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.

Adult↗

PubMedDate not supplied

Acute porphyria in the emergency department.

Patients with acute hepatic porphyria present with abdominal pain and neurologic abnormalities. Although the disease is uncommon, the emergency physician will occasionally encounter a patient with porphyria. The relevant pathophysiology of acute hepatic porphyria and the treatment of the patient with acute hepatic porphyria are reviewed.

Acute Disease↗