Leeches, which are bloodsucking annelids widely distributed in natural environments globally, can cause hirudiniasis when they invade the human body. The most common site of infestation in humans is the nasopharynx, although they can also infiltrate less common sites, such as the trachea, esophagus, and urinary and reproductive tracts. We present the case of a 47-year-old male patient with a persistent cough for 2 months associated with hemoptysis and intermittent hoarseness for 1 month. Nasopharyngoscopy revealed an actively moving worm located above the vocal cords. Subsequently, under intravenous anesthesia, we removed the live worm through bronchoscopy, and it was identified as a leech. In areas where hirudiniasis is endemic, the possibility of tracheal leech infestation should be considered in patients presenting with chronic cough, hemoptysis, and hoarseness. Furthermore, it is crucial to take necessary precautions during outdoor activities to prevent the occurrence of hirudiniasis.