Leech Infestation in the Vulvar Region: A Possibility to be Considered

Abstract

DEAR EDITOR, We visited a 75-year-old G7L7 rural woman with a painful vulvar lesion highly suspicious for malignancy near the introitus measuring 5 cm × 3 cm × 2 cm. The lesion was oval shaped, erythematous, and purple colored with a soft consistency and started bleeding during examination. Inguinal lymphadenopathy was absent. The patient's past medical history was unremarkable. Biopsy was planned according to the suspicious clinical appearance of the lesion. Accidently, an experienced gynecologist visited the patient prior to biopsy taking. She became suspicious of the presence of a leech tightly attached to the mucosa of the region and flushed normal saline onto the surface of the lesion. A leech bloated with blood gradually detached from the vulvar mucosa and the suspicious clinical picture almost disappeared. After removal of the leech, we took further history from the patient and understood she does not have access to hygienic water in her village for body cleaning and uses well water for washing the perineal region after voiding. On the review of the literature, we found some reports of leech infestation in the lower female genital tract. Jana et al. have reported 3 cases of the leech bite among 52 rural Indian women with nonobstetric lower genital tract injuries.[1] Aribarg and Phupong from Thailand have reported leech infestation as one of the causes of vaginal bleeding in children under 10 years old.[2] Leech infestation through lower body orifices including vagina has also been reported to be common in children of rural Bangladesh.[3] Rare complications such as intraperitoneal hemorrhage and shock have been reported in a 2-year-old girl from India as a consequence of intraperitoneal leech which had entered the peritoneal cavity through vagina and uterus.[4] Leech bite on the vaginal wall has also been reported as the cause of vaginal bleeding in postmenopausal women.[5 6] The possibility of the leech bite should be considered in the vulva and vagina in regions where leeches are prevalent and hygienic water for body cleaning is not available. This condition may present as a lesion with unusual and unfamiliar clinical picture or vaginal bleeding. Familiarity with the lesion is of great importance in making the correct diagnosis. Application of normal saline is enough for removal of the leech in most instances. However, surgical intervention under local or general anesthesia is required in some cases.[3]