A 42-year-old, otherwise healthy, woman presented with persistent left-sided chest pain. A chest X-ray revealed a large opacity in the left hemithorax which prompted further investigation with an MRI. MRI revealed a large left apical mass occupying approximately two-thirds of the left hemithorax. The mass was investigated further with a CT with contrast which did not reveal any vascular involvement or invasion into adjacent structures. The patient successfully underwent tumour resection via left thoracotomy. The tumour was removed in its entirety. Grossly, the tumour was a 23×10×10 cm, well encapsulated, ovoid, fibrous nodule. Histopathology revealed ganglion cells, nerve fibres and Schwann cells in a mucous matrix consistent with ganglioneuroma. Postoperative course was unremarkable.

Rumpel-Leede phenomenon (RLP), also known as acute capillary rupture syndrome (ACRS), is a rare occurrence where distal dermal capillaries rupture in response to a proximal compressive force, such as a blood pressure cuff or tourniquet. This phenomenon has been reported to occur in states of vascular fragility such as long-term steroid use, hypertension or diabetes mellitus. Here, we provide a report of RLP occurring secondary to tourniquet application in a 26-year-old woman with adult-onset Still's disease (AOSD) and a recent drug rash. In this case, the cause of the phenomenon is most likely multifactorial. Likely contributing factors include long-term steroid use for the treatment of AOSD, and increased vascular permeability secondary to the drug rash. Patients and clinicians should be aware that the treatment of AOSD may induce a state of capillary fragility and they should work together to minimise the risk of complications.

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