Linda L. Herman, MD, Christine Bies, MD


Western J Emerg Med. 2014;15(6):664-666. 

In This Article

Abstract and Introduction


Haff disease, rhabdomyolysis after ingesting certain types of fish, was first reported in 1924 in Europe. There have been a limited number of cases reported in the United States. We present the case of a patient who presents with symptoms of rhabdomyolysis after eating cooked buffalo fish purchased at a suburban grocery market.


Fish consumption is considered part of a healthy diet. Fish is lower in total calories, saturated fat and total fat than a comparable amount of red meat. However, like all food products, there are potential illnesses associated with the consumption of fish. Common illnesses known to be associated with fish consumption in the United States include Scombroid and Ciguatera poisoning and are well known to emergency medicine (EM) physicians, but Haff disease is unfamiliar to most. A rare consideration, it is important to recognize the symptoms that occur with Haff disease because the treatment of the rhabdomyolysis requires specific interventions, primarily larger amounts of intravenous fluid than those used to replace the fluid loss from the vomiting and diarrhea associated with more common fish poisonings.

Chest pain accompanying the presentation of Haff disease may be confused with aortic dissection or cardiac ischemia. This may result in extensive, invasive and expensive testing for conditions that the patient does not have. We present the case of a patient who developed rhabdomyolysis after ingestion of cooked buffalo fish. The patient's initial presentation included back and chest pain prompting concern for a possible aortic dissection. Despite the sporadic nature of the presentation of this etiology for rhabdomyolysis, Haff disease must be considered in the differential diagnosis so that appropriate treatment can be initiated.