Leptospirosis produces numerous clinical findings, but two general patterns occur. In the less severe and generally nonfatal form, often called anicteric leptospirosis and accounting for 90% of cases, the illness commonly begins abruptly and includes headache, myalgias, conjunctival suffusion and other ocular abnormalities, fever, nausea, vomiting, rash, and meningismus. Epistaxis or other minor bleeding can occur, as can myocarditis. In addition to these features, the more severe form of leptospirosis, called icteric leptospirosis or Weil disease, causes jaundice, renal impairment, and major hemorrhagic complications. Laboratory abnormalities include leukocytosis and thrombocytopenia. Myositis may cause elevated muscle enzymes. In icteric leptospirosis, the serum bilirubin typically remains < 20 mg/dL, although values as high as 60 to 80 mg/dL can occur. Transaminases are also usually elevated but rarely exceed 200 U/L.17 In 20 to 40% of icteric cases, renal impairment develops, accompanied by elevations in BUN (typically < 100 mg/dL) and creatinine (usually 2.0 to 8.0 mg/dL), as well as proteinuria, hematuria, and pyuria.17 Fatalities, significantly more frequent in the icteric form, typically arise from renal, cardiac, or respiratory failure. Both mild and severe cases often have a biphasic pattern, with an initial “leptospiremic” period and a subsequent “immune” phase marked by antibody production and urinary excretion of leptospira.17,21–22 This sequence occurred with our patient. The first phase usually lasts 4 to 9 days, followed by 1 to 3 symptom-free days, and then the second phase of fever and other features, especially aseptic meningitis.