Motor neuropathy following inhalational exposure to aluminum phosphide: a case report and literature review.

Introduction: Aluminum phosphide (AlP) poisoning is a common means of self-harm in South Asia, while accidental inhalational exposure remains underreported despite its severe toxicity. This case reports a unique instance of acute neurotoxicity following inhalational AlP exposure, thereby expanding the current knowledge of phosphine-related neurological sequelae. Case presentation: A previously healthy 21-year-old female developed acute shortness of breath, vomiting, tingling sensations, and symmetrical limb weakness after inhaling AlP fumes. Examination revealed respiratory distress with bilateral limb weakness but preserved consciousness. Investigations showed respiratory alkalosis, elevated lactate, and transient hyperglycemia. She required ICU admission, mechanical ventilation, high-flow oxygen, and supportive care. Although clinically stabilized, persistent bilateral lower-limb weakness remained. Neuroimaging excluded central causes, suggesting peripheral motor neuropathy secondary to phosphine toxicity. Nerve conduction studies were planned during follow-up; however, the patient declined further evaluation because of financial constraints. Conclusion: This case highlights inhalational AlP as a dangerous route of exposure, capable of inducing early and significant neurological deficits even in the absence of altered mental status. It underscores the importance of heightened clinical vigilance, early neuro-monitoring, and research into neuroprotective strategies for phosphine toxicity. It also emphasizes the need for public education on the dangers of pesticide misuse, particularly in unventilated environments.