Angina Bullosa Hemorrhagica Clinical Presentation

Updated: Sep 12, 2022
  • Author: Kara Melissa Torres Culala, MD; Chief Editor: Dirk M Elston, MD  more...
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A notable inciting trigger, usually trauma while eating, can typically be elicited prior to the appearance of the blister. Others will recall trauma from dental procedures, imaging or anesthetic procedures involving the oral mucosa, shouting, sneezing, and mucosal fragility from corticosteroid use notably from long term inhaler use and other systemic diseases. [14] There are reports of cases without identifiable trigger. [13]  


Physical Examination

The blister of angina bullosa hemorrhagica (ABH) appears tense, dark red to purple in color, non-pulsatile, and blood-filled surrounded by an ecchymotic halo. It has an average size of 1-3 cm in diameter. [9] They are often solitary, but multiple lesions have been described. [5]  The  vesiculobullous lesions may be mildly painful or have "burning or tingling sensation" but are otherwise asymptomatic. [13] There are no other cutaneous findings elsewhere.

Note the image 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.

The soft palate is the most commonly affected site in angina bullosa hemorrhagica. [17] Occasional lesions have been reported in the buccal mucosa, alveolar ridge, [6] tongue, hard palate, [7]  floor of the mouth, [13]  and rarely, the gingiva  [22]  and vulva. [13] 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. [7] Approximately one third of the patients exhibit lesions in more than 1 location.

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