Fatalities are still reported following methanol poisoning. Methanol is extensively metabolized by alcohol dehydrogenase to formaldehyde and by aldehyde dehydrogenase to formic acid which is the main toxic metabolite. Survival with extremely high blood methanol concentration is possible provided that aggressive symptomatic and specific therapy is applied. This is illustrated by the clinical observation of a 27-year-old man who was admitted 22 hours after poisoning and presented a peak blood methanol concentration of 12.9 g/l. Treatment included correction of metabolic acidosis, ethanol infusion, haemodialysis and peritoneal dialysis. The patient survived with moderate visual sequelae and oesophageal stenosis. The range of toxicity of methanol according to blood levels determination is discussed.