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In Reply—Rumpel-Leede Sign: Consider Underlying Vitamin C Deficiency

      To the Editor:
      We thank Dr Martin Windpessl for his interest in our case of Rumpel-Leede sign. As was pointed out, the cutaneous manifestation of a petechial rash should also suggest vitamin C deficiency. On discovery of the rash, our team did include vitamin C deficiency as part of the differential, consulted with the dermatology service, and sent a vitamin C level that returned within normal limits. We regret not being able to elaborate on this work-up in our initial manuscript because of the word limit associated with submissions of this nature. Whereas consideration of vitamin C deficiency is certainly warranted, previous reports of cutaneous manifestations of vitamin C deficiency describe a diffuse, bilateral pattern of the rash.
      • Ward R.
      • Fox N.
      • Natkunarajah J.
      Scurvy: a forgotten cause of purpuric rash.
      • Baluch A.
      • Landsberg D.
      Scurvy in the intensive care unit.
      • Nguyen R.T.
      • Cowley D.M.
      • Muir J.B.
      Scurvy: a cutaneous clinical diagnosis.
      Thus, in the setting of a normal vitamin C level and a sharply demarcated, unilateral, petechial rash in a patient with known risk factors for vascular fragility, we determined that this presentation was likely to be an occurrence of the Rumpel-Leede sign.

      Potential Competing Interests

      The authors report no competing interests.

      References

        • Ward R.
        • Fox N.
        • Natkunarajah J.
        Scurvy: a forgotten cause of purpuric rash.
        Clin Exp Dermatol. 2021; 46: 956-957
        • Baluch A.
        • Landsberg D.
        Scurvy in the intensive care unit.
        J Investig Med High Impact Case Rep. 2021; 923247096211067970
        • Nguyen R.T.
        • Cowley D.M.
        • Muir J.B.
        Scurvy: a cutaneous clinical diagnosis.
        Australas J Dermatol. 2003; 44: 48-51

      Linked Article

      • Rumpel-Leede Sign: Consider Underlying Vitamin C Deficiency
        Mayo Clinic ProceedingsVol. 97Issue 11
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          To the Editor: I read with interest the article by Mohammad et al.1 The authors report the case of a man in his 60s, in whom a petechial rash appeared on his arm after measuring his blood pressure early in his hospitalization. In the context of normal laboratory results, this finding was interpreted as an example of the Rumple-Leede phenomenon (intracutaneous hemorrhage produced by prolonged proximal pressure, signifying increased capillary fragility). Given the specifics of this case (the patient had a history of intravenous drug use, retained needles in the forearm give a picture of self-neglect), consideration should be given to underlying vitamin C deficiency (scurvy), which can also be manifested in this manner.
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