The patient is a 51-year-old man who arrived at our facility complaining of fever, chills, myalgia, and generalized weakness that had begun 5 days before coming to the hospital. His fever was continuous, and he reported that his eyes have been yellow for the previous 3 days; he also complained of a headache in the frontal area. He is a fishery officer and works in the rice paddies as well. He reported severe vomiting 4 to 5 times per day and a decreased appetite and a change in urine color during the previous few days.
The patient had no significant familial history of any disease. Except for one capsule of Omeprazole (20 mg) each day for heartburn; he reported no other current medications and no history of drug abuse history. The patient's physical examination showed the following vital signs: blood pressure 120/80 mmHG, pulse of 80, respiratory rate of 18, and temperature of 38 C. 
His conjunctiva was congested. No neck stiffness was detected. On both arms multiple petechia and, purpura were observed, but there was no sign of ecchymosis. The heart beat was normal. No organomegaly was detected in an abdominal examination. The lower limbs had normal appearance and function. 
The laboratory data are shown in Table 1.
After a brain CT scan the radiologist reported "multiple hemorrhagic lesions in the temporal and parietal lobes, especially in the left side" (see Figure 1).
The patient's chest X-ray was normal, and he tested negative for HBs Ag and HBs AB.
His diagnosis was reviewed, and in view of the deranged hepatorenal functions and seasonal prevalence (recent floods in the area where the patient resided), leptospirosis was clinically suspected, which was further confirmed by the positive serum IgM-ELISA (IgG value of 100 and an IgM value of 20). Epidemics of leptospirosis in our region and unavailability of Microscopic agglutination test (MAT) made us to consider IgM-ELISA for confirmation of leptospirosis. 
In an abdominal sonography, 70 cc of fluid were found in Morison's pouch, and the liver exhibited hepatitis-like changes. An MRI showed intracranial hemorrhage, especially in the left lobe.
With intracranial hemorrhage care and Ceftriaxone (1 mg/day) and Dexamethasone (8 mg two times daily) for 1 week and 15 unit platelets, his condition improved. After 26 days of hospital care with a normal platelet count and normal renal function the patient was discharged from hospital.