Urban Leptospiral Meningoencephalitis Associated With Bottle Recycling: A Case Report and Literature Review.

Leptospirosis is a preventable zoonotic infection that can present with a broad spectrum of clinical features, ranging from mild flu-like illness to severe multi-organ dysfunction. Meningitis caused by Leptospira is rare in developed countries and among the urban population. We describe the case of a 50-year-old male with schizophrenia and hypothyroidism who presented with seizures, jaundice, shock, and respiratory failure. Initial evaluation revealed severe metabolic acidosis, acute kidney injury, transaminitis, and thrombocytopenia. Lumbar puncture showed xanthochromic cerebrospinal fluid with lymphocytic predominance. Serum polymerase chain reaction confirmed leptospiral exposure. The patient was treated with antibiotics. He recovered following a complicated and prolonged hospital course. Epidemiologic history revealed daily collection of discarded bottles in areas with reported rodent exposure. Our patient's occupational exposure from bottle collection likely facilitated Leptospira infection. The urinary pneumococcal antigen detection during admission led to anchoring bias and subsequent delayed recognition of leptospiral meningitis. This case highlights the importance of a thorough exposure history and broad diagnostic testing in atypical presentations of meningitis, particularly when occupational or environmental risk factors are present.