Angina bullosa hemorrhagica‐like lesions: a rare presentation of drug‐induced thrombocytopenia

Abstract

Angina bullosa hemorrhagica presents in middle-aged or elderly people as self-limiting, single or multiple, oral hemorrhagic lesion(s) of sudden onset. These are asymptomatic blood-filled blisters over non-keratinized epithelium of the soft palate, lateral border of the tongue, and floor of the mouth, which spare the hard palate and gingiva. They are temporary, cause short profuse bleeding, and heal without scarring. Recurrences are rare. The exact etiology of this occurrence remains obscure, and most laboratory investigations show normal findings. There are no possible underlying systemic or hemorrhagic disorders, and suggested relationships with the use of steroid inhalers or diabetes mellitus remain unsubstantiated. Trauma caused by mastication, hot drinks, shouting, or dental procedures remains the most implicated etiologic factor. Thrombocytopenia, an uncommon and occasionally life-threatening adverse drug reaction, commonly presents with petechiae, purpura, or ecchymosis, but angina bullosa hemorrhagica-like blisters are rare. We describe two cases of drug-induced thrombocytopenia (DIT) presenting as angina bullosa hemorrhagica-like blisters in the oral cavity in order to highlight a rare adverse effect of very commonly used drugs. Case reports