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Singh J, Wanjari A. Angina Bullosa Hemorrhagica: A Rare Presentation of Oral Bleeding. Cureus 2024; 16:e56797. [PMID: 38654779 PMCID: PMC11035899 DOI: 10.7759/cureus.56797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
Angina bullosa hemorrhagica (ABH) is a rare condition seen in the oral cavity which is characterized by the presence of single or multiple blood-filled cavities which are generally not associated with any other systemic illness or condition. These lesions tend to rupture spontaneously and lead to epithelial erosions, which heal over the course of a few days without any signs of scarring. The condition is mostly attributed to trauma in the oral cavity, which occurs as a result of sharp metallic crowns or other such metal implants on the teeth or due to chewing hard and crispy food. This report presents a case of a 50-year-old female with no comorbidities who presented with bleeding from the mouth after eating cashew nuts. The case was diagnosed clinically and conservatively managed. The report aims to increase awareness regarding the causes and management of the condition.
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Affiliation(s)
- Jayant Singh
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
| | - Anil Wanjari
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
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2
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Patigaroo SA, Sarah M, Nafees R, Showkat SA. Angina Bullosa Hemorrhagica: Frightening Experience-A Case Series. Indian J Otolaryngol Head Neck Surg 2023; 75:2293-2297. [PMID: 37636738 PMCID: PMC10447771 DOI: 10.1007/s12070-023-03618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023] Open
Abstract
Angina bullosa haemorrhagica (ABH) is characterized by the recurrent appearance of haemorrhagic bullae on the oropharyngeal mucosa which rupture spontaneously leading to complete recovery within a weeks' time without any scarring. We report the clinical features of six cases of ABH. A cross-sectional observational study was performed. A total of six cases of ABH fulfilling the Ordioni et. al. criteria for diagnosis of ABH were enrolled.The age of our patients were 65, 25, 20, 35, 55 and 48 years. Four of them were females (67%), whereas two were males (33%).Retromolar trigone involvement was most common.The chief complaint in all was reddish bulla(e) in the oral cavity of 1 day duration. Five of the patients had solitary lesions, while one had multiple lesions. The lesions measured from 1 to 3 cm in diameter. Complete blood counts and clotting factors were normal in all patients. All cases healed within a week's time. ABH is not a very common disorder encountered by ENT surgeons, dermatologists, general practitioners, and the lack of knowledge of its normal presentation can lead to unnecessary anxiety and incorrect treatment. The typical hemorrhagic bulla(e) usually erupt after eating hard, hot, or spicy food. These lesions heal spontaneously and treatment is not necessary except for reassurance and mild anxiololytics.
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Affiliation(s)
- Suhail Amin Patigaroo
- Postgraduate Department of ENT and HNS, Government Medical College Srinagar, Srinagar, JK India
| | - Mehrukh Sarah
- Postgraduate Department of ENT and HNS, Government Medical College Srinagar, Srinagar, JK India
| | - Rezwana Nafees
- Postgraduate Department of ENT and HNS, Government Medical College Srinagar, Srinagar, JK India
| | - Showkat A. Showkat
- Postgraduate Department of ENT and HNS, Government Medical College Srinagar, Srinagar, JK India
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3
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Angina Bullosa Haemorrhagica in COVID 19: A Diagnostic Conundrum. Case Report and Review of Literature. Indian J Otolaryngol Head Neck Surg 2023. [PMCID: PMC9979882 DOI: 10.1007/s12070-023-03584-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Oral manifestations of COVID-19 are amongst the most obscure and ill-reported. Of these, angina bullosa haemorrhagica is amongst the rarest. Only 2 cases of angina bullosa haemorrhagica in COVID-19 patients have been reported in literature. Angina bullosa haemorrhagica (ABH) is an enigmatic, abstruse condition represented by sudden onset of painful subepithelial, mucosal blood-filled vesicles and bullae in the oral cavity. It is not attributed to any systemic conditions, blood dyscracias or other well-known dermatological pathologies. The occurrence of these lesions in patients of COVID-19 suggests that the underlying pathology of the latter may predispose to ABH and thus help in shedding some light onto the pathogenesis of this obscure disease. Herein we present 2 cases of ABH in patients of COVID-19 within a few weeks of the resolution of the latter. Both patients reported that they had never had this condition before and that this was the first presentation of the symptom. A review of literature shows that the etiopathogenesis of ABH is ambiguous at best and that the pathology underlying the oral manifestation of COVID-19 may well be applicable to ABH as well. Various mechanisms have been proposed to cause oral manifestations in COVID-19 patients. These include imbalance in the RAS pathway causing mucosal disruption, immune dysregulation, deranged cellular immune mechanism and disruption of local immune mechanisms. Since ABH has been reported in COVID 19, it is plausible that some of the mechanisms underlying the pathogenesis of oral manifestations may explain the pathogenesis of ABH.
