Rumpel-Leede Phenomenon as a Rare Complication After Transulnar
Percutaneous Coronary Angiography and Intervention
Sandoval, Letícia1*; Cafundó,
Nayara1; Ferreira, Raphael1;
Segovia, Samela1; Rosa, Ximena1
University of Brasilia1
Corresponding author*
All authors declare no conflict of interest.
Consent:
Written informed consent was obtained from the patient to publish this
report in accordance with the journal’s patient consent policy.
Case Report
A 55-year-old female patient presented to the emergency department with
a two-day history of worsening epigastric pain and dyspnea. Medical
history was positive for myocardial infarction, stroke, metabolic
syndrome, and smoking. At admission, ECG revealed a Q wave on inferior
leads and troponin level of 10,7 ng/mL (reference range < 0,1
ng/dL), then the patient was diagnosed with myocardial infarction.
The patient underwent PCI. Transradial access was not possible due to
spasms. The interventionist team decided on a transulnar puncture
approach. A sub-occlusive lesion on the right coronary artery was
diagnosed and treated with a stent. A compressive bandage was placed at
the puncture site for hemostasis. An hour later, a rash appeared on her
right hand. It was a petechial, non-blanching, non-raised, non-tender
lesions and had clear margins distal to the occlusive band (Figure 1).
There were no sensory or motor deficits and no rash on any other part of
her body. Radial and ulnar pulses were well palpable. The patient had
thrombocytosis of 620.000 (per mm3) and partial active thromboplastin
time was more than 250 seconds (the reference range is 37 seconds). She
was in the use of clopidogrel and aspirin. Despite these laboratory
values and the rash, the assistant doctor decided to maintain the
anticoagulation therapy. A clinical diagnosis of rumpel-leede was made
based on the characteristics of the lesions. She did not have any other
hemorrhagic event and was safely discharged home after 24-hour
observation, with partial resolution of the rash.