Nasopharyngeal hirudiniasis, a rare cause of masked hemoptysis in an older patient: A case report.

Leeches commonly inhabit freshwater environments and feed on blood; however, pharyngeal leech infestation in humans remains an unusual cause of hemoptysis that poses significant diagnostic challenges. We report the case of a male patient in his early 60s presenting with a 2-week history of persistent hemoptysis and pharyngeal discomfort. Physical examination revealed a transient, mobile structure behind the uvula that initially mimicked a blood clot. Flexible nasopharyngoscopy subsequently demonstrated a moving foreign body attached to the nasopharyngeal wall. The organism, identified as a 3-cm leech, was successfully removed using curved forceps without anesthesia, leading to immediate symptom resolution. This case underscores the necessity of considering parasitic infestation in the differential diagnosis of unexplained upper airway bleeding. It highlights the importance of obtaining a detailed environmental history regarding untreated freshwater exposure and utilizing endoscopy as a gold standard diagnostic tool.