Oropharyngeal leech infestation as a cause of severe anemia in a 65-year-old male patient: a case report

Leech infestations are rare but potentially serious medical conditions, often leading to hemorrhage and anemia. Leeches, which belong to the phylum Annelida and class Hirudinea, typically infest humans through contact with contaminated water or ingestion of unfiltered water. They attach to the mucosa of the aerodigestive tract, causing bleeding, and in severe cases, complications such as airway obstruction or severe anemia. Leech infestations are more prevalent in rural areas with limited access to safe water, where environmental conditions facilitate exposure.

We presented the case of a 65-year-old male farmer  of Amhara ethnicity from a rural area in North Wollo, Ethiopia, who experienced spitting blood-tinged saliva for 2 weeks. He also reported a foreign body sensation in his throat, lightheadedness, and difficulty speaking. The symptoms started after he drank water from a spring commonly used for livestock. Upon examination, the patient appeared pale and had a dark brown cylindrical leech attached to the posterior wall of his oropharynx, along with clotted blood. The patient was first found at his home during home-to-home medical care by a mobile medical team. This case represents a rare instance of esophageal bleeding caused by a single leech infestation, which resulted in severe anemia.

This case highlighted the need to consider uncommon causes, such as leech infestations, in the differential diagnosis of anemia and oropharyngeal bleeding, particularly in rural areas with limited access to clean water. Early recognition and intervention are crucial in preventing severe complications. Preventive measures, such as promoting access to safe water and improved sanitation and educating rural communities on the importance of seeking early medical attention for unusual symptoms, are essential for reducing the incidence of leech infestations.