In this Images in Clinical Medicine from the New England Journal of Medicine, a leech is seen on nasal endoscopy in a man with epistaxis.
Comment
The authors describe a man presenting with more than a week of regular nasal blood dripping and blood-tinged mucus when spitting or coughing. Although the differential diagnosis for persistent unilateral epistaxis includes trauma and nasopharyngeal carcinoma, clinicians can’t miss the hook in this story: He had washed his face with spring water while on a mountain climbing trip nearly 3 weeks earlier. As seen on nasal endoscopy, leeches can attach to skin or mucosal surfaces, causing local trauma and persistent bleeding. Squirmy complications of hiduriniasis include profound anemia and secondary infection, especially in those with internal body infestations. A week of bleeding after mountain climbing? It turns out nature has its own …
Comment
The authors describe a man presenting with more than a week of regular nasal blood dripping and blood-tinged mucus when spitting or coughing. Although the differential diagnosis for persistent unilateral epistaxis includes trauma and nasopharyngeal carcinoma, clinicians can’t miss the hook in this story: He had washed his face with spring water while on a mountain climbing trip nearly 3 weeks earlier. As seen on nasal endoscopy, leeches can attach to skin or mucosal surfaces, causing local trauma and persistent bleeding. Squirmy complications of hiduriniasis include profound anemia and secondary infection, especially in those with internal body infestations. A week of bleeding after mountain climbing? It turns out nature has its own …