Alice in Wonderland syndrome and upper airway obstruction in infectious mononucleosis

The Alice in Wonderland syndrome is a rare clinical feature characterised by perceptual disturbances including visual disturbances and distortion of the body image. This uncommon--but often easy to recognise--syndrome, to which children seem particularly susceptible, can be defined in patients with Epstein Barr Virus (EBV) infection. This report describes a 10-year-old child with a mild upper airway obstruction and manifestations of the Alice in Wonderland syndrome resulting from an acute EBV infection. Because meningo-encephalitis was considered in the differential diagnosis, an MRI examination was performed under midazolam sedation, leading to a severe life-threatening upper airway obstruction.