Severe leptospirosis with apyrexia and an atypical presentation: rapid progression to multi-organ failure

Distinguish between fever syndrome (systemic inflammatory symptoms) and pyrexia (elevated body temperature) - patients can have severe infections with fever syndrome but normal body temperature.A national early warning score (NEWS2) based on vital signs may fail to capture disease severity in afebrile presentations, while sequential organ failure assessment (SOFA) scores provide better risk stratification.Recognise the diagnostic pattern in severe leptospirosis: markedly elevated bilirubin (>580 μmol/l) with disproportionately mild liver enzyme elevation (AST <200 U/l) combined with rapidly progressive acute kidney injury.