Hemoptysis, though a common clinical complaint, poses diagnostic challenges when accompanied with fever, jaundice, and acute liver and kidney failure. This case study describes a 47-year-old man with hemoptysis and fever. He was initially diagnosed with bacterial pneumonia with a high suspicion of pulmonary tuberculosis and was admitted for treatment. Within 24 hours of hospitalization, he rapidly progressed to acute respiratory failure and subsequently developed acute respiratory distress syndrome (ARDS), necessitating intubation and extracorporeal membrane oxygenation (ECMO) sup-port in the intensive care unit (ICU). Upon reviewing the patient’s history, it was noted that he had sustained an injury while hunting and slaughtering pigs after heavy rainfall, raising a strong suspicion of leptospirosis. Doxycycline was administered immediately, leading to a gradual improvement in in-flammatory markers and liver and kidney function. ECMO support was discontinued on hospital day 9, and the patient was successfully weaned off the ventilator on day 17. On day 18, leptospirosis was con-firmed via a blood microagglutination test. The patient was discharged on day 38. This case highlights the critical importance of obtaining a detailed history of animal exposure and environmental contact in patients presenting with hemoptysis, fever, jaundice, and acute liver and kidney failure. When lep-tospirosis is suspected, initiating appropriate empiric antibiotic therapy within the first five days is strongly recommended to optimize treatment outcomes and prevent delays due to diagnostic testing turnaround time.
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