Background: Hirudo medicinalis (H. Medicinalis), also referred to as the medical leech, not only has been used by alternative medicine since ancient times, but it has also been used in modern medical care in the last century. This report introduces and discusses some rare complications from leech bite, beyond external skin hemorrhage.
Case Report: A 42-year-old woman was referred to our emergency room with painful and itchy lesions on her feet and legs. Because of her knee and leg pain, about 14 leeches were adhered onto both her legs. There were left rubor, tumor and some other areas of itching on leech-adhered regions. In physical examination, the right popliteal region and the same leg posterior area lesions were erythematous, edematous, and plaque-like shaped, as well as ecchymotic and hemorrhagic areas at the centre of the lesions.
Conclusions: In this article we present the case of a woman referred to our emergency department with skin findings related to a leech bite. We could not find any report about regional subcutaneous hematoma and cutaneous reactions in the literature. H. medicinalis may cause ecchymosis and various skin lesions, not only external skin bleeding. Physicians should keep in mind leech bite in patients with itchy lesions on the calves, knees, and feet.

Keywords: leech bite, complications of leech bite, regional subcutaneous hematoma, Cutaneous reactions