Scombroid poisoning is a syndrome of histamine toxicity. It was first described in 1799 [1]. Scombroidpoisoning occurs after ingestion of contaminated oily fish that is not properly refrigerated. Fish of the Scombroidae and Scomberesocidae family cause many of the cases of scombroid. Tuna fish accounts for more than 80% of cases. Mackerel, Bonito, salmon and even dolphin have also been known to cause scombroid[1]. In 2016, physicians at USC reported one case of Scombroid poisoning from Tilapia. Tilapia is a non-scrombroidae fish and has never been associated with scombroid poisoning. Histamine levels greater than 50 mg of histamine per 100 g of fish are associated with clinical toxicity. An in vitro public health survey identified histamine levels of 290 mg/100 g of fish in the Tilapia species [2]. Despite these high levels, a literature review shows only one case of suspected scombroid poisoning has been reported in humans. We present another case of Scombroid poisoning from Tilapia.