Angina bullosa haemorragica: report of two cases
Department of Dermatology, Venereology and Leprosy, Meenakshi Medical College & Research institute, Enathur, Kanchipuram, Tamilnadu, India
Received: 03 December 2016
Accepted: 04 January 2017
*Correspondence:
Dr. Brindha Thangaraj,
E-mail: brinsdartz@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Angina bullosa hemorrhagica (ABH) is a term used to describe acute, subepithelial oral mucosal blisters filled with blood without any systemic disorder or hemostatic defect. They rupture spontaneously after short time resulting in painless superficial erosion that heals spontaneously within one week without scarring. We report two cases of ABH to create awareness regarding occurrence of this lesion thus avoiding any misdiagnosis.
Keywords: Angina bullosa hemorrhagica, Oral mucosal blisters
INTRODUCTION
Angina bullosa haemorrhagica (ABH) is a condition, which is characterised by swelling, haematoma, bleeding from the soft palate of unknown aetiology.1 Sometime patient may give history of trivial trauma.7 It heals spontaneously within 1 week without any treatment.
CASE REPORT
Case 1
A 30 year old male presented to Dermatology OPD with complaint of bleeding and painless swelling in the soft palate following eating.
i. Patient has had similar episode 6 months back that resolved spontaneously after episode of bleeding.
ii. No history of stridor.
iii. No history of breathing difficulty.
iv. No history of any bleeding disorder.
v. No history of dysphagia.
vi. No history of change of voice.
Examination reports as follows.
Day-1
Swelling was seen over the soft palate which was of 5×6 cm. No tenderness was present on probing. Swelling was dark red in colour (Figure 1).
Day-2
Swelling gradually reduced in size on the second day. Swelling was around 3×3 cm (Figure 2).
Day-4
Swelling completely resolved by the fourth day (Figure 3).
Case 2
A 32 year old female presented to dermatology OPD with complaint of bleeding followed by swelling in the soft palate.
i. History of foreign body sensation in the oral cavity present.
ii. No history of stridor/breathing difficulty.
iii. No history of dysphagia.
iv. No history of change of voice.
v. No history of any allergy.
On examination we found the following.
Swelling was around 4×5 cm. No tenderness was present on probing. Swelling was dark red in colour (Figure 4).
Investigation
Routine investigations were carried out for both cases which were normal. Incisional biopsy was done for both cases which revealed hemorrhagic areas with mild inflammatory cell infiltrate.
Treatment
Observation, mouth wash and antibiotics were given to prevent secondary infection.
DISCUSSION
ABH was described by Badham in the year 1967.
Other names:
i. Stomatopompholyx haemorrhagica
ii. Benign haemorrhagic bullous stomatitis
iii. Oral haemophlyctenosis
ABH is a condition, which is characterised by swelling, haematoma, bleeding from the soft palate of unknown aetiology. Sometime patient may give history of trivial. ABH has been considered as an idiopathic condition. However minor mucosal injury may be involved in pathogenesis of ABH. Sites include cheek, floor of mouth, hard palate, anterior pillar of tonsillar fossa, epiglottis, arytenoids and esophagus. The soft palate-most common site for ABH.6 Soft palate is covered by a thin, friable squamous epithelium of non-keratinized type. Mastication increase blood flow rate in soft palate via parasympathetic reflex vasodilation. So the soft palate is easily injured during mastication of hard or crispy food and is prone to ABH.7 Steroid inhalation can cause atrophy and decrease in submucosal elastic fibers.8 This may cause breakdown of capillaries, resulting in formation of ABH. Sudden onset of a solitary blood blister on soft palate is a diagnostic of ABH. Biopsy is not necessary for most of the lesion. No active treatment necessary. Large blisters should be broken to prevent airway obstruction. Spontaneous healing can be expected within 7-10 days.
CONCLUSION
Sudden haematoma, bleeding and swelling in the soft palate, may look alarming but one should think of this condition which is seen quite frequently. Complete resolution without scar within a week. No active treatment necessary.
ACKNOWLEDGEMENTS
We would like to thank our Department of Dermatology for helping us with this article and our families for their constant support.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Not required
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