Alice in Wonderland syndrome following adenovirus infection, manifesting with biphasic perceptual disturbances.

This report presents a rare case of a boy in middle childhood who developed Alice in Wonderland syndrome (AIWS) after an adenovirus infection. During the febrile phase, he experienced persistent auditory hallucinations that continued into the post-febrile period and gradually attenuated, followed by visual perceptual distortions. Neurological examination, electroencephalography and brain imaging revealed unremarkable findings. He had pre-existing hyperactivity, talkativeness and delayed task performance, which were identified after presentation and led to a diagnosis of attention-deficit/hyperactivity disorder (ADHD). To our knowledge, this is the first reported case of AIWS associated with adenovirus infection, showing a biphasic pattern of auditory and visual disturbances. Although auditory symptoms have been debated as possible manifestations within the AIWS spectrum, the auditory hallucinations in this case may also reflect adenovirus-associated encephalitic or transient neurofunctional disturbances, while the visual perceptual distortions were clinically consistent with AIWS. His symptoms improved rapidly after resuming co-sleeping with his mother, suggesting that psychosocial stress-including psychological vulnerability associated with ADHD and attachment insecurity following changes in family circumstances-may have contributed to the persistence and later recovery of his symptoms. This case highlights the importance of developmental and psychosocial factors in paediatric AIWS.