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Recurrent hemorrhagic bullae of the oral mucosa. JAAD Case Rep 2023; 34:48-51. [PMID: 37123556 PMCID: PMC10140737 DOI: 10.1016/j.jdcr.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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Nandini DB, Pragathi MS, Sameeksh BN, Deepak BS. Recurrent episodes of angina bullosa hemorrhagica of the tongue. J Oral Maxillofac Pathol 2022; 26:S1-S4. [PMID: 35450234 PMCID: PMC9017841 DOI: 10.4103/jomfp.jomfp_53_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 11/10/2021] [Indexed: 12/03/2022] Open
Abstract
Angina bullosa hemorrhagica is a relatively rare lesion of uncertain etiology affecting the oral cavity and the oropharynx characterized by blood-filled blisters or bullae of varying size. The lesions are sudden in onset, usually asymptomatic and bullae often rupture leaving ulcers which heal without scarring. No specific treatment is usually advised since it is a self-limiting lesion. Rarely, larger lesions in the oropharynx may cause air obstruction and require immediate attention. The clinical presentation of this lesion may cause apprehension to the patient and diagnostic challenge to the clinician since they clinically mimic other serious disorders such as blood disorders and vesiculobullous lesions. An awareness among clinicians is needed to prevent misdiagnosis and unnecessary diagnostic procedures of this distinct entity.
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Affiliation(s)
- D B Nandini
- Department of Oral Pathology & Microbiology, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - M S Pragathi
- Department of Oral & Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India
| | - B N Sameeksh
- Department of General Medicine, Shamanur Shivashankarappa Institute of Medical Sciences, Davangere, Karnataka, India
| | - B S Deepak
- Department of Conservative Dentistry, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
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Sree Vijayabala G, Mohanavalli S, Ellampalli H, Janagarathinam VA. Trauma-induced oral mucosal pathologies: A case series. THE SAINT'S INTERNATIONAL DENTAL JOURNAL 2021. [DOI: 10.4103/sidj.sidj_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Demir MC, Ağaçkıran İ. An extremely rare phenomenon: Angina bullosa hemorrhagica. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920964811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Angina bullosa hemorrhagica is a disease without a concomitant hematological or vesiculobullous disorder characterized by painless hemorrhagic bullae in the oral mucosa; it is rarely seen and has a good course. Case presentation: A 45-year-old female patient was admitted to the emergency department with a painless hemorrhagic bulla that suddenly appeared on the soft palate. A blister, 2 cm in diameter and dark red in color, was seen extending from the hard palate’s posterior to the soft palate. Nasolaryngoscopic evaluation was performed, and no additional hemorrhagic bulla was detected. She was discharged with the recommendation of oral mouthwash. Discussion: Solitary hemorrhagic bulla, suddenly occurring on the soft palate, is diagnostic for angina bullosa hemorrhagica. Some authors have reported that blisters in the posterior pharynx may progress to acute upper airway obstruction. Conclusion: Early nasolaryngoscopic evaluation in angina bullosa hemorrhagica is an excellent option to be considered by the emergency physician to prevent life-threatening situations.
