{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:10:29Z","timestamp":1780071029842,"version":"3.54.0"},"reference-count":11,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,15]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>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\u2014including psychological vulnerability associated with ADHD and attachment insecurity following changes in family circumstances\u2014may have contributed to the persistence and later recovery of his symptoms. This case highlights the importance of developmental and psychosocial factors in paediatric AIWS.<\/jats:p>","DOI":"10.1136\/bcr-2025-271679","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:55:22Z","timestamp":1780070122000},"page":"e271679","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Alice in Wonderland syndrome following adenovirus infection, manifesting with biphasic perceptual disturbances"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0719-4306","authenticated-orcid":false,"given":"Takanori","family":"Abe","sequence":"first","affiliation":[{"name":"Pediatrics, Haruno Uraraka Clinic, Kochi, Japan"},{"name":"Department of Medical Laboratory Science, Faculty of Health Sciences, Kochi Gakuen University, Kochi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"2026052908551015000_19.5.e271679.1","first-page":"701","article-title":"The syndrome of Alice in Wonderland","volume":"73","author":"Todd","year":"1955","journal-title":"Can Med Assoc J"},{"key":"2026052908551015000_19.5.e271679.2","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000251"},{"key":"2026052908551015000_19.5.e271679.3","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/8243145","article-title":"Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review","volume":"2016","author":"Mastria","year":"2016","journal-title":"Biomed Res Int"},{"key":"2026052908551015000_19.5.e271679.4","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association . 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Eur J Ophthalmol 2020:1120672120978882. doi:10.1177\/1120672120978882","DOI":"10.1177\/1120672120978882"},{"key":"2026052908551015000_19.5.e271679.9","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s12402-017-0230-0","article-title":"Perception in attention deficit hyperactivity disorder","volume":"10","author":"Fuermaier","year":"2018","journal-title":"ADHD Atten Def Hyp Disord"},{"key":"2026052908551015000_19.5.e271679.10","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1177\/10870547251369665","article-title":"Perception of Visual Illusions in Children and Teenagers With ADHD","volume":"30","author":"Montiel","year":"2026","journal-title":"J Atten Disord"},{"key":"2026052908551015000_19.5.e271679.11","doi-asserted-by":"crossref","DOI":"10.3390\/brainsci11111516","article-title":"Attachment Representations in Children with and without Attention-Deficit\/Hyperactivity Disorder (ADHD)","volume":"11","author":"Dekkers","year":"2021","journal-title":"Brain Sci"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-271679","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:55:24Z","timestamp":1780070124000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-271679"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":11,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,29]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bcr-2025-271679"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-271679","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}