Acute Lymphangitis after a Land Leech Bite.

A 19-year-old man presented with pain of the left arm, and a fever developed after training as a ranger in a mountainous area. He reported land leech bites with slight bleeding on his extremities during training, and symptoms developed two days after the bites occurred. His body temperature was 37.6°C, and an examination revealed two red streaks on his left palmer forearm (Picture 1), no eschar or skin abrasions on the distal part, and swelling of the supratrochlear lymph nodes (Picture 2). We diagnosed him with lymphangitis induced by a leech bite. His condition improved following five days' treatment with amoxicillin-clavulanic acid (AMPC/CVA). Infectious lymphangitis usually develops as a complication of skin wound or distal infection. There have been several reports of leech bite infections induced by symbionts of leeches, including Aeromonas spp. (1) and Rickettsia spp. (2). We administered AMPC/CVA by referencing protocols for insect bites, but careful follow-up is important in order to select appropriate agents, as some symbionts of leeches are resistant to AMPC/CVA.

Picture 1.

Picture 2.

The authors state that they have no Conflict of Interest (COI).