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Angina Bullosa Hemorrhagica Clinical Presentation

  • Author: Kara Melissa T Torres, MD, DPDS; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jan 29, 2015
 

History

Angina bullosa hemorrhagica (ABH) is characterized by its sudden onset during or just after eating.[6] The lesions may be preceded by stinging pain or a burning sensation, but they are essentially asymptomatic.[4] A large bullae in the palatal region has been reported to give rise to a feeling of suffocation.[9] Occasionally, patients may present with hoarseness or blood-tinged sialorrhea.[4]

The blisters may last from a few minutes to 24-48 hours and then spontaneously rupture, typically during meals, releasing blood into the mouth. It usually leaves an erosion covered by epithelial slough that heals without scarring, discomfort, or pain within a week’s time.[5] The lesions may appear intermittently or at regular intervals. The cases reported had a duration ranging from 4 months[10] to 25 years.[11]

Patients do not report a tendency to bleed at other sites.

Family history generally is noncontributory to angina bullosa hemorrhagica. Grinspan et al[12] reported that 44% of his patients in a series of 24 cases published in 1999 had from type II diabetes, hyperglycemia, or family history of diabetes. No conclusive evidence of a cause-and-effect relationship exists between the presence of angina bullosa hemorrhagica and glucose metabolism.

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Physical

The blister of angina bullosa hemorrhagica (ABH) appears tense, dark red to purple in color, and blood-filled surrounded by an ecchymotic halo. It has an average size of 1-3 cm in diameter.[4] They are often solitary, but multiple lesions have been described.[10]

Note the images below.

A 42-year-old man with the sudden appearance of an A 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone.
A 42-year-old man with the sudden appearance of an A 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone. Image shows 24 hours after the initial presentation of angina bullosa hemorrhagica.

The soft palate is the most commonly affected site in angina bullosa hemorrhagica.[13] Occasional lesions have been reported in the buccal mucosa, alveolar ridge,[11] tongue, hard palate,[8] and, rarely, the gingiva.[14] If located on the tongue, the anterior third is most commonly affected. The vermillion border of the lips are almost always spared.[12] Angina bullosa hemorrhagica also may involve the pharynx and the esophagus.[8] Approximately one third of the patients exhibit lesions in more than one location.

Similar lesions in other mucous membranes or the skin have not been reported.

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Causes

The described cases of angina bullosa hemorrhagica (ABH) had spontaneous onset or were related to minor trauma of ingestion of hot drinks[15] ; hard, rough, and crispy foods[16, 6] ; restorative dentistry[17] ; or periodontal therapy.[14]

Other potential causes of angina bullosa hemorrhagica mentioned in the literature are dental injections of anesthetics[16, 18] ; steroid inhalers[19, 18] ; endoscopy[15] ; trauma from the sharp edges of adjacent teeth, metal crowns, and prosthetic use[4, 20] ; tobacco consumption[20] ; anticoagulant intake[13] ; and coughing, sneezing, and shouting.[8, 6]

A report of 16 cases affecting the soft palate described hypertension as the most frequent underlying systemic condition (6 of 16 subjects); however, its relationship remains speculative, as hypertension is common in adults.[6] Other reported associated systemic factors were diabetes mellitus, chronic kidney injury on hemodialysis, asthma, rheumatoid arthritis, gastrointestinal disturbances, hyperuricemia, and systemic lupus erythematosus.[8, 13, 14, 4, 11, 21]

In general, angina bullosa hemorrhagica is not attributable to blood dyscrasia, vesiculobullous disorders, or systemic diseases. A causative factor is not identified in approximately 47% of patients with angina bullosa hemorrhagica.[8]

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Contributor Information and Disclosures
Author

Kara Melissa T Torres, MD, DPDS Visiting Research Fellow, Ackerman Academy of Dermatopathology

Kara Melissa T Torres, MD, DPDS is a member of the following medical societies: Philippine Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Roman Carlos, DDS Staff Member, Department of Pathology, Hospital Herrera-Llerandi, Guatemala; Co-Director, Professor, Oral and Maxillofacial Pathology, Centro de Medicina Oral de Guatemala; Past President, International Association of Oral Pathologists; Chairman, Oral and Maxillofacial Pathology, Centro Clínico de Cabeza y Cuello, Guatemala; Diplomate, American Board of Oral and Maxillofacial Pathology

Roman Carlos, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology and International Association of Oral Pathologists

Disclosure: Nothing to disclose.

