Timeline of medical history for patient with severe myasthenic manifestation of leptospirosis, including results of relevant neurologic and laboratory investigations. Decrement in repetitive stimulation denotes the maximum decrease in amplitude of the fourth or fifth compound muscle action potential waveform during supramaximal repetitive nerve stimulation at 3 Hz. A decrement >10% is regarded as pathologic (6). Leptospira ELISA cutoff values: IgG, <10 U/mL negative, 15 U/mL positive; IgM, <15 U/mL negative, >20 U/mL positive. CRP, C-reactive protein; LRP4, lipoprotein receptor-related protein 4.