We describe a patient who accidentally received an infusion of cyclosporin
at a rate of 30 mg/hr during 13 hr instead of the prescribed dose of 3 mg/h
r and who concomitantly developed massive intracerebral edema with brainste
m compression and death. A cyclosporin level as high as 1700 ng/ml could ha
ve been reached before the drug was withdrawn. To the best of our knowledge
, this is the first case of fatal cyclosporin overdose reported in an adult
patient.