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Unusual Case of Penile Ecchymosis

Peterson, Thomas, MD*; Supenia, Emily, PharmD; Hashikawa, Andrew, MD

doi: 10.1097/PEC.0000000000001356
Illustrative Cases

Hirudin is a potent anticoagulant found in the salivary glands of several species of leeches. We report a case of direct hirudin exposure after suspected leech bite causing significant penile ecchymosis. Diagnosis was not apparent on initial evaluation but made after a thorough history was obtained and the leech was found in the lining of his swim trunks, which he left at home. Although this presentation mimics several other potentially serious conditions, treatment is largely observational with anticipated rapid improvement over the course of hours without intervention.

From the *Department of Emergency Medicine, University of Michigan;

Departments of Pharmacy, and

Emergency Medicine, University of Michigan Mott Children's Hospital, Ann Arbor, MI.

Disclosure: The authors declare no conflict of interest.

Reprints: Thomas Peterson, MD, Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Dr, Taubman Center B1-380, SPC 5305, Ann Arbor, MI 48109 (e-mail:

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