LAUSR

Dear Editor, A 24-year-old Moroccan woman, from a rural area, presented with a 2-month history of progressive fatigue, dyspnea and abdominal pain. Physical examination was normal. Her past history included diabetes. Laboratory investigations showed a haemoglobin level of 6 g/dL (normal range 12–16), a platelet count of 40,000/L (150,000–400,000/L) and a white blood count (WBC) of 3100/L (4000–10,000/L) with 5% neutrophils, 20% lymphocytes and 75% blasts. On the basis of these findings, we suspected acute leukaemia and performed bone marrow aspiration. A bone marrow aspirate was consistent with acute myeloid leukaemia (AML M2 of World Health Organization (WHO)). Cytogenetics was suggestive of normal karyotype. The patient was treated with cytosine arabinoside and daunorubicin. Ten days after the initiation of chemotherapy, she developed febrile episodes and progressive respiratory failure. The patient was treated with intravenous antibiotics including ceftazidime, amikacin and vancomycin without any improvement. Blood culture was sterile and radiological exam showed a massive pulmonary infiltration (Fig. 1). The progression was very quick, and after hematemesis episodes, three intact alive leeches were expelled from gastro-intestinal tract (Fig. 2); patient died 4 h after. Leeches (Hirudinea) are segmented worms that are found in springs, streams and pools. Infestation occurs after drinking infested water. There are reported leech infestations in various human body sites such as genitourinary tract, rectum, pharynx, larynx, oesophagus and trachea [1]. Leeches can be located anywhere in the respiratory tract. The infestation remains symptomless until a warning sign appears. The symptoms may be diagnosed as asthma, tuberculosis, laryngitis or infections.