Haff ("shallow lagoon") disease was first described in 1924 along the Konigsberger Haff on the coast of the Baltic Sea. It appears to be caused by a toxin ingested with freshwater fish that causes rhabdomyolysis.
Features of Haff Disease:
(1) ingestion of freshwater fish within previous 24 hours
(2) sudden onset of severe muscular rigidity with myalgia
(3) negative for fever with no or minimal neurologic findings
(4) rhabdomyolysis with myoglobinuria and marked elevation of the serum CK
(5) analysis for known toxins negative
(6) other causes of rhabdomyolysis negative
Additional findings:
(1) Many of the cases have involved cooked fish, indicating that the toxin is heat stable.
(2) The fish or a hexane-soluble extract of the fish can cause symptoms in laboratory animals.
(3) Implicated fish include burbot, eel, pike and buffalo fish.
(4) Along the Baltic Sea there have been seasonal outbreaks in the summer and fall. With the storage and global transport of fish, cases may not show seasonality and may be sporadic, remote from the site of fish capture.
(5) The mortality rate is low and most patients recover quickly. Weakness and fatigue may last for months after recovery from the initial phase of illness.
