We report a case of a oropharyngeal leech infestation due to poor water supplies and sanitation, which may be presented with sore throat, dysphagia and hemoptisis and discussed treatment options. In our case, the leech was removed under general anesthesia. Even though oropharyngeal leech infestation is very rare, it may occur after drinking contaminated water. Leeches should be in the differential diagnosis for patients with oropharengeal masses in developing countries.