Jalaukavacharana (leech therapy) is an Ayurvedic para-surgical procedure generally used in the management of inflammatory and vascular conditions of the skin and underlying soft tissues. Adverse cutaneous reactions following leech application, although infrequently reported in the literature, represent an important clinical consideration. We report the case of a 34-year-old female with autoimmune thyroiditis, who developed a localized cutaneous hypersensitivity reaction manifesting as pruritus, erythema, and raised purpuric papules at the leech bite sites following leech therapy over the anterior neck region for thyroid swelling. The reaction was classified as savisha jalauka damsa per Sushruta. The condition was relieved by topical application of Vilwadi Gulika, as mentioned by Vagbhata in Visha Chikitsa, within five days, without systemic complications. This case provides valuable insight into dermatological complications of leech therapy and underscores the potential of Visha Chikitsa in its management.