Angina bullosa hemorrhagica: a case report

Angina bullosa hemorrhagica (ABH) is a rare, benign, and underdiagnosed oral mucosal condition characterized by the sudden appearance of blood-filled blisters. It is often misdiagnosed or underreported due to its self-limiting nature and lack of specific markers. This case contributes to the growing recognition of ABH by documenting its recurrent manifestation at an unusual site (tongue). It is reported to highlight the importance of avoiding misdiagnosis and unnecessary investigations. Additionally, it contributes to the limited literature on ABH in Egypt and supports established clinical diagnosis criteria.

A 56-year-old Egyptian male with no significant medical history presented with a painless, dark-purple blood-filled blister on the right side of tongue. He had experienced similar episodes over the past 2 years. Examination showed a soft, non-blanching bulla that spontaneously ruptured, leading to mild erosion that healed within 10 days. Normal blood and coagulation tests led to a diagnosis of ABH. The patient was reassured and prescribed chlorhexidine 0.12% mouthwash, and educated about the benign nature and recurrence potential of the condition.

This case underscores the importance of raising awareness about ABH to prevent misdiagnosis and unnecessary procedures. ABH is a self-limiting, recurrent oral lesion that can occur in atypical sites like the tongue, even without systemic risk factors. Diagnosis is primarily clinical, and recognizing its self-limiting nature is key for effective patient management.