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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.