Background: Toxic levels of vitamin A may accumulate in the livers of certain fish species, such as sharks, snappers, tuna and sea basses. Ingestion of large amounts of fish liver therefore can cause vitamin A poisoning, an illness characterized by severe headache, fever and desquamation. Although fish liver ingestion could cause vitamin A poisoning, human poisoning cases are rarely reported. Methods: We retrospectively reviewed the records of patients with suspected fish liver poisoning reported to the Taiwan Poison Center (PCC-Taiwan) from July 1986 through April 2007. Patient's age, gender, reason of exposure, time of exposure, ingested fish species, time elapsed after exposure, clinical manifestations, treatments, and outcomes were collected and analyzed. Results: A total of 6 incidents involving 19 patients were identified. Males outnumbered females (68% vs. 32%) in vitamin A poisoning related to fish liver ingestion. The culprit fish species were tuna in 8 patients (1 incident), sea bass in 1 patient, snapper in 3 patients (1 incident), and unknown fish species in 7 patients (3 incidents). Following the consumption of fish liver, all patients developed gastrointestinal and neurological effects, such as nausea, dizziness, headache, and weakness, within 4 to 12 hours. Some patients also manifested fever, facial flush, hypertension, and conjunctival congestion. Diffuse desquamation and/or hair loss, which might last up to 8 weeks, developed after the resolution of the aforementioned manifestations within 1 to 4 days. All of the patients recovered well with supportive therapy alone. Conclusion: Ingestion of fish livers that are rich in vitamin A can result in moderate to severe poisonings. Although it is not possible to completely exclude the coexistence of ciguatera poisoning in some of the patients, the major effects of fish liver poisoning in this study resembled those of acute hypervitaminosis A from overdosage of dietary vitamin A supplements. Prompt diagnosis of acute vitamin A poisoning can be difficult in the absence of diffuse desquamation because the clinical manifestations are indistinguishable from ciguatera poisoning and routine bioassay is unavailable. Management of vitamin A poisoning related to fish liver ingestion is primarily symptomatic and supportive, and the outcome is generally favorable.