Abstract / Summary
Angina bullosa hemorrhagica (ABH) is an uncommon benign disorder characterized by sudden onset of hemorrhagic bullae on the oral mucosa that rupture spontaneously and heal without scarring. Although ABH is well described in oral medicine and dermatology literature, it may be under-recognized in people living with human immunodeficiency virus (HIV) infection (PLHIV) and in sexual health settings, where recurrent oral lesions are often presumed infectious. We report a 63-year-old man living with HIV, virologically suppressed and immune-reconstituted on dolutegravir and lamivudine, who presented with recurrent painless oral hemorrhagic bullae over three years. He had no history of opportunistic infections but had poorly controlled diabetes mellitus. The lesions involved the tongue and buccal mucosa, ruptured spontaneously within 72 h and healed without scarring. Recurrent herpes simplex virus (HSV) infection was initially suspected and episodic oral acyclovir was prescribed. However, lesions continued to recur, and HSV polymerase chain reaction testing was negative. Platelet count, coagulation profile, and immunobullous investigations were unremarkable. Dermatology review favored ABH based on the characteristic clinical morphology, recurrent self-limiting course and oral-only involvement. This case highlights ABH as a benign mimic of recurrent infectious or immunobullous oral disease in PLHIV. HIV status broadened the differential diagnosis but did not imply a causal relationship with ABH.