An odd pilgrim in the Holy Land.

Fugu is a delicate dish prepared from Lagocephalus scleratus, a poisonous fish that contains tetrodotoxin--a very potent neurotoxin. It is usually confined to the Indo-Pacific Ocean where it is responsible for many accidental deaths each year. This very weird case report is about an Israeli couple that was poisoned by this fish caught for the first time in the eastern Mediterranean Sea. The prompt identification of the yet unrecognized fish by professional zoologists enabled an immediate effective treatment. This case represents another interesting manifestation of the globalization process our world undergoes and emphasizes, once again, the need of present emergency physicians to be aware of remote overseas medical problems. The article discusses the possible presumptions of the ways the fish arrived to the Mediterranean Sea and elaborates a review on tetrodotoxin from historical, structural, biologic activity as well as the diagnostic and treatment means available today.