Paraquat Poisoning: A Case of Daisley-Barton Syndrome and Hepatorenal Failure

Paraquat (PQ) is a highly toxic herbicide that causes severe poisoning. It mainly affects the lungs, liver, and kidneys. When ingested intentionally, it has a high mortality rate due to the absence of an effective antidote. We present a rare case of a 35-year-old female with deliberate ingestion of paraquat for a suicide attempt. Initially, she was treated conservatively at a local clinic; however, 2 days post-ingestion, she presented to the emergency department of a tertiary care hospital with complaints of respiratory distress, dysphagia, and mucocutaneous ulcerations. On laboratory examination, liver and renal function tests were deranged (AST 150 U/L, ALT 250 U/L, creatinine 18 mg/dL), and imaging revealed right-sided pneumothorax. Intensive supportive management (corticosteroids, antibiotics, N-acetylcysteine, and hemodialysis) was initiated, but the patient rapidly deteriorated, ultimately requiring mechanical ventilation; unfortunately, she succumbed to multi-organ failure in the Intensive Care Unit (ICU) within an hour of admission. This case report illustrates the novelty of paraquat poisoning and its characteristic clinical presentation (hepatorenal involvement), with atypical Daisley-Barton syndrome in Pakistan. Increased awareness and timely, precise management are crucial for preventing fatal complications, especially in resource-limited regions, and for mitigating serious case consequences.