Rare Disorder Reported in Young Swine Flu Patient

Physicians say girl, 11, suffering from Alice in Wonderland syndrome

An 11-year-old girl from the center of the country diagnosed with swine flu has also developed a condition called Alice in Wonderland syndrome, characterized by distortions in the perception of the size of objects.

The condition is named after the 1865 Lewis Carroll novel "Alice's Adventures in Wonderland" in which the protagonist of the book is depicted as confronting objects at major variance with their normal size. The syndrome was first described in medical literature in 1955 by British psychiatrist John Todd.

The Israeli patient sought medical treatment at the Sheba Medical Center at Tel Hashomer. The director of the hospital's pediatric emergency medicine department, Arie Augarten, said the patient reported that she had a sense that her parents were speaking and moving slowly. She also reported seeing a picture which in fact did not exist at all but which she perceived at times as being extremely small and at other times very large.

The case is the first reported anywhere in the world related to swine flu. The girl was examined and prescribed medication for the swine flu and released the same day. The hospital followed up on the girl's symptoms of Alice in Wonderland syndrome and found that the condition subsided after two days. The syndrome is most commonly reported in children infected with the Epstein-Barr virus, which causes mononucleosis, but the staff at Sheba found that the girl was not infected with Epstein-Barr.

"We don't understand how the current syndrome develops, however we believe the thermostat regulating the bodily senses in disrupted, leading the patient to perceive the world in a different manner through the senses or some of them. It is a passing phenomenon," said Augarten.

Swine flu, which is caused by the H1N1 virus, was initially diagnosed in Mexico in April 2009. It is the second most common form of the flu this winter in Israel and has been linked to three deaths. Although there are no reported cases other than the Israeli girl of patients with the virus suffering from Alice in Wonderland syndrome, there have been reports in Israel and abroad of patients with other neurological complications from swine flu. A boy in Texas was reported to have suffered other visual distortions.

A 1999 article in a pediatric neurology journal by researchers at Assaf Harofeh at Tzrifin reported on five cases involving children ranging in age from 10 to 13 who suffered from visual distortions in size attributed to Alice in Wonderland syndrome, called metamorphopsia in the medical literature. The article reported that the children suffered six to 23 attacks a day from the syndrome, each lasting between five and 20 minutes. The symptoms subsided after three weeks to a month.