A 61-year-old patient who presented with liver damage and poorly controlled diabetes visited the University of Pittsburgh Medical Centre Presbyterian Hospital for placement on a liver transplant waitlist. She repeatedly ran up against one problem: Even though she hadn’t been drinking, her reports show up as alcohol in a urine test.
Her doctors hesitated to believe her. In fact, she was ushered into an alcohol abuse treatment program, suspecting she had lied about her alcohol addiction.
Further investigation revealed something strange: Her urine was full of alcohol.
Yes! The 61-year old woman suffered from ‘urinary auto-brewery syndrome’ or ‘bladder fermentation syndrome,’ a rare condition that caused her bladder to make alcohol. This condition is similar to a rare disorder called “auto-brewery syndrome” (ABS), in which microbes in the gastrointestinal tract convert carbohydrates into alcohol.
People with ‘auto-brewery syndrome’ (ABS) can get drunk just from eating carbs. But, in the case of woman, the fermentation was taking place in her bladder, which makes her condition distinct from ABS. Her case has become the first documented case in a living person of an unusual medical condition where alcohol naturally brews in the bladder from the fermentation of yeast.
Her doctors explained, “However, we noted that plasma test results for ethanol and urine test results for ethyl glucuronide and ethyl sulfate, which are the metabolites of ethanol, were negative, whereas urine test results for ethanol were positive.”
“Furthermore, in addition to consistently denying having consumed alcohol, the patient did not appear to show signs of intoxication during visits to the clinic, even though her urine showed high levels of ethanol content.”
Dr. Kenichi Tamama, an associate professor of pathology and medical director of UPMC’s Clinical Toxicology Laboratory, said, “Another mystery was the presence of large amounts of glucose in her urine – a condition called hyperglycosuria – with abundant levels of budding yeast seen in urine samples.”
“These findings led us to test whether yeast colonizing in the bladder could ferment sugar to produce ethanol.”
Scientists further determined the yeast inside the woman’s body. The yeast was identified as Candida glabrata, which was closely related to the “brewer’s yeast” used to make beer. The yeast was probably making the ethanol that was showing up in her urine tests.
After all tests and experiments, the woman reconsidered for liver transplantation. However, it remains obscure whether she will receive a new organ.
The findings are reported in the Annals of Internal Medicine.