Unexpected culprit: High output heart failure induced by severe anemia from laryngeal leech infestation: A case report.

Leeches are uncommon blood-feeding parasites found in polluted water, posing serious health risks. They typically affect individuals who swim in contaminated streams or drink water that has been contaminated. Once ingested, they can attach in various parts of the upper aero-digestive tract, but leeches in the larynx are rarely observed. A 6-year-old male presented with a 2-week history of hemoptysis, blood-stained saliva, and a sensation of a foreign body in his throat. He reported hoarseness, shortness of breath while lying down, fatigue, blurred vision, and lightheadedness. Initially diagnosed with acute tonsillopharyngitis and treated with amoxicillin, his condition worsened, leading to bilateral lower extremity swelling. Upon examination, he showed tachycardia, tachypnea, fever, and pale conjunctivae. Cardiovascular examination highlighted an S3 gallop, and abdominal examination indicated tender hepatomegaly approximately 4 cm below the right costal margin. Musculoskeletal evaluation revealed grade 2 pitting edema in the lower extremities. Laboratory results indicated severe anemia (hemoglobin level of 3.0). Flexible fiberoptic laryngoscopy revealed a live leech in the larynx. Under general anesthesia, the patient underwent direct laryngoscopy for removal of the leech, followed by blood transfusions, antibiotics, and diuretics. He recovered well and was discharged on the tenth postoperative day with dietary recommendations and instructions to avoid untreated spring water. This case highlights the importance of early recognition and intervention to prevent potentially fatal complications from leech infestations, particularly in young children who experience unexplained airway or gastrointestinal symptoms after freshwater exposure. Clinicians should maintain a high level of suspicion in such cases.