Paraquat is a bipyridilium herbicide which is highly toxic. Due to its corrosive effects, it can lead to esophagitis, esophageal rupture, and gastritis. It leads to the formation of reactive oxygen species which causes multiorgan damage, prominent among those being pulmonary, renal, and liver dysfunction. One of the rare causes of respiratory distress after paraquat poisoning is spontaneous pneumothorax due to pneumocyte injury, also known as the “Daisley Barton Syndrome.” We report a case of paraquat poisoning who developed alveolitis initially and later had bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and the patient recovered initially but later deterorated due to other complications. We should be aware of this phenomenon, and sudden worsening of the respiratory parameters should alert the clinician for prompt treatment.
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