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.
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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 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. In , Badham coined a new term, angina bullosa haemorrhagica ABH , to describe oral blood-filled vesicles or bullae that could not be attributed to a blood dyscrasia, vesiculobullous disorders, systemic disease or other known causes.
Lesions of ABH occur mainly on the soft palate. Elderly patients are usually affected. ABH is more common than previously suggested, and during the past decade, several studies have been published. In , Balina of Argentina had already described the same lesions under the term traumatic oral haemophlyctenosis He also postulated a trauma-induced origin, especially in patients with senile capillary changes.
In , 14 patients were presented, and in , the clinical and histological features were detailed and documented. The authors believe that Balina was the first to describe this condition and suggested the use of the name ROH.
Pain and a burning sensation was also present in that region. In the intraoral hard tissue examination, there was generalised attrition. A metal crown was present in relation to 17, 18, which were tender on percussion and were grade I mobile.
Sharp cusps were present in relation to 16, 17, 18, 46, 47 and On palpation, they were tender and bleed on manipulation.
The patient reported no blood dyscrasias, anticoagulant therapy or liver disease and was generally having good health. Other than these oral blood blisters, the patient reported no oral conditions and no skin or eye lesions. Family history was also negative. Biopsy was advised, but the patient was not willing.
So, based on a history of continuous trauma from the teeth to the mucosa and clinical examination, we came to a provisional diagnosis of ABH. Differential diagnosis was made to exclude other mucosal or cutaneous diseases such as erythema multiforme, bullous lichen planus, pemphigus, pemphigoid and epidermolysis bullosa. Haematological blood cell count and differential and prothrombin time and activated partial thromboplastin time tests were carried out and the findings were within normal limits.
In treatment removal of the metal crown and grinding of the sharp cusps were carried out. ABH, first described by Badham in , is a condition characterised by the rapid formation of a blood-filled blister on the oral mucosa.
ABH mainly affects the soft palate, but lesions can also develop on other oral sites including the buccal mucosa, lip and the lateral surface of the tongue; the masticatory mucosa of the hard palate and gingiva does not seem to be affected. There is no apparent gender predilection. ABH has been considered as an idiopathic condition. The onset is sudden and minor mucosal insults may be involved in the pathogenesis.
It may also follow trauma caused by eating, hot drinks, dental procedures or shouting. It is also noteworthy that mastication significantly increases the blood flow rate in the soft palate via parasympathetic reflex vasodilatation, and hard or crispy may injure the palate, which leads to ABH.
Lesions predominantly occur on the soft palate. The intact bulla is red to purple in colour. Clinically, the lesions may recur. The diagnosis of ABH is largely clinical, and includes the elimination of other disease processes at histology. The histopathological features of ABH include the parakeratotic epithelium with a subepithelial separation from the underlying lamina propria. Superficially located vesicles filled with erythrocytes and fibrin are seen.
The inflammatory cell infiltrate, when present, consists primarily of lymphocytes. Neutrophils and eosinophils seen in other blistering disorders are not present. Lesions of ABH can be easily confused with those occurring in many dermatological and systemic disorders. Even if there is a typical history of rapid blistering, the absence of any dermatological, haematological or systemic sign and normal healing of the ulcers generally lead to a diagnosis of ABH.
Patients with bleeding disorders thrombocytopenia and von Willebrand's disease can present with intraoral blood-filled lesions but a haemostatic function test will distinguish between these conditions. The absence of desquamative gingivitis and nasal or conjunctival mucosal involvement will differentiate it from benign mucous membrane pemphigoid.
In oral bullous lichen, planus bullae are often associated with a striated pattern. The target-like lesion of the skin in erythema multiforme helps to distinguish it. The management of a patient presenting with oral blood-filled bullae should start with a detailed medical history and careful examination to differentiate ABH from other more serious diseases.
The lesion should be biopsied to perform histology and direct immunofluorescence in order to exclude more serious diseases. A complete blood count and baseline coagulation tests should always be performed to exclude blood disorders. The patient should be reassured of the benign nature of the blisters. A large palatal or pharyngeal blister causing a choking sensation should be surgically treated if still intact.
Management of these lesions should be symptomatic. Long-term follow-up is recommended to positively exclude other conditions which may present with oral blood containing bullae.
