Auto-Brewery Syndrome: A Rare and Mysterious Condition

Imagine being accused of being drunk when you haven’t had a drop of alcohol. For a 50-year-old woman, this was her reality, leading to repeated trips to the emergency room over two years. Despite not drinking, her blood alcohol levels were sky-high, baffling doctors and her family alike. This is the perplexing case of auto-brewery syndrome (ABS), a rare condition where the body produces alcohol internally.

The Mystery Unfolds

The woman’s troubles began with recurrent urinary tract infections and gastrointestinal reflux disease, treated with antibiotics and acid reducers. Her life took a drastic turn when she started experiencing extreme drowsiness, slurred speech, and even the smell of alcohol on her breath, all without consuming any alcohol. Despite multiple emergency department visits and being diagnosed with alcohol intoxication, she and her family insisted she hadn’t been drinking.

Clues and Misunderstandings

Her symptoms were severe: slurred speech, an alcohol odor on her breath, and lethargy that required weeks off work. Despite normal liver function and clear brain scans, her elevated blood alcohol levels puzzled her doctors. Psychiatrists also found no evidence of alcohol abuse. One particularly distressing incident led to her being held under the Mental Health Act due to concerns about her well-being.

A Breakthrough Diagnosis

After years of episodic drowsiness and a seventh emergency visit with a blood alcohol level of 62 mmol/L (or 0.285% BAC), a sharp-eyed emergency physician considered the rare diagnosis of auto-brewery syndrome. She was prescribed fluconazole, an antifungal medication, and referred to a gastroenterologist.

A New Approach

At the gastroenterology clinic, a dietitian recommended a low-carbohydrate diet, a crucial component of managing ABS. Although a CT scan showed no small bowel issues, the combination of fluconazole and the low-carb diet brought significant relief. Her symptoms disappeared for four months until she reintroduced more carbohydrates into her diet, leading to a relapse.

Managing Auto-Brewery Syndrome

The woman’s journey underscores the importance of diet in managing ABS. Upon experiencing symptoms again, she resumed the low-carb diet and fluconazole, finding relief once more. This case highlights how ABS, though rare and often misunderstood, can be effectively managed with the right approach.

Confirming the Diagnosis

Consulting with an infectious diseases clinic confirmed the diagnosis. The resolution of symptoms with fluconazole and diet changes, alongside her elevated liver enzyme levels from fluconazole, added to the evidence. The

diagnosis was further supported when her symptoms disappeared after stopping fluconazole and switching to probiotics to restore healthy gut flora. Regular follow-ups and careful management of her diet played a crucial role in her recovery.

Understanding Auto-Brewery Syndrome

Auto-brewery syndrome is a rare condition where the body ferments carbohydrates into alcohol, causing intoxication without alcohol consumption. First described in 1952 in Japan, it has been reported in only a few cases globally. It occurs when an overgrowth of certain gut microorganisms, like Saccharomyces cerevisiae and Candida species, ferment sugars into alcohol. Factors such as recurrent antibiotic use, which disrupts normal gut flora, and a high carbohydrate diet can trigger this condition. Genetic predispositions and comorbidities like diabetes or liver disease may also play a role.

Diagnosing and Treating Auto-Brewery Syndrome

Diagnosing ABS involves a detailed patient history, corroborative reports from family, physical examinations, blood tests, and sometimes, glucose challenge tests. There is no standardized diagnostic algorithm, which often leads to delays in diagnosis.

Treatment typically includes antifungal medications like fluconazole and dietary changes, particularly reducing carbohydrate intake to limit fermentation substrates. Probiotics are also used to restore healthy gut flora. In this case, the woman was advised to gradually reintroduce carbohydrates while monitoring her symptoms.

Wrapping It Up

Auto-brewery syndrome, though rare, is a fascinating condition that underscores the complexity of the human body. For those experiencing unexplained symptoms of intoxication, it’s essential to seek thorough medical evaluation. This case highlights the importance of considering ABS in patients with unexplained alcohol intoxication and the effectiveness of diet and medication in managing the syndrome. With the right care and lifestyle adjustments, individuals with ABS can lead healthy, symptom-free lives.