Septic gangrene and thrombophlebitis following leech therapy in a patient with undiagnosed arterial occlusive disease
Case report published in Iranian Journal of Medical Sciences (2025)
Abstract
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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Patient with undiagnosed peripheral arterial occlusive disease developed septic gangrene and thrombophlebitis following leech therapy — major safety case for screening protocols.
Why This Matters for Hirudotherapy
This case report describes a rare, fatal adverse event after leech therapy: a 63-year-old man developed septic thrombophlebitis and gangrene of the right leg roughly a week after a traditional healer applied leeches to his calf and thigh, with imaging showing complete arterial thrombosis extending to the iliac artery and abdominal aorta; despite antibiotics, anticoagulation, and amputation he died of septic shock and multiorgan failure. For hirudotherapy this is an important safety-side data point — it underscores that the authors attribute the catastrophic outcome to leeching performed on a patient with undiagnosed arterial occlusive disease and without medical screening, reinforcing ASH's emphasis on patient selection, vascular assessment, sterile technique, and trained practitioners. The caveat is inherent to the design: a single case cannot establish how often such events occur and cannot, on its own, separate the contribution of the underlying arterial disease from that of the leech application.
Citation
Septic gangrene and thrombophlebitis following leech therapy in a patient with undiagnosed arterial occlusive disease.
Ostovar M et al. · Iranian journal of medical sciences, 2025
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