Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 59 7 2021 08 25 454 456 EN Ebrahim Nadi Department of Internal Medicine, Division of Pulmonary Sciences and Critical Care Medicine, Beheshti Hospital, Hamadan University of Medical Sciences, Hamadan, Iran. AND School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Marzieh Naderishahab School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 2020 06 12 2021 05 19 Hemoptysis is defined as blood expectoration from below the vocal cords. Foreign bodies inhaled or consumed can be the cause of hemoptysis. Among alive foreign objects, leech infestation happens via drinking infested bodies of water. Leech infestation in the airway might be the cause of serious complications naming dysphonia, stridor, hemoptysis, choking, respiratory distress, and foreign body sensation. Although intratracheal leech infestation has been rarely reported, in the current case, a 79-year farmer presented recurrent non massive hemoptysis. Via fiberoptic bronchoscopy, a live leech was found in the trachea of the patient and with the use of lidocaine the leech was removed. In order to avoid such incidences, governments play an important role in building and repairing infrastructures regarding sanitary water and meanwhile educating and informing their population about sanitary water consumption. https://acta.tums.ac.ir/index.php/acta/article/view/8542