Leptospirosis is a globally distributed zoonotic infection, more prevalent in tropical and low-income regions due to high temperatures, humidity, rainfall, and poor socioeconomic conditions. Individuals in high-risk occupations, such as farmworkers, veterinarians, and slaughterhouse employees, are particularly vulnerable. Early symptoms include fever, headache, myalgia, and conjunctival inflammation. Prompt diagnosis via culture and agglutination tests, along with early antibiotic treatment, can reduce complications and speed recovery. Adhering to hygiene and workplace safety measures is crucial for infection prevention and control.

This report presents the case of a 45-year-old male with fever, jaundice, and multiple systemic symptoms, with a history of chronic kidney disease and recent rice paddy exposure. He was admitted to Razi Hospital in Qaemshahr, where his condition rapidly deteriorated, requiring multidisciplinary intervention from nephrology, infectious disease, pulmonology, and psychiatry specialists. Initial findings revealed severe thrombocytopenia (platelet count: 8,000) and elevated creatinine levels (6 mg/dL), prompting treatment with dexamethasone, ceftriaxone, fluid therapy, and dialysis. However, his worsening respiratory distress and alveolar bleeding led to ICU admission.

Leptospirosis was suspected based on occupational exposure and was confirmed by positive IgM antibodies in urine PCR. Despite intensive interventions—including dialysis, pleural fluid drainage, and Shaldon catheter placement—the patient developed progressive pulmonary complications and eventually succumbed.

This case highlights the diagnostic and management challenges of leptospirosis in a patient with preexisting comorbidities. It underscores the importance of a multidisciplinary approach in recognizing and addressing the complexities of infectious diseases in critical care settings.