Letters to the Editor
- 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.
- 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.
- To the Editor: Erdheim-Chester disease (ECD) is a rare non–Langerhans cell histiocytosis belonging to the L-group of the 2016 revised histiocytosis classification.1 Although frequent and associated with clinical complications, cardiac involvement is underdiagnosed in ECD.2 Cardiac magnetic resonance (CMR) imaging is the most robust way to detect cardiac involvement.3 However, access to this technique is limited. We evaluated the utility of B-type natriuretic peptides and troponin for the diagnosis of cardiac involvement in ECD.