septic gangrene and thrombophlebitis following leech therapy in a patient with undiagnosed arterial occlusive disease: a case report

Different side effects have been reported for leech therapy, such as local itching, skin reactions, infection, bleeding disorders, and anemia. the present study described a rare and lethal adverse event following leech therapy.a 63-year-old man was referred to nemazee teaching hospital (shiraz, iran) in december 2020 with a two-week history of progressive right lower extremity swelling, erythema, and ecchymosis. one week before symptom onset, he had undergone leech therapy on the lateral calf and upper thigh of the right lower extremity, administered by a traditional healer. physical examination revealed gangrene of the right leg and absence of all pulses. color doppler sonography of the leg and computed tomography angiography (cta) of the thoracic aorta to the lower extremities revealed complete thrombosis of all right lower extremity arteries, extending to the right iliac artery and abdominal aorta. with a diagnosis of arterial occlusive disease and septic thrombophlebitis, the patient received intravenous antibiotics and anticoagulant therapy. due to the inadequacy of medical treatments, a right lower extremity amputation was performed. the patient expired 5 days postoperatively due to septic shock and multiorgan failure.