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Affiliation(s)
- Mehmet Cihat Demir
- Department of Emergency Medicine, School of Medicine, Düzce University, Düzce, Turkey
| | - İlter Ağaçkıran
- Department of Emergency Medicine, Hitit University Erol Olçok Training and Research Hospital, Çorum, Turkey
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Alberdi-Navarro J, García-García A, Cardona-Tortajada F, Gainza-Cirauqui ML, Aguirre-Urizar JM. Angina bullosa hemorrhagica, an uncommon oral disorder. Report of 4 cases. J Clin Exp Dent 2020; 12:e509-e513. [PMID: 32509235 PMCID: PMC7263781 DOI: 10.4317/jced.56840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/24/2020] [Indexed: 11/05/2022] Open
Abstract
Angina bullosa hemorrhagica (ABH) is a rare oral disorder characterized by blood-filled bullous lesions in the oral cavity and the oropharynx in the absence of an underlying systemic, haematological or mucocutaneous condition. The presentation of the lesions is acute and located on the lining mucosa, mainly on the soft palate. Often, these lesions are single and rupture easily leaving an ulcerated area. In this study, we present 4 ABH cases in 3 women and 1 man and we discuss the main clinicopathological characteristics. The characteristics of this disorder are important to recognize in order to differentiate the lesions from other oral bullous conditions of the oral cavity such as mucocutaneous disorders or blood coagulation disorders. Key words:Angina bullosa hemorrhagica, angina bullosa haemorrhagica, oral blisters.
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Affiliation(s)
- Javier Alberdi-Navarro
- Oral Medicine and Oral and Maxillofacial Pathology Units. Dental Clinic Service, Department of Stomatology II, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Abel García-García
- Oral Medicine, Oral Surgery and Implantology Unit, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
| | | | | | - José-Manuel Aguirre-Urizar
- Oral Medicine and Oral and Maxillofacial Pathology Units. Dental Clinic Service, Department of Stomatology II, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
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Peters JPM, van Kempen PMW, Robijn SMM, Thomeer HGXM. Angina Bullosa Hemorrhagica: Post-traumatic Swelling in the Oral Cavity—A Case Report. JOURNAL OF ADVANCED ORAL RESEARCH 2020. [DOI: 10.1177/2320206820913696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Angina bullosa hemorrhagica (ABH) is a rare, benign disorder characterized by one or multiple blood-filled blisters in the oral cavity (mainly soft palate, and sometimes oropharynx) with a sudden onset, that may lead to a potentially threatened airway. The most common hypothesis of its unknown origin is mild trauma. This lesion can easily be confused with other mucosal diseases or hematological disorders. Knowledge of the condition is important for correct diagnosis and treatment. Incision of the bulla, intubation, or even tracheotomy may be indicated. Here we present a case of 35-year-old woman with a complaint of dysphagia without dyspnea. During oral examination, a blue and/or purple blister on the soft palate was present. On endoscopic examination, an edematous uvula was observed, without other abnormalities. Eventually, the blister ruptured spontaneously and healed within one week without any sequelae.
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Affiliation(s)
- Jeroen P. M. Peters
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pauline M. W. van Kempen
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sybren M. M. Robijn
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans G. X. M. Thomeer
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Balighi K, Daneshpazhooh M, Aghazadeh N, Rahbar Z, Mahmoudi H, Sadjadi A. Angina bullosa haemorrhagica‐like lesions in pemphigus vulgaris. Australas J Dermatol 2018; 60:e105-e108. [DOI: 10.1111/ajd.12923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/05/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Kamran Balighi
- Autoimmune Bullous Diseases Research Center Razi Dermatology Hospital Tehran University of Medical Sciences Tehran Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center Razi Dermatology Hospital Tehran University of Medical Sciences Tehran Iran
| | - Nessa Aghazadeh
- Autoimmune Bullous Diseases Research Center Razi Dermatology Hospital Tehran University of Medical Sciences Tehran Iran
| | - Ziba Rahbar
- Autoimmune Bullous Diseases Research Center Razi Dermatology Hospital Tehran University of Medical Sciences Tehran Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center Razi Dermatology Hospital Tehran University of Medical Sciences Tehran Iran
| | - Adele Sadjadi
- Autoimmune Bullous Diseases Research Center Razi Dermatology Hospital Tehran University of Medical Sciences Tehran Iran
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11
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Ordioni U, Hadj Saïd M, Thiery G, Campana F, Catherine JH, Lan R. Angina bullosa haemorrhagica: a systematic review and proposal for diagnostic criteria. Int J Oral Maxillofac Surg 2018; 48:28-39. [PMID: 30032974 DOI: 10.1016/j.ijom.2018.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 06/19/2018] [Accepted: 06/29/2018] [Indexed: 01/17/2023]
Abstract
The aim of this study was to perform a critical review of published data on the epidemiological, aetiological, clinical, histological, biological, and therapeutic characteristics of patients with angina bullosa haemorrhagica (ABH). A literature search was conducted in the PubMed, Science Direct, Web of Science, and Cochrane Library databases. All publications fulfilling the selection criteria were included in the eligibility assessment according to the PRISMA statement. The full texts of 54 retrieved articles were screened. Forty articles published between 1985 and 2016 describing 225 cases of ABH were finally selected. The mean age of the patients was 55.4 years; the male to female ratio was 0.7. The predominant localization was the palate (66%). A third of patients had no medical history. When specified, a triggering event or promoting factor was frequently found (82%). Biological tests were normal. A biopsy was performed on 35% of the patients. Treatment was symptomatic with a favourable outcome. Recurrences were frequent (62%). In conclusion, ABH is poorly documented and only by studies of low-level evidence. This review did not allow any aetiopathogenic association to be made with a general pathology or treatment. On the basis of this systematic review of the literature, diagnostic criteria aiming to improve the care of patients presenting with ABH are proposed.
