Bleeding as the result of a leech in the male urethra is very rare. We describe a 13-year-old boy who had a leech in his urethra. In the emergency department he persistently squeezed his penis in an attempt to prevent the leech from going deeper into his urethra. Manual removal by forcep failed and cystoscopic removal was recommended. Penile block with lidocaine 1% relieved the pain and enabled him to squeeze his penis harder until the leech was pushed out making forcep removal easier. Post-removal he had hematuria and penile pain for 2 days. A description of his presentation and management, along with a review of the literature is presented.
Despite being a favorite delicacy, only 200-300 of the 5,000 known mushroom species have been clearly established to be safe for consumption. Cases of mushroom poisoning have been reported with diverse clinical syndromes. A syndromic classification of mushroom poisoning has recently been developed to facilitate early interventions. We present a series of five cases of mushroom poisoning with muscarinic manifestations to highlight the difficulties we faced with exact species and toxin identification and the importance of this syndromic classification. The common symptoms in our case series are blurred vision, diarrhea, vomiting, and abdominal cramps.