A Rare Cause of Hypovolemic Shock in Prepubertal Girl: Vaginal Leech Infestation

Vaginal bleeding in girls is an alarming symptom for both parents and pediatricians. Serious underlying causes should be always excluded.

We describe here a 9 year-old girl was admitted to our emergency department due to vaginal bleeding and severe anemia. She was initially treated with oral antibiotics as a vulvovaginitis. But, due to the persistence of vaginal bleeding and worsening of her condition, she was referred to our department. No history of trauma and no evidence of abuse were reported by the parents. She was acutely sick and had marked pallor. Blood count showed profound anemia (hemoglobin at 4 g/dl). The child was treated as hypovolemic shock and resuscitated with intravenous fluids and urgent blood transfusion. Gynecologic examination found a live leech at the vulva that the extraction was facilated by applying a saline solution. We asked again the mother who revealed that the symptomatology appeared after swimming for a long day in a pond. The evolution was marked by a net improvement and stop of bleeding. The child was clinically stable and discharged home the next day with ambulatory treatment.

This case emphasizes that the possibility of vaginal leech infestation should be always carefully considered by the emergency physician in girl presenting with vaginal bleeding specially who live in rural areas and use unhygienic water.