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This is a fascinating toxicology detective story with real hematology lessons. Among 82 mostly young male migrants arriving in Lampedusa, median methemoglobin was 45% (43% were at 50% or higher), and the culprit was dermal absorption of N-methylaniline, a gasoline additive, from fuel-contaminated seawater pooling in the boats. Our takeaway is the delayed hemolysis: it hit most patients with available data around days 2 to 4 (up to day 7), every patient with transfusion data needed blood, 4 had splenic rupture, and G6PD deficiency turned up in 16 of 44 tested. It's a good reminder that antidotes only work if they are on the shelf.