Abstract Angina bullosa hemorrhagica (ABH) is a rare, self-limiting oral mucosal condition characterized by the spontaneous onset of blood-filled vesicles or bullae which are not associated with mucocutaneous blistering diseases, hematological malignancies, genetic/acquired bleeding diathesis or vascular anomalies. These blood-filled bullae are minimally symptomatic, leave shallow erosions upon rupture and heal without scarring. ABH usually affects middle-aged or older individuals with predilection for lining mucosa, and particularly the soft palate. Although most cases are solitary, multiple and/or recurrent lesions are possible. The etiology of ABH remains unclear but diabetes, hypertension, chronic use of inhaled corticosteroids and mucosal trauma during oral functions/procedures have been implicated as risk factors or triggers. Differentiation of ABH from serious conditions with similar oral presentation is important and in most cases; diagnosis can be accomplished on clinical grounds through a detailed history and physical, focused review of systems and screening blood work. Although microscopic exam of ABH shows subepithelial clefting, it does not have an immunopathologic basis and biopsy for direct immunofluorescence should be reserved for atypical situations. Management of ABH includes patient reassurance and education as well as symptomatic treatment, if necessary. Although cases of ABH have been reported in the dental, oral medicine and dermatology literature, this idiopathic entity is not well-recognized by clinicians. In this review, we present an illustrative case to detail the presentation, clinical course, and diagnostic algorithm of ABH as well as highlight features differentiating it from clinical mimics to raise awareness, facilitate recognition, minimize unnecessary diagnostic procedures and prevent misdiagnosis.
Fatahzadeh et al. (Tue,) studied this question.