Haff disease


Haff disease or Haff syndrome is the development of rhabdomyolysis (swelling and breakdown of skeletal muscle, with a risk of acute kidney failure) within 24 hours of ingesting fish.

It was first described in 1924 in the vicinity of Königsberg, Germany (now Kaliningrad, Russia) on the Baltic coast, in people staying around the haff (German: lagoon).Over the subsequent fifteen years, about 1000 cases were reported in people, birds and cats, usually in the summer and fall, and a link was made with the consumption of fish (burbot, eel and pike). Since that time, only occasional reports have appeared of the condition, mostly from the Soviet Union and Germany.

In 1997, six cases of Haff disease were reported in California and Missouri, all after the consumption of buffalo fish (Ictiobus cyprinellus). In July and August 2010, dozens of people contracted rhabdomyolysis after eating Procambarus clarkii in Nanjing, China. A month later, the Chinese authorities claimed they were victims of Haff disease.

The most recent US outbreak was reported in Brooklyn, NY on 18 November 2011, when two household members were stricken by the syndrome after eating Buffalo fish.


The most common symptoms are weakness, myalgia, nausea and abdominal pain. Other symptoms included dry mouth , vomiting, diarrhea, dizziness and headache.

No neurological abnormalities, fever, splenomegaly or heaptomegaly are observed.  


The disease is caused by a toxin that destroys skeletal muscle tissue — possibly cicutoxin, which is found in water hemlock, though the connection to Haff disease has never been proved, epidemiologist Mallory Becnel wrote last year in the Louisiana Mortality and Morbidity Report.


All patients reported consumption of fish within 24 hours before the onset of symptoms; some cases occurred in family clusters and no cases were observed after the beginning of the period of prohibition of fishing in the region that occurs every year from October to March.


Physical examination  

Laboratory evaluation included a normal complete blood count, normal electrolytes, blood urea nitro- gen and creatinine 


Treatment consisted of intravenous hydration, with administration of hepatic and stomach protective agents as well as diuretics. The drugs administered included glucurolactone, pantoprazole, furosemide, bicarbonate, reduced glutathione, inosine, cimetidine, calcium gluconate, and potassium chloride.