Angina Bullosa Hemorrhagica of the Buccal Mucosa: A Diagnostic Challenge in an Oral Medicine Practice

Abstract

Angina bullosa haemorrhagica (ABH) is an uncommon, benign oral mucosal disorder characterised by the acute and spontaneous development of blood-filled bullae involving the oral or oropharyngeal mucosa, in the absence of an identifiable systemic, haematological, or mucocutaneous condition. The present case report aims to describe the clinical presentation of ABH, with particular emphasis on its diagnostic evaluation, differential diagnosis, and management. Careful clinical assessment can facilitate an accurate diagnosis while avoiding unnecessary invasive interventions in uncomplicated cases. This case report describes a 72-year-old male who presented with a blood-filled blister on the left buccal mucosa of 2–3 days’ duration. The lesion developed shortly after food consumption, and the patient reported previous similar episodes that had resolved spontaneously without specific treatment. Clinical examination revealed a solitary, well-circumscribed, bean-shaped haemorrhagic bulla measuring approximately 20 mm in diameter near the left retromolar region. The lesion was dark red to violaceous, soft, and non-tender, with an intact, smooth surface and clinically normal surrounding mucosa. Diascopy demonstrated no blanching, consistent with the presence of extravasated blood. A biopsy was initially planned; however, the lesion resolved spontaneously before the scheduled procedure, leaving no residual lesion. Based on the clinical presentation, recurrent history, possible triggering event, absence of similar extraoral lesions, and spontaneous resolution, a clinical diagnosis of angina bullosa haemorrhagica was established.