A 50-year-old patient was diagnosed with "autobrewery syndrome"
A Toronto resident was admitted to the emergency room seven times over a two-year period with signs of alcohol intoxication. The patient herself insisted that she did not drink alcohol, and her family confirmed this. Subsequent analysis of the woman's condition revealed that she was suffering from a rare condition in which her intestines produce intoxicating amounts of ethanol through the action of their own microorganisms.
The report on an unusual case from medical practice was published by the scientific edition of the Canadian Medical Association Journal. One of the authors of the paper is the patient's attending physician and infectious disease specialist Rahel Zewude (Rahel Zewude) from the University of Toronto (Canada). She also spoke about the details of the case in an interview with CNN.
According to the doctor, when the 50-year-old patient repeatedly went to doctors, she was diagnosed with alcohol intoxication, despite denying drinking. All symptoms pointed to intoxication: the patient was lethargic and overly drowsy, even falling down, her breath smelled of alcohol and her speech was confused. In addition, ethanol was found in the blood. Its concentration varied from 39 to 62 millimoles per litre, while the normal level should not exceed two millimoles per litre.
A non-contrast computed tomography (CT) scan of the head showed no acute intracranial abnormalities in the woman. In addition, examinations by addiction psychiatrists at different hospitals did not confirm suspicions of alcoholism.
Meanwhile, the woman's medical records showed that she had repeated recurrences of urinary tract infections over the previous five years. Because of this, she had been taking frequent courses of antibiotics: ciprofloxacin and nitrofurantoin. She also had reflux disease, which was treated with dexlansoprazole.
It was not until her seventh visit to the ER that the medics realised the cause of her intoxication-like state. It was then that the concentration of ethanol in the patient's blood reached 62 millimoles per litre, which is already considered life-threatening. After comparing all the facts about her condition, the doctor recommended considering the diagnosis of "autobrewery syndrome". He prescribed the woman the antifungal drug fluconazole and referred her to a gastroenterologist for a consultation.
"Autobrewery syndrome, also known as gut fermentation syndrome, is an extremely rare condition in which bacteria and fungi in the gastrointestinal tract convert sugar and other carbohydrates from incoming food into ethanol. Treatment involves changing the diet to reduce carbohydrate intake, taking antifungal agents and probiotics to increase the number of beneficial bacteria in the digestive system.
This regimen was applied at the gastroenterology clinic where the patient had consulted. The treatment worked, although it took two courses of fluconazole and a long-term low-carbohydrate diet to get rid of the symptoms. She was also prescribed Lactobacillus acidophilus probiotics to restore her gut flora.
According to Canadian doctors, a combination of genetic predisposition and intestinal dysbiosis due to frequent treatment with antibiotics and dexlansoprazole led to the woman's "autobrewery syndrome". Today, the patient is no longer on antifungal medication, but still follows a low-carbohydrate diet due to the risk of recurrence. She also continues to be seen by a gastroenterologist and nutritionist.