Cefepime-Induced Delirium in a Patient With Chronic Kidney Disease: A Case Report

AI Summary

Cefepime can cause neurotoxicity presenting as confusion, visual hallucinations, and agitation, with heightened risk in patients with renal impairment.
Symptoms arose within 24 to 48 hours of starting cefepime and resolved within 24 hours after withdrawal; Naranjo score classified the reaction as probable.
Clinicians should closely monitor renal patients on cefepime, consider alternative therapies or dose adjustment, and recognise neurotoxicity early to avoid unnecessary interventions.

AI Summary

This case report describes a 63-year-old woman with chronic kidney disease secondary to autosomal dominant polycystic kidney disease who developed acute confusional symptoms after initiating cefepime during treatment of a urinary tract infection associated with infected renal cysts.

Although alternative contributors to delirium were present, including acute infection and renal dysfunction, the temporal relationship between cefepime exposure and symptom onset, together with rapid symptom resolution after withdrawal, supported cefepime-induced neurotoxicity as the most likely diagnosis.

This case reinforces the importance of considering cefepime-induced neurotoxicity in the differential diagnosis of delirium, particularly in patients with renal dysfunction.

Basic summary

Cureus. 2026 Jun 24;18(6):e111418. doi: 10.7759/cureus.111418. eCollection 2026 Jun.

ABSTRACT

Delirium is a frequent yet often underrecognised complication in hospitalised patients, particularly in those with renal impairment. Cefepime, a broad-spectrum cephalosporin, has been increasingly associated with neurotoxicity, manifesting as confusion, hallucinations, and agitation. This case report describes a 63-year-old woman with chronic kidney disease secondary to autosomal dominant polycystic kidney disease who developed acute confusional symptoms after initiating cefepime during treatment of a urinary tract infection associated with infected renal cysts. Following clinical improvement of the underlying infection, she developed temporal disorientation and visual hallucinations within 24-48 hours of cefepime initiation, which resolved within 24 hours of drug discontinuation. The Naranjo Adverse Drug Reaction Probability Scale classified the association as “probable” (score: 6). Although alternative contributors to delirium were present, including acute infection and renal dysfunction, the temporal relationship between cefepime exposure and symptom onset, together with rapid symptom resolution after withdrawal, supported cefepime-induced neurotoxicity as the most likely diagnosis. This case reinforces the importance of considering cefepime-induced neurotoxicity in the differential diagnosis of delirium, particularly in patients with renal dysfunction. Close clinical monitoring and early recognition are essential to prevent misdiagnosis and unnecessary interventions. Further studies are needed to refine risk assessment and explore safer therapeutic alternatives.

PMID:42500764 | PMC:PMC13399948 | DOI:10.7759/cureus.111418

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