July 26, 1985

Rumpel-Leede Sign Associated With a Noninvasive Ambulatory Blood Pressure Monitor

Author Affiliations

University of California, Irvine, Medical Center Orange

JAMA. 1985;254(4):506. doi:10.1001/jama.1985.03360040056017

To the Editor.—  In a letter reporting a petechial rash as a complication of ambulatory blood pressure monitoring, Dr White1 noted that the 65-year-old patient had diabetes but no apparent peripheral vascular disease or bleeding or clotting disorder. He felt that the patient may have had increased capillary fragility as a result of age and possibly also due to the diabetes, which could increase the risk of capillary hemorrhages from the blood pressure cuff.In a study of capillary fragility in diabetes,2 we found that 68% of 72 diabetic patients had a positive Rumpel-Leede phenomenon but this occurred in only 35% of age- and sex-matched nondiabetic controls. The presence of abnormal capillary fragility correlated with duration of diabetes and presence of diabetic retinopathy, neuropathy, and nephropathy. The incidence of positive tourniquet test results was 100% after 20 years of diabetes.Since prolonged application of a sphygmomanometer cuff can