Background <p>Aluminium phosphide (AlP) is a highly toxic pesticide widely used for grain preservation in agriculture. Acute poisoning with AlP can lead to severe systemic effects, including polyneuropathy. This case study explores the presentation, diagnosis, and management of polyneuropathy induced by AlP poisoning.</p> Case study <p>This is a rare case of AlP poisoning that emphasizes on the patients progressive development of neuropathic symptoms, initial assessment revealed signs of systemic toxicity, including hypotension, tachycardia, and metabolic acidosis. Despite aggressive decontamination and supportive care, neuropathic symptoms such as paresthesia, muscle weakness, and bilateral lower limb sensory-motor polyneuropathy leading to gait disturbances were observed. Comprehensive diagnostic evaluation included blood tests, 2D echocardiography and nerve conduction studies. Blood tests confirm elevated cardiac biomarkers and metabolic derangements consistent with AlP poisoning. CNS examination and nerve conduction studies revealed diffuse sensory and motor neuropathy. Despite initial improvement in systemic symptoms, the patient’s neuropathic symptoms persisted. Follow-up over two weeks showed gradual improvement in muscle strength and sensory function, though some residual deficits remained.</p> Conclusion <p>The case highlights the importance of early recognition and intervention in AlP poisoning to potentially mitigate long-term neurological sequelae. AlP induced polyneuropathy is a rare but serious complication of AlP poisoning. Prompt diagnosis and management are crucial to improving outcomes. This case underscores the need for increased awareness among healthcare providers regarding the potential for neurological involvement in AlP toxicity and the importance of ongoing follow-up to address chronic effects.</p>