Rumpel-Leede Phenomenon Secondary to Acute Epstein-Barr Virus Infection in a Young Adult

Rumpel‑Leede sign (RLS) or phenomenon describes the sudden appearance of well-demarcated petechiae distal to where a tourniquet or sphygmomanometer cuff have been applied. This can be a result of dermal capillary rupture in the context of increased venous hydrostatic pressure due to external compressive forces and capillary fragility or an underlying coagulopathy or thrombocytopaenia. We report the case of a 20‑year‑old male patient who initially presented with a pruritic widespread maculopapular rash following a course of Penicillin V in the context of an undiagnosed Epstein-Barr virus (EBV) infection and subsequently developed a petechial rash consistent with RLS, following application of a tourniquet prior to venepuncture. Laboratory investigations showed a normal platelet count and coagulation profile. EBV serology was consistent with acute EBV infection. No specific treatment was indicated or provided for the Rumpel-Leede phenomenon, which gradually resolved. This case highlights that RLS may occur in the setting of acute EBV infection even in the absence of thrombocytopenia or coagulopathy and underscores the importance of recognition to avoid unnecessary alarm or investigations.