Chu and Lee 361 (9): e14, Figure 1 August 27, 2009

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A 44-year-old man presented with a 7-day history of epistaxis on the left side. He reported that he had washed his face in a freshwater stream 7 days before the onset of symptoms. A suspected blood clot was seen in the left middle turbinate on anterior rhinoscopy, although endoscopic examination showed that the possible clot was a living leech. After lidocaine nasal spray was applied to the left nasal cavity, the leech was retrieved with an aspirator (video). The epistaxis subsequently resolved. Although leech infestation is not a common cause of nasal bleeding, it should be considered when an exposure that is consistent with such infestation has occurred.