 Puffer fish, Lagocephalus celeratus is a well-known source of deadly food poisoning due to a neurotoxin called tetrodotoxin. Cases of tetrodotoxin poisoning are common along the coasts of east Asian countries but rare in the Arabian Gulf region. Here, we report a case of a 19-year-old man who presented with signs and symptoms suggestive of puffer fish poisoning. Dietary history was the key to diagnosis the laboratory investigations and imaging yielded normal results. Early diagnosis and proper supportive management are essential for survival. This article was authored by Amar al-Hamsi, Nura's Hassan, Imad Hamad, and others.