Recurrent epistaxis: a diagnostic dilemma

Abstract

Hirudiniasis is the term coined to indicate leech invasion into a body orifice or cavity. Here we present a case of epistaxis due to hirudiniasis. Removal of the leech is difficult as it is slippery and firmly attached to nasal mucosa by its sucker. Various innovative techniques have been used to remove the leech as it has to be removed in total, because if a part of sucker is left behind it leads to persistent bleed and infection. This infestation is common in the tropics, Mediterranean countries, Africa and Asia. Clinicians in non leech areas might not be familiar with this condition. Advice should be given regarding lifestyle modification, particularly changes to how water is drunk, to prevent further infestation. This article is just a small attempt to familiarize doctors in the Indian subcontinent with this unique condition in cases of recurrent nasal bleed.