Unusual Cause of Life-Threatening Severe Anemia: A Rare Case of Pediatric Leech Infestation: A Case Report

INTRODUCTION: Leech infestation (hirudiniasis) is a rare but potentially life-threatening condition, particularly in pediatric populations living in rural or resource-limited settings. It commonly occurs following exposure to untreated freshwater sources and may present with a wide range of clinical manifestations depending on the site of attachment. Due to its rarity and nonspecific presentation, diagnosis is often delayed or missed, increasing the risk of severe complications such as significant blood loss and anemia. CASE PRESENTATION: We present a 4-year-old male patient admitted with a one-week history of bright red blood vomiting associated with generalized body weakness, epigastric pain, and low-grade fever. The child had a history of exposure to irrigation dam water used for domestic purposes, suggesting ingestion of contaminated water as the likely source of infestation. On examination, he had severe pallor with laboratory findings revealing severe anemia (hemoglobin: 3.8 g/dL). Initial management included stabilization with blood transfusion and supportive care. During hospitalization, the diagnosis was confirmed when the patient spontaneously expelled a live leech during vomiting, after which he showed marked clinical improvement. CONCLUSION: This case highlights the importance of considering leech infestation as a differential diagnosis in children with unexplained hematemesis and anemia, particularly in endemic regions. Early recognition, prompt management, and preventive measures such as safe water practices and community awareness are essential to reduce morbidity and prevent recurrence.