Necrotising soft tissue infection following folk leech therapy in a gout patient: A rare case report from Vietnam

Introduction

Necrotising fasciitis and soft tissue inflammation of the hand is a serious complication that often occurs after septic trauma, insect bites, marine animal stings, or non-sterile medical interventions. ¹ Leeches are sometimes used in traditional medicine but rarely cause serious complications. ² There are few reports of leech-induced cellulitis worldwide, especially in the context of patients using leeches on non-sterile puncture sites for blood sucking to treat gout disease treatment. We report a case from Vietnam in which a patient with gout allowed leeches to suck blood from the palm of his hand for pain relief, leading to severe cellulitis.

Case report

A 66-year old Vietnamese male with a 5-year history of untreated gout, the patient used three leeches to his left palm let suck blood after puncturing the skin with a sterile needle, aiming to relieve joint pain. The patient reported using a sterile needle but did not thoroughly wash his hands before puncturing the skin. Within 24 h, he developed progressive pain, swelling, and necrosis of the palm. On admission to our poison control centre, the patient had a necrotic lesion (3 × 2 cm) with pus over the palmar surface extending to the wrist. Vital signs were stable, and his pain score was 4/10. White blood cell count was elevated (26.6 x10⁹/L), with 85.7% neutrophils and elevated procalcitonin (0.83 ng/mL). Culture of necrotic pus identified Staphylococcus argenteus, a rare coagulase-positive species related to S. aureus. Blood cultures were negative.

He was treated with intravenous clindamycin and ciprofloxacin, along with surgical debridement and wound care. After seven days, inflammatory markers normalised and the wound healed well. He was discharged in stable condition (Fig. 1).

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Figure 1.

Photo of the patient's palm with necrosis at admission time.

Discussion

Leech therapy, or hirudotherapy, has ancient roots in traditional medicine but remains controversial due to infection risk.^1,2 While infections from leeches commonly involve Aeromonas spp., this case uniquely identifies Staphylococcus argenteus, a rare and newly recognised pathogen.^3,4

Leeches can carry pathogenic microorganisms such as Aeromonas species pluralis (spp), Staphylococcus spp, Pseudomonas spp and so on from the aquatic environment or from the skin of other patients.^3,4 The use of leeches on needle-punctured skin may have facilitated bacterial entry into deeper soft tissues. While the use of leeches on the punctured palm appears to have played a role in the subsequent infection, it is also possible that the pathogen was introduced from the patient's skin flora during self-puncture. Although the needle was sterile, the patient did not disinfect the skin before applying the leeches. No tests were performed to evaluate whether the patient was a carrier of Staphylococcus argenteus elsewhere on his body. Therefore, we cannot fully attribute the infection to the leech itself. Nonetheless, the practice of applying leeches on non-sterile sites poses a significant risk of severe infection.

This case underscores the dangers of unsupervised folk practices and highlights the importance of clinician awareness of emerging pathogens, especially in patients with chronic comorbidities like gout. ⁵

Conclusion

Folk leech therapy in this patient was associated with a serious necrotising infection by Staphylococcus argenteus. While the precise source of infection cannot be definitively identified, the use of leeches on a self-punctured, non-sterile site likely facilitated bacterial entry. Early recognition, appropriate antibiotics, and surgical management were key to recovery. Greater public awareness and regulation of high-risk traditional practices are warranted.