{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T11:02:06Z","timestamp":1776250926995,"version":"3.50.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Calcineurin inhibitors are widely used in organ transplantation and nephrotic syndrome, with chronic toxicities well documented, but acute toxicity is rarely reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a 3.9-year-old boy with steroid-dependent nephrotic syndrome who accidentally ingested a single dose of cyclosporine A (CsA) at 75\u2005mg\/kg (1,500\u2005mg)\u2014 over 20 times the intended dose of 3.5\u2005mg\/kg (70\u2005mg)\u2014due to medication error. He developed transient abdominal pain, diarrhea, and vomiting, which resolved without treatment. Error was discovered 12\u2005h post-ingestion, and he was hospitalized with a CsA trough level of 1003\u2005ng\/mL (measured 13\u2005h after ingestion), yet remained clinically stable. Management included CsA discontinuation, intravenous hydration, rifampin- and phenobarbital-induced cytochrome P450 activation, resulting in normalization of CsA levels within 48\u2005h. A literature review identified 28 pediatric cases of acute CsA overdose, with presentations ranging from asymptomatic to severe neurotoxicity and acute kidney injury. The varied, including supportive care, gastrointestinal decontamination, and enzyme induction, with generally favorable outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although rare, acute CsA overdose in children can pose serious risks. This case and review underscore the symptoms of overdose and prompt intervention to prevent complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1737399","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:55:03Z","timestamp":1769064903000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute cyclosporine overdose in a child with nephrotic syndrome: a case report and literature review"],"prefix":"10.3389","volume":"14","author":[{"given":"Eun Song","family":"Song","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Chonnam National University Hospital and Medical School","place":["Gwangju, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eun Mi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chonnam National University Hospital and Medical School","place":["Gwangju, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"44","DOI":"10.3390\/children12010044","article-title":"Epidemiological and clinical characteristics of pediatric acute drug intoxications: a retrospective analysis","volume":"12","author":"Singer","year":"2025","journal-title":"Children"},{"key":"B2","doi-asserted-by":"publisher","first-page":"100358","DOI":"10.1016\/j.mcpsp.2022.100358","article-title":"Acute cyclosporine overdose: a systematic review","volume":"6","author":"Ershad","year":"2023","journal-title":"Med Cl\u00edn Pr\u00e1ct"},{"key":"B3","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/s00467-024-06546-8","article-title":"Challenges in acute cyclosporine toxicity in a child with steroid-dependent nephrotic syndrome","volume":"40","author":"Gulmez","year":"2025","journal-title":"Pediatr Nephrol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"266","DOI":"10.2165\/00002018-199106040-00004","article-title":"Acute cyclosporin overdose. a review of present clinical experience","volume":"6","author":"Arellano","year":"1991","journal-title":"Drug Saf"},{"key":"B5","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/978-3-319-32159-2_25","article-title":"Cyclosporine in pediatric dermatology","volume-title":"Practical Pediatric Dermatology: Controversies in Diagnosis and Treatment","author":"Al-Mutairi","year":"2016"},{"key":"B6","doi-asserted-by":"publisher","first-page":"67","DOI":"10.21037\/tgh.2019.08.08","article-title":"A novel player: cyclosporine therapy in the management of inflammatory bowel disease","volume":"4","author":"Weissman","year":"2019","journal-title":"Transl Gastroenterol Hepatol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1038\/sj.ki.5002553","article-title":"Cyclosporin in idiopathic glomerular disease associated with the nephrotic syndrome: workshop recommendations","volume":"72","author":"Cattran","year":"2007","journal-title":"Kidney Int"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1957","DOI":"10.2165\/00003495-200161130-00006","article-title":"Cyclosporin: an updated review of the pharmacokinetic properties, clinical efficacy and tolerability of a microemulsion-based formulation (neoral) in organ transplantation","volume":"61","author":"Dunn","year":"2001","journal-title":"Drugs"},{"key":"B9","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/S0300-483X(02)00283-4","article-title":"Mechanisms of cytochrome P450 regulation by inflammatory mediators","author":"Morgan","year":"2002","journal-title":"Toxicology"},{"key":"B10","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/S0163-7258(01)00165-6","article-title":"Alteration of drug biotransformation and elimination during infection and inflammation","volume":"92","author":"Renton","year":"2001","journal-title":"Pharmacol Ther"},{"key":"B11","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/0002-9610(89)90541-2","article-title":"Cyclosporine pharmacokinetic drug interactions","volume":"157","author":"Baciewicz","year":"1989","journal-title":"Am J Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"33","DOI":"10.3390\/pharma3010002","article-title":"Rescue therapy for supratherapeutic concentrations of calcineurin inhibitors using potent cytochrome P450 inducers","volume":"3","author":"Duwor","year":"2024","journal-title":"Pharmacoepidemiology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"239","DOI":"10.2165\/00128072-200002030-00007","article-title":"Medication errors in paediatrics: a case report and systematic review of risk factors","volume":"2","author":"Diav-Citrin","year":"2000","journal-title":"Paediatr Drugs"},{"key":"B14","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1007\/s40800-015-0023-3","article-title":"Accidental overdose of oral cyclosporine in haematopoietic stem cell transplantation: a case report and literature review","volume":"2","author":"Tafazoli","year":"2015","journal-title":"Drug Saf Case Rep"},{"key":"B15","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1111\/j.1600-6143.2012.04347.x","article-title":"Acute calcineurin inhibitor overdose: analysis of cases reported to a national poison center between 1995 and 2011","volume":"13","author":"Ceschi","year":"2013","journal-title":"Am J Transplant"},{"key":"B16","first-page":"2763","article-title":"Comparative study of cyclosporine and FK 506 dosage requirements in adult and pediatric orthotopic liver transplant patients","volume":"23","author":"Jain","year":"1991","journal-title":"Transplant Proc"},{"key":"B17","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1177\/08830738060210100501","article-title":"Intractable epilepsy secondary to cyclosporine toxicity in children undergoing allogeneic hematopoietic bone marrow transplantation","volume":"21","author":"Gaggero","year":"2006","journal-title":"J Child Neurol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/BF00866326","article-title":"Treatment of a child with acute cyclosporine overdose","volume":"6","author":"Anderson","year":"1992","journal-title":"Pediatr Nephrol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1016\/S0140-6736(85)91660-5","article-title":"Activated charcoal in acute cyclosporin overdose","volume":"325","author":"Honcharik","year":"1985","journal-title":"Lancet"},{"key":"B20","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1111\/j.1399-3046.2005.00368.x","article-title":"Treatment of acute tacrolimus whole-blood elevation with phenobarbital in the pediatric liver transplant recipient","volume":"9","author":"Quir\u00f3s-Tejeira","year":"2005","journal-title":"Pediatr Transplant"}],"updated-by":[{"DOI":"10.3389\/fped.2026.1838282","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000}}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1737399\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T10:17:44Z","timestamp":1776248264000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1737399\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,22]]},"references-count":20,"alternative-id":["10.3389\/fped.2026.1737399"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1737399","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,22]]},"article-number":"1737399"}}