Angina Bullosa Hemorrhagica.

A 48-year-old male, a known case of hypertension and diabetes mellitus, presented with asymptomatic, single blood-filled blister over labial mucosa. On examination, non tender hemorrhagic bulla of size 1.5–2 cm in diameter was present over the inner aspect of lower lip [Figure 1]. It ruptured spontaneously and healed within 7 days without any sequelae. Hematological and coagulation investigations were normal. Classical clinical morphology led to the diagnosis of angina bullosa hemorrhagica (ABH).

Figure 1

Single, well defined, nontender, haemorrahagic bulla over inner aspect of lower lip

ABH, a term coined by Badham in 1967,[1] is a benign phenomenon, appearing as painless single or multiple blood-filled blisters over oropharyngeal mucosa. ABH usually affects the soft palate, but lesions may occur in the anterior pillar of the fauces, epiglottis, arytenoids, pharyngeal wall, and esophagus.[2] These lesions rupture spontaneously to form ragged, often painless, superficial erosions that heal spontaneously within 1 week without scarring. Known causes include trauma, hot-spicy foods, dental procedures, steroid inhalers, and systemic diseases such as diabetes-mellitus, hypertension, and chronic renal failure.[345] Overall, trauma has been found to the common cause. Differential diagnosis must include thrombocytopenia, pemphigus, bullous pemphigoid, bullous lichen planus, dermatitis herpetiformis, epidermolysis bullosa, and oral amyloidosis. Hematological investigations, biopsy, and immunofluorescence studies may be useful to exclude other causes of oral blisters. Diagnosis of ABH is essentially clinical and should not be confused with other severe chronic diseases of oral cavity. No treatment is required for ABH because the blood-filled blisters spontaneously rupture and heal.

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