Metal fume fever (MFF) is an acute industrial disease caused by the inhalation of a variety of heavy metal oxides. MFF occurs most commonly during welding operations, particularly those involving zinc oxide. The illness is of short duration and produces symptoms of cough, fever, chills, malaise, and myalgias. Its etiology is uncertain, and its diagnosis is difficult because symptoms resemble a number of pulmonary illnesses. Supportive treatment, with bed rest, analgesics, and fever control is used for symptomatic relief. Emergency medicine physicians must differentiate the clinical picture from other common respiratory illnesses. The mainstay of therapy for MFF consists of recognizing the disease and preventing subsequent exposure to harmful metals.