Leptospirosis beyond the Classic Triad: Fanconi-like Syndrome and Aseptic Meningitis in an Immunocompetent Adult

pale, anicteric, with bipedal edema and no lymphadenopathy.System examination revealed normal breath sounds with no added sounds over bilateral lung fields and normal cardiac auscultation with no murmurs.Abdomen was soft and nontender with no organomegaly.Clinically, he had terminal neck stiffness but no focal neurological deficit, and Kernig's and Brudzinski's signs were both negative.Lab tests at admission revealed mild normocytic anemia (hemoglobin-10.2gm/dL, range 13-17 gm/dL), normal white cell counts, and low-normal platelet count (platelet count-1.50lakhs/ mm 3 ), with normal renal and hepatic parameters but a myriad of electrolyte abnormalities-hyponatremia (sodium-119 mEq/L, range 133-146 mEq/L), hypocalcemia (corrected calcium-8 mg/ dL, range 8.5-10.5 mg/dL), hypophosphatemia (phosphorus-1.5 IntroductIonLeptospirosis is an endemic zoonotic disease caused by pathogenic spirochetes of the genus Leptospira.It is more prevalent in tropical and subtropical regions, particularly during rainy seasons, and is commonly transmitted through exposure to water contaminated with the urine of infected animals.The clinical spectrum of leptospirosis ranges from a mild, self-limiting febrile illness to severe, life-threatening forms such as Weil's disease (characterized by jaundice, renal failure, and hemorrhage) and severe pulmonary hemorrhagic syndrome.Due to its nonspecific presentation, leptospirosis often mimics other infectious diseases, such as dengue, malaria, and viral hepatitis, posing diagnostic challenges-especially in resource-limited settings.Early recognition and appropriate antibiotic therapy are crucial in reducing morbidity and mortality.We report a case of anicteric leptospirosis with an unusual presentation in a 58-year-old gentleman in the form of fever with dyselectrolytemia. case descrIptIonA 58-year-old gentleman, known hypertensive, presented in the nonrainy season with a history of ongoing high-grade fever for 7 days, associated with multiple episodes of vomiting and severe headache.Detailed history was noncontributory for any other systemic symptoms, recent respiratory or ear infections, recent travel, close contact with sick patients, or exposure to livestock, sexual, and occupational history.At presentation, his vitals revealed a temperature of 102.8°F, pulse rate of around 120 beats/minute, respiratory rate of 20 breaths/minute, blood pressure 120/70 mm Hg, and Glasgow Coma Scale (GCS) score of 15.On general examination, he was sick-looking, 1,