Central cyanosis is common clinical presentation in neonates and infants which is highly associated with congenital heart diseases (CHD) but this presentation is very unusual in adults presenting only with fever. However, thinking of central cyanosis in adults can lead us to variety of causes ranging from pulmonary embolism to valvular heart defects as well as arteriovenous malformation and poisoning. Through clinical evaluation and point of care echocardiography gives the insight of unusual diagnosis.