Nasal Leech in a Child.

The common causes of epistaxis in children are mostly local mucosal dryness, trauma, or inflammation, while epistaxis caused by leech infestation is clinically rare and easily overlooked. This article reports a case of epistaxis in a child due to leeches and, combined with a literature review, analyzes its clinical characteristics and key points of diagnosis and treatment. Children often present with recurrent unilateral epistaxis, nasal obstruction, and a feeling of insect crawling, and most have a history of exposure to natural water. The diagnosis of epistaxis due to nasal hirudiniasis mainly relies on the detection of leeches through anterior rhinoscopy or endoscopic examination, and it is necessary to differentiate it from the common causes of epistaxis. The primary treatment is the thorough removal of leeches, supplemented by nasal irrigation or anti-infective measures. This study emphasizes that in endemic areas or in the context of relevant exposure history, leech infestation should be included in the differential diagnosis of intractable epistaxis in children to improve clinical vigilance and avoid misdiagnosis or missed diagnosis.