Cephalosporin neurotoxicity: An overlooked cause of toxic-metabolic encephalopathy

Consider the following case: A 75-year-old woman with a history of chronic renal failure is admitted to the hospital for shortness of breath. She is diagnosed with pneumonia and started on ceftriaxone. Three days later, she is disoriented, speaking “ragtime,” and has intermittent myoclonus. The on-call neurologist is asked to evaluate the patient for the cause of her “altered mental status.”