Alice in Wonderland Syndrome: An Uncommon Presentation of Pyogenic Cerebral Abscess

Alice in Wonderland syndrome (AIWS) is a rare perceptual disorder causing distorted body image and spatial awareness. This is the case of a middle-aged man, known case of diabetes, hypertension, and chronic kidney disease who presented with a week-long history of fever, drowsiness, and visual hallucinations of unfamiliar people appearing unusually tall or short. He exhibited unusual behavior, frequently touching his nose and eyes as if they were unfamiliar or altered in some way. MRI revealed a ring-enhancing lesion in the left parieto-occipital region, indicating a brain abscess. He was treated with broad-spectrum antibiotics, steroids, and antifungal therapy due to his compromised immune state. On improvement of neurological symptoms, we discharged him with follow up in clinic. Our case addresses an uncommon exhibition of pyogenic cerebral abscess as AIWS. This highlights the importance of understanding of pathophysiology and contributes to the better understanding of such symptoms for similar cases in future.