Nayak Pradeepti, Gupta Somya, Pathak Vivek Kumar, Kalra Rishita
Uttar Pradesh Greater Noida, India SMS&R, Sharda University.
Indian J Otolaryngol Head Neck Surg. 2023 Mar 2;75(3):1-7. doi: 10.1007/s12070-023-03584-w.
Oral manifestations of COVID-19 are amongst the most obscure and ill-reported. Of these, angina bullosa haemorrhagica is amongst the rarest. Only 2 cases of angina bullosa haemorrhagica in COVID-19 patients have been reported in literature. Angina bullosa haemorrhagica (ABH) is an enigmatic, abstruse condition represented by sudden onset of painful subepithelial, mucosal blood-filled vesicles and bullae in the oral cavity. It is not attributed to any systemic conditions, blood dyscracias or other well-known dermatological pathologies. The occurrence of these lesions in patients of COVID-19 suggests that the underlying pathology of the latter may predispose to ABH and thus help in shedding some light onto the pathogenesis of this obscure disease. Herein we present 2 cases of ABH in patients of COVID-19 within a few weeks of the resolution of the latter. Both patients reported that they had never had this condition before and that this was the first presentation of the symptom. A review of literature shows that the etiopathogenesis of ABH is ambiguous at best and that the pathology underlying the oral manifestation of COVID-19 may well be applicable to ABH as well. Various mechanisms have been proposed to cause oral manifestations in COVID-19 patients. These include imbalance in the RAS pathway causing mucosal disruption, immune dysregulation, deranged cellular immune mechanism and disruption of local immune mechanisms. Since ABH has been reported in COVID 19, it is plausible that some of the mechanisms underlying the pathogenesis of oral manifestations may explain the pathogenesis of ABH.
新冠病毒病的口腔表现是最不明确且报道最少的症状之一。其中，出血性大疱性口炎最为罕见。文献中仅报道了2例新冠病毒病患者出现出血性大疱性口炎。出血性大疱性口炎（ABH）是一种神秘、晦涩的病症，表现为口腔内突然出现疼痛性上皮下黏膜充血性水疱和大疱。它与任何全身性疾病、血液系统疾病或其他知名的皮肤病病理学无关。新冠病毒病患者出现这些病变表明，新冠病毒病的潜在病理可能易引发ABH，从而有助于揭示这种晦涩疾病的发病机制。在此，我们报告2例新冠病毒病患者在病情缓解几周内出现ABH的病例。两名患者均表示他们以前从未有过这种情况，这是该症状的首次出现。文献综述表明，ABH的病因发病机制充其量也只是模糊不清，而新冠病毒病口腔表现的病理可能同样适用于ABH。已提出多种机制来解释新冠病毒病患者的口腔表现。这些机制包括RAS途径失衡导致黏膜破坏、免疫失调、细胞免疫机制紊乱和局部免疫机制破坏。由于新冠病毒病中已报道了ABH，因此口腔表现发病机制中的一些机制可能解释ABH的发病机制，这是有道理的。
