Two Distinct Adverse Drug Reaction in a Single Patient: Antipsychotics-Induced Tardive Dyskinesia and Suspected Ceftriaxone-Induced Fixed Drug Eruption-Like Reaction

Antipsychotic medications are associated with tardive dyskinesia (TD), while cephalosporins like ceftriaxone can rarely induce fixed drug eruption (FDE). Concurrent occurrence of these adverse drug reactions (ADR) in a single patient is uncommon. We document a 62-year-old female with psychosis who developed involuntary orofacial and hand movements after prolonged haloperidol and olanzapine use, consistent with tardive dyskinesia. During hospitalization for fever, she was treated with ceftriaxone and subsequently developed erythematous rashes at the waistline that evolved into hyperpigmentation, resembling an FDE-like reaction. Haloperidol was discontinued and replaced with aripiprazole, while ceftriaxone was replaced with ciprofloxacin. Both neurological and dermatological unwanted effects gradually improved. This dual ADR presentation underscores the risk factors of older age, female gender, and polypharmacy in ADR development. According to the Naranjo scale, both ADRs were deemed “probable.” The case highlights the need for multidisciplinary management, careful monitoring, and cautious drug selection in vulnerable populations. Dual ADRs, though rare, can complicate therapy and prolong hospitalization. Early identification, withdrawal of the offending drugs, and tailored pharmacotherapy can improve patient outcomes while reinforcing the necessity of vigilant pharmacovigilance in clinical practice.