Medicinal leech therapy (MLT) or Hirudotherapy (leeching using Hirudo medicinalis) is an ancient treatment used for various medical conditions, such as flap survival, pain management, and venous congestion. Although generally safe, it has been associated with complications, including bacterial infections, localized hypersensitivity reactions, bleeding, and rarely pseudolymphoma. Cutaneous pseudolymphoma (CPL) is a benign reactive lymphoproliferative disorder mimics cutaneous lymphoma clinically and histologically. It often appears as pruritic red or purple papules and nodules. We report a case of 55-year- older adult who presented with pruritic red-purple papulonodules around the right knee. These lesions appeared two years ago following leeching used to treat pain and swelling of the affected knee. Histopathologic examination confirmed the diagnosis of CPL. The patient was initially treated with oral cetirizine and topical fluocinolone acetonide, but intralesional triamcinolone acetonide and cryotherapy were used due to the recurrence of lesions. Response to treatment was excellent and lesions resolved after two weeks. No recurrence was seen in the follow up visits. This case highlights the need for clinicians to be aware of CPL as a potential complication of MLT and to consider appropriate management strategies, including corticosteroids and cryotherapy.