A 50-year-old male from Minnesota presented with acute kidney injury, liver dysfunction, and fever after freshwater exposure. Initial workup for common pathogens was negative. Due to persistent symptoms and epidemiological risk, leptospirosis was suspected. Diagnosis was confirmed using 16S ribosomal RNA gene PCR and next-generation sequencing of blood, identifying Leptospira. He received doxycycline and recovered. This case highlights the utility of advanced molecular diagnostics for rare infections in non-endemic areas.
Key note: Leptospirosis should be considered in patients with acute febrile illness, kidney injury, and relevant exposure history, even in non-endemic regions, and molecular methods can aid diagnosis.