Multiple angina bullosa haemorrhagica like oropharyngeal lesions associated with severe acute respiratory syndrome coronavirus 2-induced immune thrombocytopenia: A rare case report

Abstract

Rationale: Angina bullosa hemorrhagica (ABH) or blood blisters have an acute onset and occur independently of other disturbances of the human body like vesiculo-bullous disorders, vascular disorders, systemic causes etc. ABH is sometimes painful in the oral cavity, most commonly affects the soft palate and less commonly affects the masticatory mucosa. Within a short period of time, these blood filled lesions burst spontaneously resulting in superficial erosions and healing without scarring within 1-2 weeks. ABH has a good prognosis and the only complication reported in the literature has been of airway obstruction. Patient Concerns: A 50 yr old female patient presented with the chief complaint of blood filled blisters and bleeding gums since one week. Diagnosis: Blood filled blisters were noted at multiple sites in the oral mucosa. Blood investigation revealed mild alteration in platelet count and endoscopy displayed involvement of the pharyngeal mucosa. A provisional diagnosis of ABH-like lesion as a covid -19 related delayed inflammatory reaction to LA was given. Interventions: Symptomatic management with topical agents was done. Outcomes: The lesions had completely healed by the seventh day and she remains symptom free eight months post episode. Lessons: The presented case is a very rare condition affecting the oral cavity and involvement of the pharyngeal mucosa additionally in a post COVID-19 patient is even more rare. A delayed inflammatory reaction to LA due to exposure to the SARS-COV-2 spike protein and dysregulation in immune function associated with immune thrombocytopenia (ITP) are postulated in this case of ABH-like lesions involving the oro-pharyngeal mucosa. It is very important to be clinically observant in recovered covid 19 patients too for atypical presentations.