Atypical soft palate pyogenic granuloma in an elderly anticoagulated patient presenting with acute oropharyngeal hemorrhage

Abstract Pyogenic granuloma (PG) is a benign lobular capillary proliferation of mucocutaneous tissues that usually arises in response to local irritation. It typically occurs on the gingiva, with extragingival sites such as the soft palate being very rare. We report a 69-year-old female on Apixaban who presented with sudden, profuse oropharyngeal bleeding. Examination revealed a friable, sessile erythematous mass on the right soft palate that was actively bleeding. The lesion was surgically excised with electrocautery under local anesthesia after appropriate management of anticoagulation. Histopathology confirmed lobular capillary hemangioma (PG). No recurrence was observed at follow-up. This case highlights the importance of prompt recognition and complete excision of PG in anticoagulated patients, as even small lesions may precipitate life threating hemorrhage.