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Leptospirosis, long thought to be a disease of sewage workers and found post-flooding is re-emerging as a potentially life threatening infectious disease in urban India during monsoon and immediately after due to poor sanitation and drainage. However, it is often ignored and under diagnosed due to a low index of suspicion. We present a fatal case of leptospirosis with acute liver failure, respiratory failure and jaundice and encephalopathy.

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