When a 61-year-old woman went to a hospital to try to get on the waitlist for a liver transplant, she was told that it would probably be a better idea if she got her addictions under control first. Despite never displaying any symptoms of intoxication, her urine tests were positive for ethanol, and the doctors suspected that she was just doing a poor job at hiding her alcoholism.
After being denied a transplant at that unnamed medical facility, her next stop was the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital. The doctors at UPMC noted that she did have cirrhosis—which can frequently be caused by alcohol abuse—and also untreated diabetes. But when the docs conducted another urine test, they realized that two metabolites of alcohol that should've been present in a heavy drinker's pee weren't there. Her urine also contained high levels of both glucose and a yeast called Candida glabrata, which was puzzling too.
"These findings led us to test whether yeast colonizing in the bladder could ferment sugar to produce ethanol," the clinicians wrote in a case study, which was published in the Annals of Internal Medicine.
They collected another urine sample and immediately chilled it. When the sample was placed in a test tube and raised to the average 98.6 degree body temperature, they "saw remarkably high levels of ethanol production," which means that the woman was literally brewing alcohol inside her own bladder.
"As I went over the medical record of the patient and learned the situation of the patient, I started feeling obliged to do something for this patient, because she might have been falsely mislabeled as an alcohol abuser," Dr. Kenichi Tamama, an associate professor of pathology and medical director of UPMC's Clinical Toxicology Laboratory, told LiveScience.
Dr. Tamama and his team tried using antifungal medications to reduce the amount of yeast that the woman's body was producing, but the treatment didn't take. But all of those weird pee tests were enough to convince the doctors that she wasn't an alcoholic, which meant that she was allowed to reapply for a liver transplant.
The UPMC doctors documented the woman's case to "alert clinicians to the possibility of a previously unrecognized auto-brewery syndrome in which ethanol is produced through endogenous fermentation in the urinary system." They have referred to her condition as 'urinary auto-brewery syndrome,' and one of the only other reported cases was discovered after the patient's death. (In another known case, the urine fermented in an accidentally unrefrigerated test tube.)
"Clinicians must be diligent about paying close attention to medical record documentation and laboratory results and should always investigate in the event of incongruences," the docs warned.
Auto-brewery syndrome, also called gut-fermentation syndrome, is a rare condition in which excess yeast in the digestive system is fermented into alcohol and then released into the bloodstream. (In the Pittsburgh patient's case, the fermentation only occurred in her bladder, which is why her blood tests were always negative for ethanol.)
Yes, that can become ultra-problematic for anyone who's afflicted with ABS. Last April, an Ohio man got into a serious car accident, and he was sent straight to jail when his post-crash blood alcohol content was measured at a stunning .325. Michael Forrest Behne admitted to having one glass of wine before he left his house, but that shouldn't have been enough to put him at four times the legal limit.
After he was sentenced to two years for aggravated assault, Behne's mother started researching ABS, and she became convinced that her son had it. To prove that theory, Behne had a series of blood tests while he was being quarantined in a hospital with no access to alcohol –– but his blood alcohol levels still showed some "dramatic" changes. (Without drinking, every test should've come back with a 0.00 result.)
Although the sentencing judge seemed to be sympathetic to his condition, Behne's sentence was not reduced, nor was he allowed to serve his time in a hospital or medical facility where his ABS could be monitored and treated.
As for the woman in Pittsburgh, the published case study didn't reveal whether or not she'd been approved for a new liver, whether she'd ultimately had the surgery, or what her current condition was like. At the very least, maybe now she can convince her doctors that she's not hammered… although her bladder might be.