Background Leptospirosis is a neglected tropical disease endemic to Sri Lanka, with outbreaks reported in 2008, 2011 and 2013. This report describes the most recent outbreak of leptospirosis in Padaviya, a rural area in Anuradhapura district, with a focus on clinical presentation and epidemiological deviations from previous outbreaks in the district. Methods Two distinct datasets were used for analysis in this study. The first was a retrospective review of records from Padaviya Base Hospital for patients admitted for suspected leptospirosis in December 2014. The second dataset was derived from questionnaires administered to patients admitted to the same hospital between 12 and 15 January 2015 with a suspected diagnosis of leptospirosis. Results A total of 19 suspected cases of leptospirosis were reviewed: 14 from admissions in December 2014 and 5 from admissions between 12 th and 15 th of January 2015. Renal compromise and cardiovascular symptoms were significant characteristics of this particular outbreak, with proteinuria seen in 73.7% of patients, bradycardia in 15.8% and hypotension in 36.8%. In addition, a significant discrepancy was noted between the number of cases identified by hospital staff and the number of cases reported to the regional health authorities. Conclusion The most striking feature of this outbreak was the higher prevalence of hypotension and bradycardia in patients, which raises the question of micro geographical distribution of leptospirosis as explained previously in Sri Lanka.