At the Interface of Urban Exposure and Infection: A Classical Case of Leptospirosis in New York City.

Leptospirosis is a zoonotic spirochetal infection transmitted through exposure to water or soil contaminated with animal urine, often associated with unsanitary living conditions and environmental exposure. Early recognition and prompt initiation of appropriate antimicrobial therapy are critical to prevent severe complications, including multiorgan failure and death. We present a case of a 43-year-old man from New York City (NYC) with alcohol use disorder who was experiencing homelessness and presented with bilateral lower extremity myalgias after sleeping outdoors on a soccer field while intoxicated several days prior. He was initially managed for sepsis of unknown origin with broad-spectrum antibiotics. Subsequent diagnostic testing confirmed leptospirosis, prompting de-escalation to targeted therapy with ceftriaxone. The patient improved clinically despite developing severe acute kidney injury and hyperbilirubinemia and was discharged to complete a course of doxycycline, with a favorable outcome.