Markedly elevated creatinine phosphokinase, cotton wool spots, and pericarditis in a patient with leptospirosis.

We are reporting a patient with acute leptospirosis whose creatinine phosphokinase was markedly elevated secondary to an associated myositis. In patients presenting with acute hepatitis, an elevated creatinine phosphokinase should suggest the diagnosis of leptospirosis. Our patient's course of illness was made unusual by the appearance of cotton wool spots, previously unreported in leptospirosis as well as by pericarditis in the absence of uremia. This illustrates our ever widening recognition of the clinical manifestations of leptospirosis.