Background: Organophosphorus (OP) pesticide poisoning is a major public health concern across Indian population. Its ingestion is associated with high morbidity and mortality. Early recognition and prompt management is important for saving patient’s life. Organophosphorus poisoning leads to three main syndromes: a) acute cholinergic syndrome b) intermediate syndrome c) OP induced delayed polyneuropathy.

Case Report: A 30-year-old female patient presented in emergency after consumption of organophosphorus pesticide. After proper resuscitation she was given atropine and pralidoxime and intubated and shifted to ICU. She was extubated after complete recovery but showed symptoms of muscle weakness and respiratory distress after two days pointing towards intermediate syndrome, an uncommon subacute complication of organophosphorus poisoning. The symptoms resolved with the use of glycopyrrolate and the patient eventually made a complete recovery.

Conclusion: Intermediate syndrome is characterized by the onset of weakness of neck flexors, proximal limb muscles and respiratory muscles within one to four days after organophosphorus poisoning. Recognition of this syndrome is important as it affects the respiratory system which may require ventilatory support.