Haff disease associated rhabdomyolysis is correlated with the ingestion of certain freshwater fish and shellfish and is caused by an unidentified toxin. We report the case of a patient who experienced rhabdomyolysis approximately 2 hours after ingestion of the freshwater fish Mylossoma duriventre (pacu-manteiga) approximately 3 years after an outbreak had been reported in Manaus, Brazilian Amazon.
Rhabdomyolysis/diagnosis; Foodborne diseases; Fishes; Diagnosis, differential; Case reports
| Tests | Results |
| Abdominal and pelvic CT | Within the normal range |
| Chest X-ray | Within the normal range |
| Electrocardiogram | Sinus rhythm + incomplete left bundle-branch block |
| Hemoglobin (/mm3) | 14.6 milion |
| Hematocrit (%) | 41.6 |
| Leukocytes (/mm3) | 12.6 thousand |
| Eosinophils (%) | 1 |
| Band neutrophils (%) | 7 |
| Segmented neutrophils (%) | 73 |
| Lymphocytes (%) | 16 |
| Platelets (/mm3) | 218.000 |
| Glucose (mg/dL) | 133 |
| C-reactive protein (mg/dL) | 0.15 |
| Urea (mg/dL) | 43 |
| Creatine (mg/dL) | 0.9 |
| Sodium (mEq/l) | 138 |
| Potassium (mEq/l) | 3.5 |
| Total CPK (U/L) | 4.456 |
| Myoglobin (ng/mL) | 37,868.5 |
| Troponin (ng/mL) | 0.01 |
| Tests | Results | ||||||
| Admission | Day 1 ICU | Day 2 ICU | Day 3 ICU | Day 4 ICU | Day 5 ICU | Day 8 at hospital | |
| Total leukocytes (/mm3) | 12.600 | 19.900 | 18.300 | 10.300 | 8.900 | 6.600 | |
| Band neutrophils (%) | 7 | 9 | 8 | 6 | 3 | 3 | |
| Total CPK (U/L) | 4.456 | 61.730 | 47.764 | 16.170 | 7.127 | 319 | |
| CPK MB (U/L) | 2.921 | ||||||
| Troponin (ng/mL) | 0.01 | 0.01 | |||||
| Myoglobin (ng/mL) | 37.868.5 | 32.663 | 1.241 | 137.9 | 94.3 | 44 | |
| Lactic acid (mg/dL) | 22.0 | 19 | 18 | 17 | |||
| C-reactive protein (mg/dL) | 0.15 | 0.29 | |||||
| Urea (mg/dL) | 43 | 44 | 21 | 16 | 14 | 16 | 22 |
| Creatinine (mg/dL) | 0.9 | 0.8 | 0.6 | 0.7 | 0.7 | 0.6 | 0.7 |
| pH | 7.381 | 7.559 | 7.419 | 7.45 | 7.42 | ||
| Sodium (mEq/l) | 138 | 139 | 145 | 142 | 143 | 142 | 140 |
| Potassium (mEq/l) | 3.5 | 3.7 | 3.9 | 3.7 | 3.8 | 4.2 | 4.2 |
| Ionic calcium (mg/dl) | 4.0 | 3.9 | 4.4 | 4.6 | |||
