Rumpel-Leede phenomenon, also known as the Hess test or Torniquet test or capillary fragility test refers to acute dermis capillary rupture, is classically seen in microvascular fragility disorders and relates either to a vasculopathy or to a reduced number or function of the platelets.

The phenomenon is considered nonspecific, it occurs in response to application of a compressive device such as when inflating a blood pressure monitoring cuff or when applying a tourniquet which results in capillary rupture and formation of a petechial rash distal to the compression device. R-L phenomenon is believed to occur most often in patients with underlying vascular disease, such as diabetes mellitus or thrombocytopenia. Historically it has been used for the assessment of capillary fragility and thrombocytopenia though petechiae are caused by physical traumas or medical conditions. Phenomenonis mostly benign and usually resolves within 2 weeks with no treatment except the treatment of the underlying vascular disease or thrombocytopenia, if any. Thus awareness of this phenomenon can avoid the need of unnecessary investigations.

1. Madke B, Doshi B, Pande S, Khopkar U. Phenomena in dermatology. Indian J Dermatol Venereol Leprol 2011;77:264-75.
2. Dubach P, Mantokoudis G, La¨mmle B. Rumpel–Leede sign in thrombocytopenia due to Epstein–Barr virus-induced mononucleosis. British J Haematol 2009; online.
3. Hartley A, B. Lim P, Hayat SA. Rumpel-Leede phenomenon in a hypertensive patient due to mechanical trauma: a case report. J Medical Case Reports 2016;10:15.
4. Jeon YS, Kim YS, Lee JA, Seo KH, Hyeok J.Rumpel-Leede phenomenon associated with noninvasive blood pressure monitoring-A case report.Korean J Anesthesiol 2010;59:203-5.
5. Nguyen TA, BS; Garcia D, Wang AS,  Friedlander SF,  Krakowsk AC. Rumpel-Leede Phenomenon Associated With Tourniquet-like Forces of Baby Carriers in Otherwise Healthy Infants; Baby Carrier Purpura. JAMA Dermatol 2016; 152:728-30.
6. Wiesmann ,Castori M, Malfait F and Wulf H. Recommendations for anesthesia and perioperative management in patients with Ehlers-Danlos syndrome(s). Orphanet Journal of Rare Diseases 2014; 9:109.
7. Ramme AJ, Gales J, Stevens N, Verma V, and Egol K. Rumpel-Leede Phenomenon in a Patient with Laboratory Markers Positive for Sjögren Disease. Cases-anesthesia-analgesia.org 2016; 6:352-4.
8. Abdulla RK, Safian RD. Rumpel–Leede Phenomenon After Radial Artery Catheterization.Circ Cardiovasc Interv. 2018;11:6507.

Himang Jharaik

Obstetrics Dept, Civil Hospital Theog, District Shimla 171201.Himachal Pradesh, India