Epiglottis leech infestation presenting as coughing and hemoptysis successfully removed by oropharyngeal laryngoscopy under sequential topical anesthesia: a case report

Leeches are freshwater parasitic worms that typically infest the human nasal or oral cavities, or pharynx via drinking contaminated water, while epiglottic laryngeal infestation is extremely rare due to the larynx’s anatomical barriers. We report the case of a 70-year-old male from rural Leshan, China, with a 5-year history of hypertension and no residual mobility impairment following hemiplegia recovery 30 years ago. He presented with a 2-week history of throat itching, foreign body sensation, occasional cough, and mild hemoptysis, which developed shortly after drinking unboiled mountain spring water. Laryngoscopic examination revealed a 5-cm, wriggling, greyish-brown leech attached to the surface of the epiglottis, with no other pharyngeal or laryngeal abnormalities. Given the primary hospital’s lack of an electronic fiber laryngoscope, the leech was successfully extracted via conventional oropharyngeal laryngoscopy under topical anesthesia using specialized laryngeal forceps, with minimal stimulation to avoid tracheal aspiration. Post-procedural follow-up confirmed complete resolution of all symptoms. This case provides practical guidance for primary hospitals lacking advanced equipment, demonstrating that local surface anesthesia combined with oropharyngeal laryngoscopy is safe and effective for epiglottic leech removal. It also emphasizes the importance of strengthening health education on boiled drinking water in rural areas.