June 4, 2024 From Western Standard
A 50-year-old Canadian woman has been diagnosed with auto-brewery syndrome, a rare medical condition where the body produces alcohol internally, mimicking the effects of drunkenness. This diagnosis came after she was repeatedly misdiagnosed over two years, highlighting the challenges in identifying this uncommon disorder.
What is Auto-Brewery Syndrome?
Auto-brewery syndrome, also known as gut fermentation syndrome, involves endogenous alcohol fermentation by fungi in the gut. This condition causes carbohydrates in the stomach to ferment, converting sugar to alcohol, leading to elevated blood ethanol levels. The Canadian Medical Association Journal (CMAJ) describes the condition as having symptoms similar to drunkenness, including slurred speech, blurred vision, and sudden sleepiness.
The Diagnostic Journey
The woman visited emergency departments seven times over two years, each time presenting with symptoms of apparent alcohol intoxication, despite her claims of not drinking. Her breath smelled of alcohol, and her speech was slurred, leading ER doctors to dismiss her symptoms as drunkenness and even refer her for addiction care. Despite consistently scoring zero on assessments for alcohol use disorder, her condition remained undiagnosed until her seventh ER visit when a physician considered auto-brewery syndrome.
Confirming the Diagnosis
The diagnosis was confirmed through a combination of collateral history, ethanol levels measured by an oral glucose process, and tests of fungal culture and gastrointestinal secretions. Dr. W. Taylor Kimberly and colleagues from Massachusetts General Hospital noted, “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.”
Treatment and Management
Auto-brewery syndrome can be managed through long-term, multidisciplinary care involving primary care, gastroenterology, infectious diseases, mental health, and dietary specialists. Patients must adhere to a low-carb diet and antifungal therapy to maintain a normal lifestyle. This treatment approach was effective for the Canadian woman, leading to the resolution of her symptoms.
A Rare but Documented Condition
This syndrome is extremely rare, with fewer than 100 documented cases worldwide. The earliest case dates back to 1948, with subsequent cases reported sporadically. A 2020 UK systematic review identified only 20 cases since 1974. This rarity contributes to the challenges in diagnosing and managing the condition.
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