Once splinter hemorrhage can be considered as a pathognomonic sign of subacute bacterial endocarditis. But it can also be associated with a variety of systemic disorders that increase capillary fragility or primary nail bed involvement in dermatologic disorders. The cause of splinter hemorrhage can usually be established by careful history and physical examination. We report a case of 33-year-old man with splinter hemorrhages, who had polycythemia vera.
Adult ; Capillary Fragility ; Endocarditis, Subacute Bacterial ; Hemorrhage* ; Humans ; Physical Examination ; Polycythemia Vera* ; Polycythemia*

A 46-year-old diabetic woman visited our hospital with generalized edema and high blood pressure. An appropriately sized noninvasive blood pressure cuff was placed on her right arm above the elbow to measure blood pressure. While we were checking her blood pressure, we noticed small red petechial spots distal to the cuff involving her entire right forearm. Her blood pressure was 170/96 mmHg. The laboratory findings showed no abnormality of anticoagulation. The rest of the patient's extremities were not affected. The petechiae on the right arm resolved spontaneously after ten days. The most likely explanation for these petechiae is acute dermal capillaryrupture, which is called the Rumpel- Leede phenomenon. Acute dermal capillary rupture appears as petechiae in an area following application of vascular constriction such as application of tourniquet to draw blood specimen or use of blood pressure cuff due to capillary fragility or abnormal platelets in numbers or in function. This situation has been reported previously in the literature as the Rumpel-Leede phenomenon in association with prolonged noninvasive BP monitoring. In the patient described herein, increased venous pressure from blood pressure measurement and capillary fragility associated with diabetes mellitus may have increased the risk of acute dermal capillary rupture.
Arm ; Blood Platelets ; Blood Pressure ; Capillaries ; Capillary Fragility ; Constriction ; Diabetes Mellitus ; Diabetic Nephropathies ; Edema ; Elbow ; Extremities ; Female ; Forearm ; Humans ; Hypertension ; Middle Aged ; Purpura ; Rupture ; Tourniquets ; Venous Pressure