Case Report

Fatal outcome due to cyclosporine neurotoxicity with associated pathological findings

  • Bone Marrow Transplantation volume 23, pages 191193 (1999)
  • doi:10.1038/sj.bmt.1701542
  • Download Citation


We present a case of death likely to be directly due to cyclosporine (CsA) neurotoxicity. To date, there have been no reports of deaths directly due to CsA neuro- toxicity, nor has an associated histological lesion been described independent of confounding processes. A 54-year-old male received an HLA-matched-unrelated BMT for CML. He developed progressive encephalo- pathy and on day +79 had a generalized seizure. All CSF studies were negative for infectious causes. MRI revealed diffuse, symmetrical white matter abnormalities located in the occipital sub-cortex, thalamus, mid brain, pons, and cerebellum which were typical of CsA toxicity. The patient died of central respiratory failure within 72 h of discontinuing CsA. Autopsy revealed diffuse patchy white matter edema and astrocytic injury without evidence of axonopathy, demyelination, microvascular injury, or infectious/inflammatory process. This case demonstrates previously undescribed lethal CsA neurotoxicity and may reveal an associated primary pathological lesion.

Author information


  1. Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    • AK Gopal
  2. Department of Medicine, Division of Medical Oncology, University of Washington, WA, USA

    • AK Gopal
  3. Department of Pathology, University of Washington, WA, USA

    • DR Thorning
    •  & AL Back
  4. Veterans Administration, Puget Sound Health Care System, Seattle, WA, USA

    • DR Thorning
    •  & AL Back


  1. Search for AK Gopal in:

  2. Search for DR Thorning in:

  3. Search for AL Back in:

Corresponding author

Correspondence to AK Gopal.