We report a case of fulminant leptospirosis that was acquired in New York City by a patient with underlying infection with human immunodeficiency virus (HIV). Review of the liter-ature on leptospirosis in HIV-infected persons showed that all patients were severely ill but responded well to treatment, which highlights the importance of recognizing this poten-tially life-threatening illness, especially in unusual settings. visible track marks on his extremities. He was neurologically intact without any meningeal signs. The following laboratory values were significant: acetaminophen level, !10 m g/mL; cre-atinine level, 12.8 mg/dL; platelet count, 57,000 cells/mm 3 ; total bilirubin level, 11.3 mg/dL; prothrombin time, 11.5 s; alkaline phosphatase level, 134 U/L; and alanine aminotransferase level, 27 U/L. His chest radiograph showed mild pulmonary con-gestion,. [ABSTRACT FROM AUTHOR]