A Rare Cause of Hemoptysis: Hypopharyngeal Leech

Abstract

A 58-year-old male patient was admitted to the Otorhinolaryngology department with acute hemoptysis. In his history, it was understood that he drank natural water 2 days ago. The patient had hemoptysis, which occurred with spitting. The patient had difficulty swallowing and discomfort when swallowing. Endoscopic examination revealed a blackish live foreign object in the hypopharynx with right local posterior hypopharyngeal oozing. Hypopharyngeal leech was suspected and removed immediately using forceps. After the leech was removed, the bleeding stopped immediately and the patient started swallowing and breathing comfortably. Pharyngeal leeches should be included in the differential diagnosis of patients with hemoptysis, especially in patients with a history of drinking unfiltered water from sources where aquatic leeches are commonly found.

Case Report: Profound Anemia in a 2-Year-Old Boy Associated with a Leech in the Oropharynx

“…Because of their weaker jaws, aquatic leeches, as occurred in this case, normally enter through body orifices and feed on mucosal surfaces of the upper aerodigestive tract (nasopharynx, larynx, esophagus, trachea, or even bronchi), lower genitourinary tract (urethra and vagina), and rarely, the eyes. The literature contains reports of leeches found in the nasopharynx of adults and older children, 2 , 9 , 10 in the oropharynx of adults and children, in the vagina of premenarchal girls 11 and postmenopausal women, 12 and in patients varying in ages from 4 to 75 years. In addition, a leech was found in the urethra of a 13-year-old boy.…”

“…Leech infestation, although rare, should always be considered when a patient has unexplained anemia in a locale in which leech infestation is endemic. 1 The literature from a number of middle-income countries reports leeches attaching themselves to various mucous membranes, 2,3 including in the nasopharynx of adults 4,5 and the oropharynx of children. 6,7 The experience of our Kenyan coauthor is that the nasopharynx of a child is too small to house a full-sized leech, but the full-sized leech can fit in the nasopharynx of an adult.…”