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All that wheezes is not asthma
  1. Pyng Lee1,
  2. Ze-Ying Tan1,
  3. Thanh Pham2
  1. 1 Respiratory and Critical Care Medicine, National University Hospital, Singapore
  2. 2 Department of Respiratory Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
  1. Correspondence to Professor Pyng Lee, Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore 119228, Singapore; pyng_lee{at}nuhs.edu.sg

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A 31-year-old man complained of intermittent wheeze, dyspnoea and hoarse voice for 2 months. He was diagnosed with asthma and prescribed inhaled corticosteroid by the general practitioner. However, his symptoms persisted despite compliance to inhaler therapy. He was a non-smoker, worked as a logger and remembered quenching his thirst at a nearby river prior to his symptoms. Physical examination revealed a well-nourished man with audible wheeze, normal vital parameters and saturating 96% on room air. Chest radiograph (CXR) was unremarkable. Flexible bronchoscopy performed for hoarse voice revealed a leech straddling the vocal cords. It was attached to the …

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