Alice in Wonderland syndrome and Epstein-Barr virus infection

Infection with Epstein-Barr virus (EBV) is common and usually occurs in childhood or early adulthood. EBV is the cause of infectious mononucleosis, usually associated with fever, sore throat, swollen lymph nodes in the neck, and sometimes an enlarged spleen. Alice in Wonderland Syndrome (AIWS), also called Todd’s syndrome, is a rare condition, principally involving visual and somesthetic integration. AIWS remains a poorly known and probably misdiagnosed syndrome, can occur at any age but mostly in children is mostly associated with migraine and EBV infection. We present a 10-year-old patient who went to the emergency department with visual distortion of corporal form and bizarre behaviour, initially suspected as a psychiatric pathology but subsequently diagnosed with infectious mononucleosis and serologically confirmed Epstein-Barr virus (EBV) infection. This case reflects the importance of recognizing this syndrome by emergency physicians in order to avoid inadequate referrals to the psychiatric service.