Angina Bullosa Hemorrhagica of the Ventral Tongue: A Case Report and Literature Review.

Angina bullosa hemorrhagica (ABH) is an abruptly developing oral blood blister that most often affects the soft palate. Ventral-tongue presentations are uncommon and can mimic traumatic, vascular, hematologic, or immune-mediated disease. A 78-year-old Saudi man with hypertension and Type 2 diabetes presented with a 3-day history of tongue discomfort and a solitary hemorrhagic bulla measuring 1.5 × 1.0 cm on the right ventral tongue. No other oral lesions, cutaneous involvement, or airway symptoms were present, and he reported a previous similar palatal lesion. Based on the characteristic clinical appearance, oral-only distribution, and prior recurrence, a clinical diagnosis of ABH was made. The lesion was managed conservatively. Four days later, it had ruptured. At 2-month follow-up, the lesion had completely healed without scarring. This case highlights an uncommon ventral-tongue presentation of ABH and emphasizes that ABH should be considered in the differential diagnosis of solitary hemorrhagic bullae and postbullous erosions of the tongue. Recognition of its characteristic clinical course may prevent misdiagnosis and unnecessary intervention while ensuring appropriate hematologic evaluation and, when indicated, investigation for immune-mediated disease.