title: Unilateral epistaxis after swimming in a stream.
abstract: A 55-year-old Chinese woman presented with a 3-week history of unilateral left-sided epistaxis and nasal obstruction. She had swam in a freshwater stream 1 month prior to the onset of symptoms. Endoscopic examination revealed a live leech at the left middle meatus with a large part of its body inside the left maxillary antrum. Local anaesthetic was applied to anaesthetise the leech and facilitate removal. Magnetic resonance imaging performed following removal confirmed that no other leeches were present in the sinonasal area. The endoparasitism might have persisted because of the inconspicuous site of infestation and the absence of pain. This form of leech infestation has not been previously reported.
authors.affiliation: Division of Otorhinolaryngology, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong. ckchow@hkucc.hku.hk
authors.forename: C K
authors.initials: CK
authors.lastname: Chow
authors.forename: S S Y
authors.initials: SS
authors.lastname: Wong
authors.forename: A C W
authors.initials: AC
authors.lastname: Ho
authors.forename: S K P
authors.initials: SK
authors.lastname: Lau
mesh_terms: D000818:Animals; D004844:Epistaxis / Q000209:etiology*; D005260:Female; D006801:Humans; D007865:Leeches; D008875:Middle Aged; D009666:Nose / Q000469:parasitology*; D045483:Rivers; D013550:Swimming