Background: Aquatic leeches have a worldwide distribution; can be swallowed accidentally from springs and fresh water in endemic area. Infestation of leech depending on attachment site can produce different symptoms such as hemoptysis and oronasal bleeding.
Case Report: Here in a rare case of hemoptysis caused by a leech infestation that was referred 5-days after drinking water from a spring is presented.
A 53-year-old man presented with a 2-week history of oral spitting blood. Examination showed a green-brown mass protruding from the nasopharynx behind the soft palate, which was a blood-engorged leech. Laryngoscopy was performed with local anesthesia, and the leech was removed with forceps.
Conclusions: Leeches infestation should be considered for differential diagnosis of hemoptysis and oral blood spitting, after drinking water from a spring or stream in areas where aquatic leeches are commonly found.

Keywords: leech, Hemoptysis, Nasopharynx