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A 4-Year-Old Boy Is Brought to the Emergency Department by His

question 134

Multiple Choice

A 4-year-old boy is brought to the emergency department by his parents due to fever, runny nose, cough, and unusual behavior. The boy has been at home for the past 3 days since his fever started; his parents note that he has become increasingly restless over the past 2 days, and yesterday he began making odd comments about his dog being in the room when the dog was clearly not there. Since he has been at home, the parents have treated his cold symptoms with over-the-counter nasal decongestants and antihistamines and humidified the air in his bedroom, without much benefit. Temperature is 38.3 C (101 F) , blood pressure is 110/60 mm Hg, pulse is 100/min, and respirations are 26/min. Physical examination shows a slightly erythematous oropharynx with no exudate, clear nasal discharge, clear lung fields, and normal S1 and S2. The abdomen is soft and nontender. Neurologic examination is within normal limits. During the examination, the patient starts talking to something in the room, saying that he can see a "bunny sitting on the bed" with him and that "the animals have followed us to the hospital." Which of the following is the most likely explanation for this boy's visual hallucinations?

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