Delirium associated with moxifloxacinin a patient with toxic epidermal necrolysis due to methazolamide: a case report.

BACKGROUND

Toxic epidermal necrolysis (TEN) is a potentially life-threatening adverse drug reaction characterized by extensive epidermal detachment and mucosal erosions. While delirium is a known complication in critically ill patients, its association with TEN remains poorly characterized.

CASE: We report a case of moxifloxacin-induced delirium with psychotic features in a patient who developed TEN secondary to methazolamide following orbital trauma. Physical examination revealed erythematous plaques with multiple flaccid bullae and widespread skin sloughing involving more than 40% of the total body surface area. The SCORTEN score was calculated as 2, corresponding to a predicted mortality rate of 12.1%. The patient was treated with intravenous immunoglobulin, systemic glucocorticosteroids, and supportive care. During hospitalization, she developed delirium attributable to moxifloxacin administration, which resolved promptly upon drug discontinuation.

CONCLUSION

Delirium in critically ill dermatological conditions such as TEN is often multifactorial in origin. It may arise as a direct complication of severe systemic illness or as an adverse effect of necessary pharmacotherapy, with fluoroquinolones representing a well-recognized precipitant.