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Affiliation(s)
- U Ordioni
- Department of Oral Surgery and Odontology, APHM, Timone Hospital, Marseille, France; Centre Massilien de la Face, Marseille, France.
| | - M Hadj Saïd
- Department of Oral Surgery and Odontology, APHM, Timone Hospital, Marseille, France; Faculty of Medicine, Aix-Marseille University, EFS/CNRS, APHM, Marseille, France
| | - G Thiery
- Centre Massilien de la Face, Marseille, France
| | - F Campana
- Department of Oral Surgery and Odontology, APHM, Timone Hospital, Marseille, France; Centre Massilien de la Face, Marseille, France
| | - J-H Catherine
- Department of Oral Surgery and Odontology, APHM, Timone Hospital, Marseille, France; Faculty of Medicine, UMR 7268 ADES, Aix-Marseille University/EFS/CNRS, Marseille, France
| | - R Lan
- Department of Oral Surgery and Odontology, APHM, Timone Hospital, Marseille, France; Faculty of Medicine, UMR 7268 ADES, Aix-Marseille University/EFS/CNRS, Marseille, France
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12
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Plantier F. [Angina bullosa haemorragica]. Ann Dermatol Venereol 2018. [PMID: 29525065 DOI: 10.1016/j.annder.2018.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- F Plantier
- Cabinet de dermatopathologie, 35, avenue Mathurin-Moreau, 75019 Paris, France.
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Affiliation(s)
- Karina Paci
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Katherine M Varman
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Rodrigues S, Albrechete M, Monsanto R, Chagury A, Lorenzetti F. Hemorrhagic Bullous Angina: A Case Report and Review of the Literature. Turk Arch Otorhinolaryngol 2016; 54:134-137. [PMID: 29392033 DOI: 10.5152/tao.2016.1795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/11/2016] [Indexed: 11/22/2022] Open
Abstract
Hemorrhagic bullous angina (HBA) is described as the sudden onset of one or more bullous lesions in the oral cavity, not attributable to other vesiculobullous diseases, blood dyscrasias, or autoimmune and vascular diseases. These lesions occur almost exclusively in the oral cavity, particularly in the soft palate, and do not affect the masticatory mucosa. Here we present the case of a 57-year-old male who had a spontaneously ruptured hemorrhagic bulging in his soft palate diagnosed as HBA, along with discussion of the literature. In conclusion, HBA is a rare, benign, oral disease with low complication rates. Diagnosis is essentially clinical, and treatment consists of local hygiene and prevention of oral trauma.
