A Diagnostic Trap: Fatal Leptospirosis in Disguise

Abstract

Leptospirosis is a common post-monsoon zoonosis and an important cause of febrile jaundice with acute kidney injury (AKI). We report a 35-year-old farmer with floodwater exposure who presented with fever, myalgias, jaundice, oliguria, shock and breathlessness. Investigations showed severe hyperbilirubinaemia (peak 44 mg/dl), AKI, thrombocytopenia, metabolic acidosis and bilateral pulmonary infiltrates. Despite antibiotics and intensive supportive care, he progressed to refractory multiorgan dysfunction syndrome (MODS) and succumbed following attempted albumin dialysis. This case highlights leptospirosis as a diagnostic trap and reinforces the need for early suspicion and timely organ-support in severe disease.