Pulmonary hemorrhage is a very rare and a serious complication of leptospirosis. It is the leading cause of death in leptospirosis.Leptospirosis is a worldwide zoonotic disease caused by genus Leptospira, has been reported in India since 1931. 1 the incidence in southern India being 25.6%.2 We herein report an uncommon case of severe pulmonary hemorrhage and multiple organ failure due to leptospirosis in an elderlysouth Indian farmer, who was previously healthy. Giving history of working in paddy field barefooted and came in contact with rat feces,contaminated water. Complaints of fever with myalgia and hemoptysis brought the patient to the hospital. Patient developed severe respiratory distress, requiring mechanical ventilation. Prompt diagnosis of leptospirosis as a rare differential for pulmonary hemorrhage, appropriate antibiotics, escalated the patient recovery, extubated, and was discharged on the 8th day of admission.