A Case of Severe Leptospirosis with Gram-Negative Sepsis Due to Obstructive Uropathy: Diagnostic and Therapeutic Challenge

We report a 46-year-old male presenting with fever, jaundice, myalgia, and acute kidney injury following exposure to contaminated water, suggestive of severe leptospirosis. Clinical course was complicated by gram-negative urosepsis secondary to obstructive uropathy, refractory shock, and acute respiratory distress syndrome. Management included timely initiation of antibiotics and escalation, ureteric stenting under transfusion support for source control, invasive ventilation with lung-protective strategies, and careful hemodynamic monitoring. Multidisciplinary collaboration and prompt source control facilitated recovery. This case underscores the importance of early recognition of multi-organ involvement and overlapping infections in endemic, resource-limited settings to optimize outcomes in severe leptospirosis.