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Affiliation(s)
- Sara Rodrigues
- Department of Otolaryngology, Banco de Olhos de Sorocaba Hospital, Sorocaba, Brazil
| | - Marielle Albrechete
- Department of Otolaryngology, Banco de Olhos de Sorocaba Hospital, Sorocaba, Brazil
| | - Rafael Monsanto
- Department of Otolaryngology, Banco de Olhos de Sorocaba Hospital, Sorocaba, Brazil
| | - Azis Chagury
- Department of Otolaryngology, Banco de Olhos de Sorocaba Hospital, Sorocaba, Brazil
| | - Fabio Lorenzetti
- Department of Otolaryngology, Banco de Olhos de Sorocaba Hospital, Sorocaba, Brazil
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15
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Brajon D, Bagnères D, Berbis P, Rossi P. Angina bullosa haemorragica. J Eur Acad Dermatol Venereol 2014; 30:190-1. [PMID: 25174662 DOI: 10.1111/jdv.12705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D Brajon
- Dermatology department, Hopital Nord, Marseille, France
| | - D Bagnères
- Internal medicine department, Hopital Nord, Marseille, France
| | - P Berbis
- Dermatology department, Hopital Nord, Marseille, France
| | - P Rossi
- Internal medicine department, Hopital Nord, Marseille, France
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Beguerie JR, Gonzalez S. Angina bullosa hemorrhagica: report of 11 cases. Dermatol Reports 2014; 6:5282. [PMID: 25386327 PMCID: PMC4224003 DOI: 10.4081/dr.2014.5282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/06/2014] [Accepted: 03/15/2014] [Indexed: 11/23/2022] Open
Abstract
Angina bullosa hemorrhagica is a rare and benign disorder, usually localized in the subepithelial layer of the oral, pharyngeal and esophageal mucosa. The lesions are characterized by their sudden onset. They appear as a painless, tense, dark red and blood-filled blister in the mouth that rapidly expand and rupture spontaneously in 24-48 hours. The underlying etiopathology remains ill defined, although it may be a multifactorial phenomenon including diabetes, and steroid inhalers. The condition is not attributable to blood dyscrasias, nor other vesicular-bullous disorders. In this study, eleven patients with such blisters are described. Physical examination of the patients revealed a single blister with hemorrhagic content localized in the oral mucosa. Biopsy of the lesions showed sub epithelial blisters with a mild infiltrate. In general practice, dermatologists could face a blood-filled bullous lesion of the oral mucosa. Recognition is, therefore, of great importance for dermatologists.
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Affiliation(s)
- Julieta Ruiz Beguerie
- Dermatology Department, Austral University Hospital, Austral University , Buenos Aires, Argentina
| | - Silvina Gonzalez
- Dermatology Department, Stomatology Clinic, Hospital de Clinicas Jose de San Martin , Buenos Aires, Argentina
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Abstract
A woman in her early 40s presented with a painless ulceration on the right side of the posterior palate, she had an earlier history of similar lesions after the rupturing of blood filled blisters in the oral cavity. On examination, a diffuse erythematous area and ulcers covered with necrotic slough were noticed on the right and left side of the posterior palate and on the right buccal mucosa. On follow-up visit, a large blood filled blister was noticed in the buccal vestibule. We advised routine haematological investigations to rule out any bleeding disorders and direct immunofluorescence of the affected tissue and perilesional areas to rule out autoimmune blistering conditions. Haematological investigations revealed no abnormalities and immunofluorescence testing was negative. A diagnosis of angina bullosa haemorrhagica was made by excluding all other conditions. Symptomatic treatment was given, patient was educated about the condition and reassured.
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Affiliation(s)
- Hitesh Shoor
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
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19
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Abstract
Angina bullosa haemorrhagica is the term used to describe benign subepithelial oral mucosal blisters filled with blood that are not attributable to a systemic disorder or haemostatic defect. It is a very rare condition. Elderly patients are usually affected and lesions heal spontaneously without scarring. The pathogenesis is unknown, although it may be a multifactorial phenomenon. Trauma seems to be the major provoking factor and long-term use of steroid inhalers has also been implicated in the disease. We present a 50-year-old patient with angina bullosa haemorrhagica. Trauma by sharp cusp of adjacent tooth and metal crown were identified as aetiological factors in this case. Lesions healed after removal of the metal crown and rounding of the cusp. Therefore, recognition of the lesion is of great importance to dentists, to avoid misdiagnosis.
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Affiliation(s)
- Dipti Singh
- Department of Oral Medicine and Radiology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
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Abstract
Angina bullosa hemorrhagic (ABH) describes the acute and sometimes painful onset of oral blood-filled vesicles and bullae, not attributable to blood dyscrasia, vesiculobullous disorders, systemic diseases or other known causes. The haemorrhagic bullae spontaneously burst after a short time resulting in ragged, often painless, superficial erosions that heal spontaneously within 1 week without scarring. Trauma appears to be the most common identifiable precipitating factor, but the essential tissue defect is yet unidentified. This paper presents two cases of ABH with the aim to create awareness regarding occurrence of this lesion, thus avoiding any misdiagnosis.