References
  1. Brajon D, Bagnères D, Berbis P, Rossi P. Angina bullosa haemorragica. J Eur Acad Dermatol Venereol. 2014 Aug 29. [Medline].

  2. Singh D, Misra N, Agrawal S, Misra P. Angina bullosa haemorrhagica. BMJ Case Rep. 2013 Feb 8. 2013:[Medline].

  3. Shoor H, Mutalik S, Pai KM. Angina bullosa haemorrhagica. BMJ Case Rep. 2013 Dec 11. 2013:[Medline].

  4. Beguerie JR, Gonzalez S. Angina bullosa hemorrhagica: report of 11 cases. Dermatol Reports. 2014 Feb 17. 6(1):5282. [Medline]. [Full Text].

  5. Rai S, Kaur M, Goel S. Angina bullosa hemorrhagica: report of two cases. Indian J Dermatol. 2012 Nov. 57(6):503. [Medline]. [Full Text].

  6. Horie N, Kawano R, Inaba J, et al. Angina bullosa hemorrhagica of the soft palate: a clinical study of 16 cases. J Oral Sci. 2008 Mar. 50(1):33-6. [Medline].

  7. Guillot B. Skin reactions to inhaled corticosteroids. Clinical aspects, incidence, avoidance, and management. Am J Clin Dermatol. 2000 Mar-Apr. 1(2):107-11. [Medline].

  8. Pahl C, Yarrow S, Steventon N, Saeed NR, Dyar O. Angina bullosa haemorrhagica presenting as acute upper airway obstruction. Br J Anaesth. 2004 Feb. 92(2):283-6. [Medline].

  9. Stephenson P, Scully C, Prime SS, Daly HM. Angina bullosa haemorrhagica: lesional immunostaining and haematological findings. Br J Oral Maxillofac Surg. 1987 Dec. 25(6):488-91. [Medline].

  10. Kurban M, Kibbi AG, Ghosn S. Expanding the histologic spectrum of angina bullosa hemorrhagica: report of one case. Am J Dermatopathol. 2007 Oct. 29(5):477-9. [Medline].

  11. Shashikumar B, Reddy RR, Harish M. Oral hemorrhagic blister: an enigma. Indian J Dermatol. 2013 Sep. 58(5):407. [Medline]. [Full Text].

  12. Grinspan D, Abulafia J, Lanfranchi H. Angina bullosa hemorrhagica. Int J Dermatol. 1999 Jul. 38(7):525-8. [Medline].

  13. 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 Sep. 64(9):1433-6. [Medline].

  14. Curran AE, Rives RW. Angina bullosa hemorrhagica: an unusual problem following periodontal therapy. J Periodontol. 2000 Nov. 71(11):1770-3. [Medline].

  15. Hosain SI, Bounds G, Stanford J. Angina haemorrhagica bullosa causing respiratory obstruction postoperatively. Anaesthesia. 1991 May. 46(5):422. [Medline].

  16. Garlick JA, Calderon S. Oral blood blisters in angina bullosa haemorrhagica secondary to trauma of eating and dental injection. Br Dent J. 1988 Oct 22. 165(8):286-7. [Medline].

  17. Corson MA, Sloan P. Angina bullosa haemorrhagica: an unusual complication following crown preparation. Br Dent J. 1996 Jan 6. 180(1):24-5. [Medline].

  18. de las Heras ME, Moreno R, Núñez M, Gómez MI, Ledo A. Angina bullosa hemorrhagica. J Dermatol. 1996 Jul. 23(7):507-9. [Medline].

  19. Higgins EM, du Vivier AW. Angina bullosa haemorrhagica--a possible relation to steroid inhalers. Clin Exp Dermatol. 1991 Jul. 16(4):244-6. [Medline].

  20. Mehrotra R, Thomas S, Nair P, Pandya S, Singh M, Nigam NS, et al. Prevalence of oral soft tissue lesions in Vidisha. BMC Res Notes. 2010 Jan 25. 3:23. [Medline]. [Full Text].

  21. Domínguez JD, Rodríguez-Peralto JL, Iglesias L. Recurrent oral blood blisters. Arch Dermatol. 1999 May. 135(5):593-4, 596-7. [Medline].

  22. Stephenson P, Lamey PJ, Scully C, Prime SS. Angina bullosa haemorrhagica: clinical and laboratory features in 30 patients. Oral Surg Oral Med Oral Pathol. 1987 May. 63(5):560-5. [Medline].

 
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A 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone.
A 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone. Image shows 24 hours after the initial presentation of angina bullosa hemorrhagica.
 
 
 
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