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.