae with the Rumpel-Leede phenomenon. The pathogenesis of this event needs to be further studied to establish a conclusive relationship with COVID-19 infection.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Jimenez-Cauhe J, Ortega-Quijano D, Prieto-Barrios M, Moreno-Arrones OM, Fernandez-Nieto D. Reply to “COVID-19 can present with a rash and be mistaken for Dengue”: Petechial rash in a patient with COVID-19 infection. J Am Acad Dermatol 2020;83:e141-2.  |
| 2. | Karaca Z, Yayli S, Çalışkan O. A unilateral purpuric rash in a patient with COVID-19 infection. Dermatol Ther 2020;33:e13798. |
| 3. | Killion L, Beatty PE, Salim A. Rare cutaneous manifestation of COVID-19. BMJ Case Rep 2021;14:e240863. |
| 4. | Mizumoto J. Parvovirus B19 infection with positive Rumpel-Leede sign. Am J Med 2020;133:e195-6. |
| 5. | Valtueña J, Martínez-García G, Ruiz-Sánchez D, Garayar-Cantero M, Dueñas C, Hadi A, et al. Vascular obliteration because of endothelial and myointimal growth in COVID-19 patients. Int J Dermatol 2021;60:73-80. |
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