Uncommon cause of airway obstruction and hypovolemic shock: pharyngeal leech infestation in a rural Ethiopian child

Leech infestation of the upper airway is an uncommon but potentially life-threatening condition, especially among children living in rural areas with limited access to safe drinking water. Early recognition and intervention are crucial to prevent severe complications such as airway obstruction and profound anemia. We present the case of an 8-year-old boy from rural North Gondar, Ethiopia, who arrived at our facility with a 5-day history of coughing up blood, blood-stained saliva, hoarseness, throat discomfort, and progressive respiratory distress. On examination, he was acutely ill, severely anemic (hemoglobin 4.0 g/dL), and in hypovolemic shock. A dark, mobile foreign body was visualized in the oropharynx. Due to the unavailability of laryngoscopy, the leech was manually extracted with MaGill forceps at the bedside. The patient received blood transfusions and antibiotics, resulting in rapid clinical improvement and an uneventful recovery. Oropharyngeal and laryngeal leech infestations, while rare, are important considerations in children from endemic regions presenting with unexplained upper airway symptoms and anemia. The parasite’s anticoagulant and anesthetic secretions can delay symptom onset and diagnosis, increasing the risk of morbidity. Limited resources often hinder optimal management, but prompt recognition and removal of the leech are essential for a favorable outcome. This case highlights the importance of heightened clinical awareness of leech infestations in at-risk populations. Public health measures to improve water, sanitation, and community education are vital to prevent future cases in resource-limited settings.