Leech in the epiglottis: An unusual discovery in our times

Abstract

A 76-year-old woman with an unremarkable medical history arrived at the emergency room of “Punta de Europa” Hospital, complaining of slight blood emissions from the mouth on 2 previous occasions, which were within a few days of each other. She did not complain of dyspnea or hemoptysis. A general clinical examination showed that her chest was normal, as was routine analysis. An otolaryngologic examination was requested, and a dark brown, cyst-like formation was found on the laryngeal face of the epiglottis, close to the forward commissure. The patient was asked again if she was taking anticoagulant, analgesic, or anti-inflammatory drugs, or if there had been any trauma related to the appearance of the blood-containing flictene. Her reply was negative, so she was asked if she had had any contact with water possibly contaminated with leeches, to which her reply was also negative. Because of the rarity and location of the wound, other members of the otolaryngology staff were asked to examine the patient. During an indirect laryngoscopy the “wound” was observed to move, which indicated a possibility of contact with contaminated water. When questioned in front of relatives, who had been previously warned about the possibility of leech infestation, our patient responded that she had been drinking water throughout her entire life from the same spring, which was located about 20 km from the town and was frequented at times by her whole family. Under local anesthetic via indirect laryngoscope and with a pair of larynx biopsy tweezers, we proceeded to extract the parasite, which was completely detached because of the pressure applied and showed normal signs of vitality (Fig 1). The patient was discharged and returned a few days later to have her larynx and the area where the leech had been attached checked. Leeches are classified as a species of phylum Annelida, similar to annelids. Leech infestation is known as hirudiniasis. Internal hyrundiniosis occurs either as a result of the intake of water contaminated with aquatic