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Affiliation(s)
- Shalu Rai
- Department of Oral Medicine and Radiology, IDST Dental College, Kadrabad, Modinagar, Uttar Pradesh, India
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22
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Milin C, Fouche B. Angine bulleuse hémorragique après des soins dentaires : présentation d’un cas. ACTA ACUST UNITED AC 2011. [DOI: 10.1051/mbcb/2011130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Horie N, Kawano R, Inaba J, Numa T, Kato T, Nasu D, Kaneko T, Kudo I, Shimoyama T. Angina bullosa hemorrhagica of the soft palate: a clinical study of 16 cases. J Oral Sci 2008; 50:33-6. [PMID: 18403881 DOI: 10.2334/josnusd.50.33] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Angina bullosa hemorrhagica (ABH) is an oral mucosal blood blister that develops without blood dyscrasia or vesiculobullous disorder. Although a minor mucosal trauma has been suggested as a triggering factor for ABH, its etiopathogenesis, especially the causative role of systemic conditions, is largely unknown. We investigated the presence or absence of local factors as well as systemic background disease in 16 patients with ABH arising in the soft palate. All the lesions were solitary, and 75% of them (n = 12) appeared during the ingestion of hard or crispy food. With regard to underlying systemic conditions, hypertension was the most common (n = 6), and asthma, insomnia, diabetes mellitus, rheumatoid arthritis, gastrointestinal disorder and hyperuricemia were also recorded (n = 1 each). Five patients had no significant background disease. There were no recalcitrant or recurrent cases. In conclusion, the present study has revealed that scratching of the oral mucosa during eating plays an important role in the formation of ABH. Hypertension appears to be the most frequent background condition, but its pathogenic relationship with ABH remains speculative, as hypertension is fairly common in adults.
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Affiliation(s)
- Norio Horie
- Department of Oral Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
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Kurban M, Kibbi AG, Ghosn S. Expanding the histologic spectrum of angina bullosa hemorrhagica: report of one case. Am J Dermatopathol 2007; 29:477-9. [PMID: 17890919 DOI: 10.1097/dad.0b013e3181492beb] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Angina bullosa hemorrhagica (ABH) is a rarely described phenomenon in the dermatology/dermatopathology literature. It is a self-limited condition occurring exclusively in the oral mucosa characterized clinically by tense hemorrhagic blisters that heal without any sequelae and histologically by a pauci-inflammatory subepithelial hemorrhagic bulla with occasional lymphocytic infiltrate.A 24-year-old healthy woman presented with a 4-month history of recurrent tense blisters over the buccal mucosa which lasted for a few days and resolved without scarring. Histopathology revealed a hemorrhagic subepithelial bulla containing numerous neutrophils with a moderately dense superficial perivascular and interstitial neutrophilic infiltrate. Direct immunofluorescence studies were negative. Based on these findings, the diagnosis of ABH was made. To the best of our knowledge, this is the first report of ABH mimicking histologically neutrophil-rich subepithelial blistering disorders.
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Affiliation(s)
- Mazen Kurban
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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Yamamoto K, Fujimoto M, Inoue M, Maeda M, Yamakawa N, Kirita T. Angina bullosa hemorrhagica of the soft palate: report of 11 cases and literature review. J Oral Maxillofac Surg 2006; 64:1433-6. [PMID: 16916681 DOI: 10.1016/j.joms.2005.11.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kazuhiko Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Nara, Japan.
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Curran AE, Rives RW. Angina bullosa hemorrhagica: an unusual problem following periodontal therapy. J Periodontol 2000; 71:1770-3. [PMID: 11128928 DOI: 10.1902/jop.2000.71.11.1770] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Angina bullosa hemorrhagica (ABH) describes benign subepithelial oral blood blisters not attributable to a systemic disorder. Little is known about the pathogenesis of ABH, although most cases have been associated with mild trauma prior to appearance of the lesion. This report discusses the clinical and histopathologic features of ABH which appeared after routine scaling and root planing.
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Affiliation(s)
- A E Curran
- University of Mississippi School of Dentistry, Department of Diagnostic Sciences, Jackson 39216, USA
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