Bizarre case of woman who brews her own alcohol, in her urinary system

Clinicians in the United States have encountered a case of ‘urinary auto-brewery syndrome’, in which a 61-year-old woman urinated alcohol despite claims that she did not drink alcohol.

The previously unrecognised condition produced a substantial amount of alcohol via yeast fermenting sugar in the patient’s urinary system, even though the patient insisted she had not consumed alcohol. A case report is published in Annals of Internal Medicine.

Similar to traditional auto-brewery syndrome, the clinicians from the University of Pittsburgh Medical Center Presbyterian Hospital propose calling the distinct condition ‘urinary auto-brewery syndrome’ or ‘bladder fermentation syndrome’.

Clinicians saw the patient — who had cirrhosis and poorly controlled diabetes — for placement on the liver transplant waitlist. Because the woman’s urine tests for alcohol were repeatedly positive, she was advised to seek treatment for alcohol use disorder by two liver transplant teams rather than going on the waitlist, even though she claimed not to drink alcohol.

The patient continued to deny alcohol use. The clinicians noted that plasma test results for ethanol and urine test results for ethyl glucuronide and ethyl sulfate (metabolites of ethanol) were negative, whereas urine test results for ethanol were positive. In addition, the patient had no symptoms of alcohol intoxication.

The authors tested to see if yeast colonising in the bladder could ferment sugar to produce ethanol and found that it could, experimentally. The clinicians therefore concluded that the patient had a novel form of auto-brewery syndrome and not alcohol use disorder.

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