A woman who was told she was simply drunk on the multiple occasions she showed up at hospital with slurred speech and extreme tiredness has been diagnosed with auto-brewery syndrome.
The 50-year-old visited hospital seven times, only to be discharged with a diagnosis of being drunk – despite saying she had not been drinking – before she was correctly diagnosed with the condition.
Auto-brewery syndrome is a condition which sees fungi in the gut create alcohol through fermentation.
In April, a 40-year-old Belgian man was cleared of drink-driving after doctors diagnosed him with the extremely rare condition.
Those with the condition can have symptoms identical to being drunk, including slurred speech, stumbling, loss of motor functions, dizziness and belching.
Sufferers are not born with the condition and its trigger can vary, from prolonged antibiotic use to diets high in carbohydrates, according to scientists.
Researchers say awareness of this syndrome – which has social, legal, and medical consequences – is essential for proper diagnosis and management.
Auto-brewery syndrome is an extremely rare condition, also known as “drunkenness disease”.
Sufferers produce large amounts of ethanol in their gut through the fermentation of ingested carbohydrates in the gastrointestinal tract of the body.
Scientists say the condition is caused by specific bacteria or fungi in the gut.
Once produced, the alcohol is then absorbed in the small intestine, causing an increase in blood alcohol concentrations that produce the effects of intoxication.
The condition can have a profound impact on sufferers, who can exhibit symptoms such as slurred speech, stumbling, loss of motor functions, dizziness, and belching, as well as mood swings and neurological issues.
The condition is rare, but is thought to be underreported. Sufferers are not born with the condition and its trigger can vary, from prolonged antibiotic use to diets high in carbohydrates, according to scientists.
Lisa Florin, clinical biologist with Belgian hospital AZ Sint-Lucas, said people can also get ABS while suffering from other intestine-related conditions.
Over two years, the female patient visited the emergency department complaining of extreme daytime sleepiness and slurred speech.
She had been on several antibiotic courses for recurrent urinary tract infections alongside a proton pump inhibitor to reduce the amount of acid in her stomach.
Despite not drinking alcohol, the woman also had elevated blood alcohol levels and alcohol on her breath.
She would therefore be sent home with a diagnosis of alcohol intoxication every time she would report to hospital with her symptoms.
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The patient would have to take up to two weeks off work after each episode, during which she ate very little.
While her symptoms would improve after one or two weeks, they would represent within one or two months.
On the third visit, the mother was even certificated under the Mental Health Act, as the doctor had concerns for self-neglect when she discharged herself before psychiatric assessment.
However, at her seventh visit the emergency doctor considered a diagnosis of auto-brewery syndrome, and after being prescribed some medication, she was referred to a specialist.
A dietitian suggested a low-carbohydrate diet, and after completing a one-month course of an antifungal medication and the diet, the woman’s symptoms went away and remained absent for four months.
The woman slowly started to eat carbohydrates again, but one month after doing this she had a recurrence of slurred speech and drowsiness, which led to a fall.
She was advised to restart the low-carbohydrate diet again, and her symptoms resolved.
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Writing in the Canadian Medical Association Journal, Dr Rahel Zewude, from the University of Toronto, and her co-authors, said: “Auto-brewery syndrome carries substantial social, legal, and medical consequences for patients and their loved ones.
“Our patient had several (emergency department) visits, was assessed by internists and psychiatrists, and was certified under the Mental Health Act before receiving a diagnosis of auto-brewery syndrome, reinforcing how awareness of this syndrome is essential for clinical diagnosis and management.”
