Doctors thought she was drunk, but she had a condition that pretty much turned her liver into a brewery.

By Claire Gillespie
February 26, 2020

Now and then a bizarre case study comes along that reminds us how unbelievable—and unpredictable—the human body can be. The latest was published online in the Annals of Internal Medicine on February 25, and it’s about a woman who pees alcohol.

Yes, that’s right—she pees alcohol. But she’s not an alcoholic, although it took doctors a while to believe that. Two teams of medical experts believed the unidentified 61-year-old was hiding an addiction from them when all her urine tests for alcohol came back positive. She was also suffering from cirrhosis, a liver condition associated with alcohol abuse, and was on the waiting list for a liver transplant. 

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But after specialists from the University of Pittsburgh Medical Center got involved, the woman was finally diagnosed with bladder fermentation syndrome, also called urinary auto-brewery syndrome. It’s so rare that she’s the first person in the world to have been diagnosed with it. 

After numerous tests, docs realized that the woman had high levels of Candida glabrata in her bladder. This is a yeast produced naturally by the body, and it’s similar to Saccharomyces cerevisiae, a fungus known as brewer's yeast because beer makers use it to convert carbohydrates in grains into alcohol. 

The same type of conversion process was taking place inside the patient’s bladder when she ate foods containing sugar, and it was taking its toll on her liver, which had to try and get rid of the yeast. 

There have been a few reported cases of auto-brewery syndrome (ABS) in the past, but not involving the liver. In ABS, ingesting sugar causes yeast to accumulate in the gut and makes sufferers feel intoxicated and unable to perform simple tasks. 

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In August 2019, the case study of a 46-year-old man who had been charged by police for drink driving due to ABS was published in BMJ Open Gastroenterology. Like the latest case study, the man’s family and doctors (as well as the police) were convinced he was harboring a secret alcohol addiction. But he was eventually diagnosed with ABS in 2017 when he was found to have high levels of Saccharomyces cerevisiae in his feces. 

Whenever he ate carbohydrates, his blood alcohol level spiked, sometimes to the point where it was 11 times the drink-drive limit. When this happened, he experienced mental foggiest, dizziness, and memory loss. In his case, doctors believed his condition stemmed from a course of antibiotics he took in 2011 for a thumb injury, which disrupted the balance of microbes in his gut. 

ABS might sound familiar to fans of Gray’s Anatomy. The condition was featured in a season 15 episode, when a high-school teacher collapses (and sends a student into a table saw, no less). When the Gray Sloan Memorial Hospital docs discover his blood-alcohol level is extremely high, they assume he’s suffering from alcohol addiction before figuring out that he actually has ABS. 

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But for people with this rare condition, it’s definitely not entertaining. The appearance of unidentified, arbitrary intoxication can seriously affect patients as well as their family and work lives. 

The University of Pittsburgh researchers who authored the recent case study highlight the importance of considering ABS as a possibility in any patient who shows alcohol toxicity but denies drinking alcohol, adding that the woman’s experience “demonstrates how easy it is to overlook signals that urinary auto-brewery syndrome may be present.”  

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