Early Childhood-Onset Prosopometamorphopsia Following Respiratory Tract Infection With Serological Evidence of Mycoplasma pneumoniae Exposure: A Pediatric Case Report

We report a pediatric case of prosopometamorphopsia (PMO), a rare disorder characterized by distorted face perception. Following a respiratory tract infection at four years of age, the male patient began to perceive visual distortions in human faces. His developmental and medical histories were unremarkable. He had no neurological abnormalities, and his blood tests showed elevated serum levels of Mycoplasma pneumoniae antibodies (1:160). Urinalysis, developmental examination, head image testing, and electroencephalography revealed no obvious abnormalities. In his drawings of human faces, only the faces, ears, and hair regions were elongated, both vertically and horizontally. Based on the patient’s characteristic facial distortions, consistent drawings, and the exclusion of other neurological, structural, and developmental causes, we diagnosed PMO following a respiratory tract infection. To our knowledge, this is the first reported case of PMO characterized by early childhood onset and a possible post-infectious trigger. We hypothesize that PMO may have been triggered by an autoimmune or inflammatory process following exposure to Mycoplasma pneumoniae, given the absence of other structural causes. When a child reports these symptoms, it is important to consider that they may genuinely perceive them, and PMO should be included in the differential diagnosis rather than dismissing the report as a joke or imagination.