Case presentation
A 9-year-old female was presented to the emergency room of our hospital
with complaints of exhibiting abnormal behaviors. The symptoms had
developed over the previous six hours. She complained of being dizzy and
experiencing a dry mouth. Intermittent hallucinations started. She
described her visions of “her friends playing games.” She heard “her
mother’s voice calling her.” She also had a tactile hallucination in
which she felt something crawling on her back. She constantly attempted
to pick imaginary things from the floor.
Upon arrival at the emergency, the girl was hyperactive and was held
still by her uncle. She had a blood pressure of 110/70 mm of Hg, a heart
rate of 92 /min, a temperature of 98.2 F, respiratory rate of 20 /min.
Her mouth and skin were dry. Pupils were slightly dilated and reactive
to light. She was constantly agitated and restless. Her cognitive
deficits were quite remarkable because she was unable to recognize
previously familiar people and was not oriented to place or time. There
were no focal neurological abnormalities found. There was no history of
head trauma, and no obvious injuries were discovered. A day prior, the
girl had visited OPD for complaints of abdominal pain for which hyoscine
butylbromide 20 mg was prescribed to be taken three times a day.
Laboratory results for hemoglobin, total leukocyte count, platelet
count, urine routine and microscopy, liver function test, renal function
test, and random blood sugar were within normal limits. The chest X-ray
was normal. Due to her bizarre behavior and suspicion of hyoscine
intoxication, she was admitted for further evaluation. A pediatrician
and a psychiatrist were consulted. The prescription of hyoscine was
stopped.
The evening after admission, the girl showed improvement in her symptoms
including her memory and hallucinations. She was no longer hyperactive
and began to become shy. After proper counseling to her relatives, she
was discharged. On follow-up, there was no recurrence of those symptoms
and she was completely recovered.