The authors present a case study of a mentally healthy man who repeatedly experienced short-lived obsessional-like suicidal ideas & images after ingestion of the anti-fungal drug ketoconazole. Ego-alien, suicidal ideas are an extremely rare form of adverse drug reaction. This is probably the first report of the drug-induced ego-dystonic, mood incongruent suicidal ideas appearing in a fully conscious, healthy individual. (12 refs.)