A 39-year-old man on business in Japan was brought to the emergency room (ER) by paramedics with initial complaints of numbness and tingling around the face and mouth. His symptoms progressed to include lightheadedness and nausea/vomiting, which prompted the visit. He had just completed a successful business venture and had celebrated the occasion with dinner at a fine restaurant by feasting on some puffer fish, a Japanese delicacy. Upon his arrival, he rapidly became unable to move and had severe respiratory distress. Telemetry recordings demonstrated an irregular heart beat. He was quickly intubated and placed on mechanical ventilation. Unfortunately, he expired shortly after his presentation. Autopsy confirmed a diagnosis of tetrodotoxin (TTX) poisoning.