Aim of the Study: The aim of the study is to present a case of leptospirosis in pregnancy with uncommon presentation. Introduction: Leptospirosis is a zoonotic disease and has varied manifestation with overlapping features of malaria, hepatitis, typhoid and dengue. Leptospirosis is uncommon and difficult to diagnose due to its non-specific clinical presentation. Case description: A 26-year-old multigravida with 28 weeks of gestation, presented to the obstetrics outpatient department of our hospital with the chief complaints of high grade fever associated with chills, myalgia, nausea and vomiting. She also complained of having giddiness. She gave history of having oliguria and passage of dark colored urine. Following investigations were carried out: blood glucose, Liver function tests included serum total and direct bilirubin, AST, ALT, total protein and albumin, renal function tests included BUN and creatinine and C- reactive protein as inflammatory marker. Laboratory findings included high serum AST, ALT, total and direct Bilirubin, BUN, S. Creatinine, C- reactive protein and leukocytosis. Hemoglobin, S. total protein, albumin and random blood sugar were reported low. Urine analysis was positive for proteinuria. Peripheral smear was negative for malaria. Serological tests were negative for typhoid, hepatitisand dengue. Serological test was positive for antibodies (IgM) to leptospira at titer of 1:1,000. Diagnosis of leptospirosis was confirmed and management was carried out for the same. Conclusion: Since leptospirosis often presents with symptoms which overlap with the clinical features of malaria, dengue, hepatitis, enteric fever, therefore these conditions can be considered in the differential diagnosis of leptospirosis in pre exposure cases associated with pregnancy. Clinical Significance: Due to its nonspecific presentation, its diagnosis can be overlooked. It is important to have a high index of suspicion, for early diagnosis of the disease and start treatment, so as to avoid complications especially in pregnant women.

Keywords: Hyperbilirubinemia, leptospirosis, pregnancy, proteinuria.