Severe Hemoptysis Associated With Probable Tracheobronchial Leech Infestation Following Spontaneous Expectoration: A Case Report.

Airway leech infestation is a rare but potentially life-threatening cause of severe hemoptysis, usually occurring after exposure to untreated freshwater in rural or endemic areas. Mechanical mucosal injury, together with the anticoagulant and antiplatelet effects of leech saliva, including hirudin and other bioactive substances, may contribute to persistent bleeding, while nonspecific symptoms can delay diagnosis. We report the case of a 56-year-old chronic smoker who was admitted with severe hemoptysis, dysphonia, and mild dyspnea after recent exposure to untreated freshwater. Computed tomography pulmonary angiography showed parenchymal consolidations associated with bilateral ground-glass opacities suggestive of alveolar hemorrhage, without pulmonary embolism, vascular malformation, or structural bronchial abnormality. On the second day of hospitalization, the patient spontaneously expectorated a live leech measuring approximately 5 cm in length. This was immediately followed by complete cessation of hemoptysis and rapid clinical improvement. Flexible bronchoscopy performed after expectoration showed a normal tracheobronchial tree, with no active bleeding, residual parasite, endobronchial lesion, or mucosal abnormality. No recurrence was observed during a three-month follow-up period. This case highlights the need to consider airway leech infestation in patients with unexplained severe hemoptysis, particularly in endemic regions or after exposure to untreated freshwater. Bronchoscopy is the standard diagnostic and therapeutic approach in most reported cases, although spontaneous expectoration may rarely result in complete recovery.