Ceftriaxone is the most used third-generation cephalosporin anti-microbial agent in treating infections caused by gram-positive and gram-negative organisms. Chorea is a movement disorder characterized by involuntary and hyperkinetic movements of the affected body parts due to rapid and unpredictable contractions. We report an uncommon case of ceftriaxone-induced acute reversible chorea. 84-year-old male with a medical history of diabetes mellitus, hypertension, previous myocardial infarction, and gouty arthritis was admitted to the hospital with complaints of altered mental status (AMS) and right 1st metacarpal-phalangeal joint (MTP) swelling, erythema and ruptured wound draining pus-like fluid. The patient was febrile with a temperature of 101.3 F. The rest of the vitals were normal. The patient had an initial workup and was empirically started on ceftriaxone and vancomycin for skin and soft tissue infection. His wound cultures and blood cultures grew pan-sensitive streptococcus agalactiae. His antibiotics were de-escalated to ceftriaxone. X-ray showed severe soft tissue swelling and erosive changes at the base of the proximal phalanx of the first digit secondary to gout or osteomyelitis. MRI of the right foot was attempted, but the patient could not tolerate it. TTE was negative for Endocarditis. The patient had initial improvement in his AMS, but 72 hours later, he became increasingly confused with choreiform movements. Ceftriaxone was discontinued, and Ertapenem was started. Patient’s confusion and choreiform movements improved after the discontinuation of ceftriaxone. Patient was discharged to a rehabilitation facility with four weeks of IV Ertapenem. Ceftriaxone is a third-generation cephalosporin that inhibits mucopeptide synthesis in the bacterial cell wall. Ceftriaxone is a well-tolerated anti-microbial agent with a low toxicity profile. Common adverse effects include gastrointestinal disturbances, skin rashes, and hematological disorders. Neurological symptoms like encephalopathy is an uncommon adverse effect. Chorea is a movement disorder due to hereditary or acquired causes. Drug-induced chorea is one of the rare causes of acquired chorea. History and physical examination are essential in diagnosing acquired causes of chorea. Further workup with laboratory tests and neuroimaging are required to evaluate secondary causes. Chorea due to ceftriaxone is described in a patient with end-stage renal disease on hemodialysis in a case report previously, but our patient did not have any chronic kidney disease [1]. It is postulated that beta-lactam antibiotics increase neurological hyperexcitability by increased glutamate release in the striatum and cerebral cortex, causing movement disorders [2]. It is noted that pre-existing neurological conditions and excessive dosage are shown to be significant risk factors for cephalosporin neurotoxicity. Our patient, however, did not have any neurological condition but was treated with 2 grams of ceftriaxone daily before he had choreiform movements. Upon removal, the patient improved significantly within 36-48 hours. Ceftriaxone is a widely used anti-microbial with broad coverage. Although uncommon, recognizing that neurotoxicity due to third generation cephalosporins is essential. Prompt diagnosis and withdrawal of the offending agent is critical in improving the patient’s symptoms. Age, prior neurological conditions, kidney disease, and dosage must be carefully evaluated before administration.