Tetrodotoxin poisoning has been commonly reported in Japan due to consumption of contaminated fugu (puffer fish). Poisoning is possible when the fish is not cleansed and dressed properly. Puffer fish is considered a delicacy by the Japanese as the fish meat is very tender and tasty. A certified chef trained in ways of preparing this poisonous fish should only be allowed to serve this fish. Despite careful preparation, this fish remains a deadly meal for many as 50 deaths are reported annually1 . An outbreak of 34 cases of tetrodotoxin occurred in Johor in May 2008. Here, we would like to report three cases of tetrodotoxin poisoning in a family who consumed this deadly fish and was admitted to Hospital Sultanah Aminah Johor Bahru (HSAJB).