Woman diagnosed with ‘urinary auto-brewery syndrome’

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Doctors in the US have reported the first known case of a woman who urinates alcohol

The doctors published their findings in the Annals of Internal Medicine, in a bid to alert clinicians to the possibility of a previously unrecognised auto-brewery syndrome in which ethanol is produced through endogenous fermentation in the urinary system.

In this case, a 61-year-old woman with cirrhosis and poorly controlled diabetes presented at the Pittsburgh Medical Center Presbyterian Hospital for placement on the liver transplant waitlist.

The woman had been advised to seek treatment for alcohol use disorder by two liver transplant teams, instead of going on the waitlist.

This was because urine tests for alcohol were repeatedly positive – even though the patient claimed not to have consumed alcohol.

She continued to deny alcohol use, and the clinicians noted that plasma test results for ethanol and urine test results for ethyl glucuronide and ethyl sulfate, which are metabolites of ethanol, were negative, whereas urine test results for ethanol were positive.

The woman also did not appear to be intoxicated.

The clinicians then decided to test to see whether yeast colonising in the bladder could ferment sugar to produce ethanol and found that experimentally, it could.

Therefore, they were able to conclude that the patient had a novel form of auto-brewery syndrome and not alcohol use disorder.

Previously recognised auto-brewery syndrome is a rare medical condition in which intoxicating quantities of ethanol are produced by specific types of yeast or bacteria through endogenous fermentation in the digestive system.

The newly reported case is similar to but distinct from this traditional auto-brewery syndrome, that the clinicians propose calling “urinary auto-brewery syndrome” or “bladder fermentation syndrome”.

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