A Rare Cause of Epistaxis, Hemoptysis and Anemia: Leech in the Nasopharynx

Abstract

        Leeches are blood-sucking endoparasites that can be seen in different colors and sizes. Leech infestation is endemic in tropical regions like Mediterranean countries, Africa and Asia. Leeches enter the human body when the polluted water is drunk, and they localize in the mucosa of the oropharynx, nasopharynx, tonsils, esophagus or nose but rarely in larynx. Depending on its localisation in the body, the leech which attaches firmly on the mucosa secretes an anticoagulant substance called hirudin and may cause different clinical symptoms such as epistaxis, hemoptysis or hematemesis. A dark colored and moving foreign body in nasopharynx was observed in the endoscopic examination of three cases of 12 to 70 years of age who were applied to our emergency department with complaints of epistaxis, nasal obstruction and hemoptysis lasting for about a month. All three cases were from rural areas and used well water as drinking water. They were treated by immediate removal of the foreign body using forceps, and it was detected to be a species of leech. Following this procedure, all three cases recovered uneventfully. Although leeches are rarely observed in the respiratory system, it may occasionally cause life-threatening complications if it is not accurately diagnosed. Therefore, leech infestation should be considered as a cause of unexplained hemoptysis, epistaxis or anemia in leech-endemic areas. A definitive diagnosis can be made by endoscopic assessment.

doi:10.4021/jmc41e