Haff Disease After Eating Salmon

Langley, Ricky L. MD, MPH; Bobbitt, William H. III MD

Disclosures

South Med J. 2007;100(11):1147-1150. 

In This Article

Abstract and Introduction

While fish consumption is considered a component of a heart-healthy diet, many illnesses have been associated with eating contaminated fish. The authors describe two cases of muscle weakness and rhabdomyolysis that occurred after eating salmon. Cases of rhabdomyolysis and muscle weakness after consumption of fresh water fish have rarely been reported in the United States but have been frequently reported from the Baltic region. This illness is known as Haff disease. While the etiology is unknown, it is felt to be a toxin. Palytoxin, found in marine fish, has been associated with rhabdomyolysis, and may serve as a model for further study of the suspected toxin responsible for rhabdomyolysis after consumption of fresh water fish. If a case of Haff disease is suspected, contact the Centers for Disease Control and Prevention and collect any uneaten fish, which may be sent for laboratory analysis.

Fish and other varieties of seafood are increasingly being recognized as an important component of a healthy diet. Many species of fish and shellfish are sources of omega 3 fatty acids.[1] Research has shown these fatty acids and other nutrients in fish to be beneficial in the neurologic development of the child and maintaining cardiovascular health.[2] However fish also may become contaminated with toxins, either natural or man-made, which can have adverse effects on humans if ingested. Mercury, PCBs and dioxins can bioaccumulate in fish tissue and have caused illness in people or their offspring after consumption.[3] The classic example is Minimata disease from consumption of fish contaminated with mercury.[4]

Fish and/or shellfish consume many different species of microalgae and dinoflagellates. These microscopic organisms can produce toxins.[5,6] Some of the recognized illnesses associated with consumption of contaminated seafood include paralytic shellfish poisoning, diarrheic shellfish poisoning, amnesic shellfish poisoning, ciguatera poisoning, puffer fish poisoning, and scombroid poisoning. Some of these poisonings cause fatalities or have severe sequelae.[5]

A rare illness in the United States due to consumption of fish or shellfish resulting in rhabdomyolysis is known as Haff disease. Only 21 cases have been reported in U.S. literature. Cases in the U.S. have been associated with the consumption of Buffalo fish[7,8] or crawfish[9] that originated in the waters of Louisiana or Missouri. We describe two additional cases in an elderly couple associated with the ingestion of a salmon meal.

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