Elevated Liver Enzymes as a Manifestation of Haff Disease.
Adult
Alanine Transaminase
/ analysis
Aspartate Aminotransferases
/ analysis
Creatine Kinase
/ analysis
Diarrhea
/ etiology
Emergency Service, Hospital
/ organization & administration
Enzymes
/ analysis
Humans
Liver
/ enzymology
Male
Rhabdomyolysis
/ blood
Saline Waters
/ adverse effects
Seafood
/ adverse effects
Vomiting
/ etiology
ALT
AST
CK
CPK
Haff disease
LFT
buffalo fish
gastroenteritis
liver enzymes
myalgias
rhabdomyolysis
seafood
urinalysis
Journal
The Journal of emergency medicine
ISSN: 0736-4679
Titre abrégé: J Emerg Med
Pays: United States
ID NLM: 8412174
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
22
02
2019
revised:
04
07
2019
accepted:
01
08
2019
pubmed:
27
11
2019
medline:
25
8
2020
entrez:
27
11
2019
Statut:
ppublish
Résumé
Haff disease is a rare syndrome of rhabdomyolysis thought to be caused by a heat-stable toxin associated with the consumption of seafood from fresh or brackish water. We present the case of a patient with Haff disease who presented to the emergency department with nausea/vomiting, diarrhea, and myalgias after a seafood buffet. Initially, he was treated with i.v. fluids and antiemetics for presumed gastroenteritis, but his symptoms did not improve. He was found to have elevated aspartate aminotransferase and alanine aminotransferase, normal point-of-care ultrasound, urinalysis with large blood and no red blood cells, and an elevated creatine phosphokinase (CPK). He was admitted to the hospital to receive ongoing fluid resuscitation for rhabdomyolysis presumed to be from fish. Liver enzymes and CPK downtrended, and patient was discharged on hospital day 3. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Undiagnosed Haff disease has important clinical implications, including multi-organ failure and death. Always maintain a high level of suspicion for Haff disease in patients with symptoms suggestive of gastroenteritis, but complicated by minor liver function test elevations and dipstick positivity for heme, without significant numbers of red blood cells per high-power field, in the setting of recent seafood ingestion.
Sections du résumé
BACKGROUND
BACKGROUND
Haff disease is a rare syndrome of rhabdomyolysis thought to be caused by a heat-stable toxin associated with the consumption of seafood from fresh or brackish water.
CASE REPORT
METHODS
We present the case of a patient with Haff disease who presented to the emergency department with nausea/vomiting, diarrhea, and myalgias after a seafood buffet. Initially, he was treated with i.v. fluids and antiemetics for presumed gastroenteritis, but his symptoms did not improve. He was found to have elevated aspartate aminotransferase and alanine aminotransferase, normal point-of-care ultrasound, urinalysis with large blood and no red blood cells, and an elevated creatine phosphokinase (CPK). He was admitted to the hospital to receive ongoing fluid resuscitation for rhabdomyolysis presumed to be from fish. Liver enzymes and CPK downtrended, and patient was discharged on hospital day 3. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Undiagnosed Haff disease has important clinical implications, including multi-organ failure and death. Always maintain a high level of suspicion for Haff disease in patients with symptoms suggestive of gastroenteritis, but complicated by minor liver function test elevations and dipstick positivity for heme, without significant numbers of red blood cells per high-power field, in the setting of recent seafood ingestion.
Identifiants
pubmed: 31767218
pii: S0736-4679(19)30659-6
doi: 10.1016/j.jemermed.2019.08.007
pii:
doi:
Substances chimiques
Enzymes
0
Aspartate Aminotransferases
EC 2.6.1.1
Alanine Transaminase
EC 2.6.1.2
Creatine Kinase
EC 2.7.3.2
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e181-e183Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.