The diagnosis is difficult in patients as angina bullosa haemorrhagica is asymptomatic and heals spontaneously without scarring and its rare appearance. The diagnosis of the lesion is very important as a rapidly expanding blood-filled bulla in the oropharynx can cause upper airway obstruction.
Therefore, a high level of suspicion is warranted on the part of the dentists who may be the first to encounter the lesion. Competing interests: None. Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed. National Center for Biotechnology Information , U. BMJ Case Rep. Published online Feb 8. Author information Copyright and License information Disclaimer. Correspondence to Dr Neeta Misra, moc.
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. Background In , Badham coined a new term, angina bullosa haemorrhagica ABH , to describe oral blood-filled vesicles or bullae that could not be attributed to a blood dyscrasia, vesiculobullous disorders, systemic disease or other known causes.
Open in a separate window. Investigations The patient reported no blood dyscrasias, anticoagulant therapy or liver disease and was generally having good health. Differential diagnosis So, based on a history of continuous trauma from the teeth to the mucosa and clinical examination, we came to a provisional diagnosis of ABH.
Treatment In treatment removal of the metal crown and grinding of the sharp cusps were carried out. Discussion ABH, first described by Badham in , is a condition characterised by the rapid formation of a blood-filled blister on the oral mucosa. Learning points. Footnotes Competing interests: None. References 1. Angina bullosa haemorrhagica: presentation of eight new cases and a review of the literature. Grinspan D. Hemoflictenosis bucal recidivante. In: Enfermedades de la boca. Angina bullosa haemorrhagica.
Angina bullosa hemorrhagica of soft palate: report of 11 cases and litreture review. Angina bullosa hemorrhagica of soft palate: a clinical study of 16 cases.
Angina bullosa haemorrhagica: a report of three cases and review of the litreture. Angina bullosa haemorrhagica presenting as acute upper airway obstruction.
Angina bullosa haemorrhagica: an unusual problem following periodontal yherapy. Korman N. Bullous pemphigoid. Clinical evaluation of oral lesions associated with dermatologic diseases. Amyloidosis: a rational approach to diagnosis by intraoral biopsy.
Angina Bullosa Hemorrhagica: Report of Two Cases
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. Angina bullosa hemorrhagic is an example of traumatic lesion characterized by oral blood-filled vesicles and bullae, not attributable to blood dyscrasia, vesiculobullous disorders, systemic diseases or other known causes.
Case Report: A rare cause of oral bullae: Angina bullosa hemorrhagica
Angina bullosa haemorrhagica ABH : diagnosis and treatment. Angina bullosa hemorrhagica is a disorder of unknown etiology characterized by the sudden onset of blood blisters in the oral and oropharyngeal mucosa. Objective: The present study describes six cases of patients diagnosed with ABH affecting the soft palate and tongue. Lesions appeared after meals, suggesting mastication trauma as the probable causative factor. From six, 04 occurred in the soft palate and 02 in the tongue, showing firstly a bubble blood, and subsequently to its rupture, the appearing of an ulcer. Final consideration: The authors discuss diagnostic criteria, essentially based on clinical data, as well as possible treatment approaches. Keywords: Palate oft.
Angina bullosa haemorrhagica
Pahl, S. Yarrow, N. Steventon, N. Saeed, O. The larynx could not be visualized by either awake fibreoptic laryngoscopy or direct laryngoscopy under anaesthesia. Surgical tracheostomy was therefore performed under general anaesthesia.
Angina bullosa haemorrhagica is a condition of the mucous membranes characterized by the sudden appearance of one or more blood blisters within the oral cavity. The blisters usually affect the palate or oropharynx, and are often long lived to the extent that patients burst them for symptomatic relief. The condition is diagnosed on the basis of exclusion of other conditions and the typical presentation, particularly the constant presence of blood as the blister fluid. Angina bullosa haemorrhagica does not cause desquamative gingivitis. From Wikipedia, the free encyclopedia. Angina bullosa haemorrhagica Other names ABH Bullosa haemorrhagica oralis BHO Angina bullosa haemorrhagica is a condition of the mucous membranes characterized by the sudden appearance of one or more blood blisters within the oral cavity. Andrews' Diseases of the Skin: Clinical Dermatology.