Rumpel–Leede sign in thrombocytopenia due to Epstein–Barr virus-induced mononucleosis
Article first published online: 26 MAY 2009
© 2009 Blackwell Publishing Ltd
British Journal of Haematology
Volume 148, Issue 1, page 2, January 2010
How to Cite
Dubach, P., Mantokoudis, G. and Lämmle, B. (2010), Rumpel–Leede sign in thrombocytopenia due to Epstein–Barr virus-induced mononucleosis. British Journal of Haematology, 148: 2. doi: 10.1111/j.1365-2141.2009.07736.x
- Issue published online: 14 DEC 2009
- Article first published online: 26 MAY 2009
A 19-year-old adolescent was hospitalized with lymphadenopathy, pharyngotonsillitis and palatal petechiae (left). As an incidental finding, the left arm had a positive Rumpel–Leede sign, i.e. multiple petechiae where the patient’s blood pressure had been taken the day before (centre and right).
Blood tests showed a platelet count of 38 × 109/l, a haemoglobin concentration of 154 g/l and a white cell count of 16 × 109/l with 49·5% lymphocytes and 13% atypical mononuclear cells. The platelet count reached a nadir of 36 × 109/l on the second day of hospitalization and then recovered spontaneously. Seroconversion 2 weeks later confirmed the suspected Epstein–Barr virus (EBV) infection.
Mild EBV-associated thrombocytopenia is found in about 30% of mononucleosis patients. However, petechiae are uncommon.
A Rumpel–Leede sign denotes the development of cutaneous petechiae after tourniquet application. Initially reported in 1909 by Rumpel and in 1911 by Leede as a clinical sign of scarlet fever it soon became associated with leukaemia, liver disease and infantile scurvy. Current interpretation considers the phenomenon as nonspecific, related either to a vasculopathy or to a reduced number or function of the platelets. In our patient it may be explained by thrombocytopenia and possibly mild vasculitis.
EBV infection may present with petechiae formation and a positive Rumpel–Leede test adding to the occasionally puzzling clinical presentations of this disease.