Tracheal Hirudiniasis: A Case Report.

Introduction: Leeches are freshwater ectoparasites that inhabit streams, pools, and springs. Internal infestation occurs by ingestion of contaminated water or direct exposure while swimming. This report presents a rare case of tracheal hirudiniasis.

Case description: A 34 year-old Nepalese woman presented with 1 week history of throat discomfort and dysphagia after the ingestion of river water. The initial clinical and endoscopic evaluations were unremarkable. Twelve hours after admission, a leech was visualized at the base of the tongue, but multiple failed extraction attempts led to its migration. Subsequently, rigid bronchoscopy under general anesthesia identified a leech in the trachea, 2 cm proximal to the carina. The parasite was successfully extracted with rigid bronchoscopy under general anesthesia, and the patient had a smooth recovery.

Discussion: Internal hirudiniasis affects primarily the nasal cavity, oral cavity, pharynx, larynx, tracheobronchial tree, and esophagus, with rare cases in the abdomen, vagina, and eye. Symptoms depend on the site of infestation. Nasal cases present with epistaxis and obstruction, while tracheobronchial involvement may cause cough, dyspnea, and hemoptysis. Removal is challenging due to the mucosal attachment of the leech and its slippery nature. Various detachment techniques, including anesthetics, cryoprobes, and hypertonic solutions, have been described in the literature. In this case, general anesthesia likely facilitated detachment, enabling a successful extraction.

Conclusions: Internal hirudiniasis should be considered in patients with freshwater exposure with relevant symptoms. Prompt recognition and appropriate extraction techniques are essential to prevent complications. Increased awareness among health care workers and the general population is essential for early diagnosis, prevention, and effective management.