A 44-year-old man presented with a 7-day history of epistaxis on the left side. He reported that he had washed his face in a freshwater stream 7 days before the onset of symptoms.
A suspected blood clot was seen in the left middle turbinate on anterior rhinoscopy, although endoscopic examination showed that the possible clot was a living leech. The leech was retrieved with an aspirator. The epistaxis subsequently resolved.