An unusual cause of unilateral epistaxis: a leech in the nose

Abstract

Leeches are blood-sucking endoparasites and a very rare cause of foreign bodies in the airways. They generally inhabit fresh water. Transmission to humans generally occurs when using contaminated water for washing, swimming, or drinking. Leeches can enter the pharynx, larynx, trachea, and bronchi through the mouth and nose, which can result in potentially fatal complications1,2. Epistaxis is a common symptom and an emergency ear, nose, and throat (ENT) condition. It can be either bilateral or unilateral. Frequent causes of unilateral epistaxis include septum deviation, nasal or nasopharyngeal tumors, and foreign bodies. However, leeches are responsible for only a very small portion of foreign bodies seen in the airways and are very rare as causes of unilateral epistaxis. Leeches have been reported as nasal foreign bodies in few publications3,4. We report a case of a living leech lodged in the posterior nasal floor in a patient that presented to the emergency department with unilateral epistaxis and a difficult diagnosis.