Leech Bite: A Rare Cause of Postmenopausal Vaginal Bleeding

Dear Editor, Postmenopausal vaginal bleeding has various causes. Differential diagnoses include exogenous estrogens, atrophic endometritis/vaginitis, endometrial or cervical cancer and polyps, uterine sarcoma, urethral caruncles and trauma. Therefore, it is necessary to rule out the pathological etiology of bleeding in postmenopausal women. The leech is a member of the phylum Annelida of the class Hirudinea and a blood-sucking aquatic ectoparasite. Its size varies from about 5 mm to nearly 45 cm. Leeches are found in rivers and ponds in tropical and subtropical regions. The leech has an oral sucker as a mouth, and a caudal sucker for movement. Leech bite in various human body sites such as the nose, pharynx, larynx, esophagus, rectum, and bladder has been reported sporadically in the literature. It is commonly found in children after bathing in the river. However, leech bite in the vagina is an uncommon problem. It is a very rare cause of vaginal bleeding but it should be kept in mind, especially in people who live in poor hygienic conditions. A 79 -year-old woman, with a postmenopausal period of 29 years, referred to the Gynecology and Oncology Department of Ghaem Hospital in Mashhad, Northeast Iran with vaginal bleeding in order to rule out cancer. She had had such complaints since three months before the referral. She suffered from continuous moderate to severe vaginal bleeding and moderate vertigo. The patient did not complain of any other symptoms. She did not live in a hygienic and healthy environment, and she used to wash her external genitalia with infected water. The only specific event worth mentioning in her history was that she had undergone vaginal hysterectomy because of a prolapsed uterus five years earlier. Upon physical examination, she seemed pale and her vital signs were as follows: Heart rate=110 beat/min, blood pressure=80/60 mm hg, temperature=36.8 ̊C, and respiratory rate=28/min. During gynecological examination, no abnormality was noticed in the vulva. Atrophic bloody mucosa was seen upon vaginal inspection with a speculum, and one leech, 5 cm in length, was stuck to the mucosa of the distal segment of the vagina (Figure 1). Then the vagina was washed with physiological normal saline solution to clean the bleeding point. However, the leech was not removed. The laboratory tests showed: hemoglobin=5.9 mg/dL, hematocrit=19%, platelet count=149000, prothrombin time=14, partial thromboplastin time=40 and INR=1.