Main Article Content
A 72-year-old woman presented with a one-week history of fever, non-productive cough, and three unwitnessed syncopal episodes, with no other associated symptoms. She had poor recollection of the episodes, but denied urinary/fecal incontinence, tongue biting, numbness, parasthesias, or weakness. Her medical history was significant for hypertension, dyslipidemia, leg ulcers, psoriasis, stress incontinence, and gastroesophageal reflux disease. She did not have diabetes, coronary artery disease, or peripheral vascular disease. Her medications included Atorvastatin, Enalapril, Hydrochlorothiazide, Lansoprazole, and Calcium. She did not smoke or drink.
On examination, her vital signs were stable and she was afebrile. Chest auscultation revealed crackles in the right lower base. She developed an erythematous, lacy sharply demarcated rash on her left hand that lasted for 3–4 hours after her blood pressure was taken on the same arm (Figures 1 and 2). Blood tests were unremarkable and included glucose, complete blood count, electrolytes, urea, creatinine, liver function tests, and coagulation studies.
2. White WB. The Rumpel-Leede sign associated with a noninvasive blood pressure monitor. JAMA 1985;253:1724.
3. Eichner HL. Deller JJ Jr, Kahn CB. Capillary fragility as an index of diabetic microangiopathy. Diabetes 1973;22:318.
4. Rehman HU, Ahlijah W. Rumpel Leede sign. J ECT 2012;28:205.
5. Anstey A, Mayne K, Winter M, et al. Platelet and coagulation studies in Ehlers-Danlos syndrome. Br J Dermatol 1991;125:155–63.
6. Sartorius JA. Steroid treatment of idiopathic thrombocytopenic purpura in children. Preliminary results of a randomized cooperative study. An J Pediatr Hematol Oncol 1984;6:165–9.