A 50-year-old Canadian woman who went to the emergency room seven times for alcohol intoxication but said she never had a drink has been diagnosed with auto-brewery syndrome — a rare condition that allowed fungi in her gut to produce its own alcohol.
The case, documented in an article in the Canadian Medical Association Journal this week, involved the woman returning to the ER feeling drunk multiple times over two years. In the preceding years, the patient reported “episodes of falling asleep suddenly” before work or while preparing meals, notes the study, led by Dr. Rahel Zewude, an infectious disease specialist at the University of Toronto who studied internal medicine at the University of B.C.
“On her [emergency department] visits, she was discharged with the diagnosis of alcohol intoxication, despite her reports of no alcohol intake, corroborated by her family,” write Zewude and her colleagues.
The patient visited her family physician with slurred speech, falls from falling asleep, and the smell of alcohol on her breath. After her first emergency room visit, the woman took one to two weeks off work to cope with persistent lethargy and the sudden onset of sleep.
But the symptoms continued to appear every one to two months. By her seventh visit to the hospital, a physician finally suspected auto-brewery syndrome and sent her to the gastroenterology clinic where a dietician suggested a low-carbohydrate diet and anti-fungal therapy.
After eating mostly fruit, vegetables, eggs, meat and fish, the symptoms went away for four months. But when she started increasing her carb intake again, they returned.
“On consultation with the patient in our infectious diseases clinic, we agreed with the diagnosis of auto-brewery…” write Zewude and her colleagues.
Zewude, who also founded the group Black Physicians of B.C., traces the first report of auto-brewery syndrome to 1948, when a boy with a ruptured stomach smelled of alcohol. It was later diagnosed in Japan in 1952, while the first cases in North America were published in the U.S. during the 1980s. And a 2020 systematic review of past research, meanwhile, identified 20 auto-brewery syndrome patients since 1974.
The Canadian researchers write that “auto-brewery syndrome is thought to result when microorganisms capable of fermenting alcohol from carbohydrates outgrow normal gut flora.” It’s uncommon because many variables have to line up at once to produce “substantial overpopulation of fermenting microorganisms, and high carbohydrate consumption,” they note.
Several illnesses such as diabetes and inflammatory bowl disease are associated with the disorder, and genetic predisposition — where an inactive enzyme fails to properly metabolize alcohol — may play a role, says the study.
In the Canadian woman’s case, the researchers suspect their patient developed the auto-brewery syndrome after taking recurrent antibiotics for urinary tract infections and a heartburn medication called dexlansoprazole.
Zewude and her team warn that auto-brewery syndrome can lead to “substantial social, legal, and medical consequences for patients and their loved ones.”
“Our patient had several [emergency department] visits, was assessed by internists and psychiatrists, and was certified under the Mental Health Act before receiving a diagnosis of auto-brewery syndrome, reinforcing how awareness of this syndrome is essential for clinical diagnosis and management,” they write.
