Introduction: Methemoglobinemia is a rare and potentially life-threatening medical emergency. It can be acquired from a variety of chemicals, medications and drugs and can be overlooked when evaluating someone in respiratory distress. Without early recognition respiratory failure and death may result. Case: A 14-year-old female presented to the emergency department by EMS for dyspnea and lightheadedness. Her mother reported a blue color to her lips and fingers and stated she collapsed twice that day. While several common etiologies were being considered, blood drawn for labs was found to be dark brown in color. Subsequent laboratory results confirmed an elevated methemoglobin. Methylene blue was administered with resolution of the patients' symptoms and she was stabilized for admission. Discussion: Diagnosis requires a thorough history, physical exam and appropriate diagnostic testing. Methemoglobinemia must be included in the differential for this presentation as rapid clinical recognition and treatment are vital to patient outcomes.