A 50-year-old Canadian woman has been diagnosed with a rare medical condition called auto-brewery syndrome, where the body self-produces…beer. The patient was dismissed by ER doctors on seven occasions over the course of two years prior to the diagnosis because they presumed she was drunk. Symptoms of the disorders are much like those of drunkenness, including slurred speech, blurred vision and sudden sleepiness. The Canadian Medical Association Journal (CMAJ) in reporting the case describes auto-brewery syndrome as involving “endogenous alcohol fermentation by fungi in the gut.”The disorder manifests when carbohydrates in the stomach ferment, converting sugar to alcohol, and causing blood ethanol levels to rise. Less than 100 cases have ever been documented worldwide. The unidentified woman presented herself in emergency departments seven times with apparent alcohol intoxication despite her insistence she hadn’t been drinking, a claim corroborated by family members. She lives with her husband and two children and while she once would have a glass of wine on the holidays, she has since stopped drinking altogether. Doctors in diagnosing the disorder evaluate collateral history (information gathered from people other than the patient, including family members and medical professionals), ethanol levels measured by an oral glucose process and sometimes testing fungal culture and gastrointestinal secretions, wrote the CMAJ. Auto-brewery syndrome can be treated by long-term, “multidisciplinary care” including primary care, gastroenterology, infectious diseases, mental health, and dietary specialists. Patients must adhere to a low-carb diet and antifungal therapy in order to maintain a normal lifestyle while living with the disease. .The Canadian woman prior to the two-year stint of unsuccessful ER visits, had regular urinary tract infections (UTIs) requiring medications ciprofloxacin and nitrofurantoin and gastrointestinal reflux disease, which was treated with dexlansoprazole.She first went to the ER when she began experiencing “excessive somnolence” (strong desire to fall asleep, prolonged sleepiness) and episodes of fully falling asleep while performing everyday tasks like cooking or getting ready for the work day. Her breath smelled like alcohol and she had slurred speech when she presented at the ER, where she was diagnosed with alcohol intoxication and discharged. Her alcohol level was elevated even though she said she hadn't been drinking. Subsequent ER visits led to recommendations for addictions care, but she scored zero on their assessments for alcohol use disorder. On her third visit the physician certified her under the Mental Health Act out of self-neglect concerns — which means the patient loses the right to made decisions about her health, and doctors may treat her against her will. Finally on the seventh ER visit, with her alcohol level elevated even higher, the treating physician considered auto-brewery syndrome. She was prescribed oral fluconazole and was referred to a gastroenterology specialist. “On consultation with the patient in our infectious diseases clinic, we agreed with the diagnosis of auto-brewery syndrome based on her recurrent intoxication presentations with elevated ethanol levels and consistent self- and corroborated reporting of no alcohol consumption,” wrote CMAJ doctors. “The complete resolution of symptoms and absence of detectable alcohol levels after treatment with fluconazole and a low-carbohydrate diet provided additional support for the diagnosis.”The earliest case of auto-brewery syndrome is from 1948 when a boy’s stomach ruptured and the contents smells like alcohol. There was another case in 1952 in Japan, and two case in the United States in the 1980s. As of 2020, a UK systematic review identified 20 in total since 1974.
