To the Editor.—Eastaugh and Shephard, 1 in the review article that appeared in the August 1989 issue of the Archives, did not include Haff disease. The first epidemic of myopathy due to this disease occurred in 1924 around the shores of the Bay of Königsburg Haff on the Baltic Sea in East Prussia, and a second epidemic occurred in the same region in 1932.2 An epidemic occurred around the shores of Lake Onega in Russia in 1934 and around Lake Yinsen near Mariestad in Sweden in 1942.3 In 1985, Sidorova et al reported 10 epidemics in 60 years in Russia, the most recent being in October 1984 on the shore of Lake Ubin.4
The clinical picture is that of severe generalized muscle pain and tenderness with weakness, especially in the lower extremities. Tachypnea, diaphoresis, tachycardia, hypertension, and a drop in temperature occurs. The urine may turn
SOLOMON M. Haff Disease. Arch Intern Med. 1990;150(3):683. doi:10.1001/archinte.1990.00390150149028
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