Auto-brewery syndrome diagnosis detailed in new case report

A 50-year-old woman baffled doctors when she visited emergency rooms seven times over two years showing signs of alcohol intoxication even though she does not drink.

“She told doctors her religion does not allow drinking, and her husband verified she did not drink,” Dr. Rahel Zewude, an infectious disease specialist at the University of Toronto, told CNN.

Zewude treated the unidentified woman and coauthored a Monday report on her case in the Canadian Medical Association Journal. The woman suffers from auto-brewery syndrome, a rare but serious condition that occurs when an overgrowth of yeast or bacteria in the gastrointestinal tract turns carbohydrates from food into alcohol via fermentation.

This is not the first case of auto-brewery syndrome, which has been described in medical literature since the 1940s. A Belgian man was acquitted of a drunk-driving charge in April after three doctors confirmed his diagnosis. A former Long Islander who lost his teaching and coaching jobs because of alcohol-related accusations shared his story last year.

People who have diabetes, liver disease, abnormal contractions in their intestines or inflammatory bowel disease are at greater risk for auto-brewery syndrome, which can also occur in healthy people who have taken antibiotics.

In the latest case, the Toronto woman battled excess sleepiness. She would fall asleep suddenly while getting ready for work or preparing meals.

She went to her doctor several times about her sleep troubles, according to the case report.

Emergency room physicians noted she had fallen because of her drowsiness. She also had slurred speech and alcohol could be smelled on her breath. She was eventually referred to a gastroenterology clinic.

“If she didn’t eat many carbs, the symptoms weren’t so bad,” Zewude told CNN. “But then she might have a slice of cake or another big carbohydrate meal, which led to a rapid rise in her alcohol level. These were the times where she might be getting lunch ready for her kids and just fall asleep.”

Since her mid-40s, the woman had experienced urinary tract infections that were treated with antibiotics, plus she took a heartburn drug for her gastrointestinal reflux disease.

Zewude said the helpful bacteria in her intestinal tract began to wane, paving the way for the fermenting fungi to proliferate.

Patients diagnosed with auto-brewery syndrome typically take antifungal medications before starting a long-term probiotic to improve their levels of beneficial bacteria. They are also advised to purchase a breathalyzer to measure their breath alcohol content in the mornings, evenings or whenever they are symptomatic.

Zewude said her patient finished her antifungal therapy — now she’s following a very low-carb diet after suffering a relapse.

“In this case, the woman has a very supportive husband, who called me immediately when he began to smell alcohol on her breath again,” Zewude said. “For anyone dealing with the syndrome, it’s important that your spouse, friend, roommate or whatever know the signs and symptoms and connect with physicians or bring the person to the emergency department when this occurs.”