Leptospirosis presenting with colonic growth

Leptospirosis is a common zoonotic disease with a 10-fold higher incidence in tropical regions compared to temperate zones. The disease is endemic to the Indian subcontinent, particularly prevalent in the southern states. It has a wide spectrum of presentations, most commonly high-grade fever, myalgia, conjunctivitis, haematuria, jaundice, abdominal pain, and vomiting. Severe infection manifests as multisystemic vasculitis and Weil's disease. Here we describe an atypical presentation which posed a diagnostic dilemma. Considering the age of the patient and the presenting symptoms, colonic malignancy with hepatic metastasis was suspected, and further investigations were conducted, which indeed revealed a colonic growth in the descending colon, consistent with the clinical suspicion. However, the colonic growth was found to be an inflammatory mass caused by leptospiral infection, confirmed by various investigation modalities and response to antibiotic therapy. Few publications have reported cases of leptospirosis presenting with episodes of bleeding per rectum with colonic growth.