Leech infestation can cause many different clinical symptoms such as epistaxis, haemoptysis, haematemesis, and vaginal bleeding. Therefore leech infestation should be considered as a cause of unexplained severe anemia in rural areas where aquatic leeches are common. In this paper we report a case of pharyngeal leech infestation (Limnatis nilotica) presenting with haemoptysis, and epistaxis which resulted in difficulty in making a diagnosis.