P0545 - Underdiagnosed Medical Condition: Auto-Brewery Syndrome

Bhoomi Shah, MD, Maria F. Kewish, MD
Southeasthealth, Dothan, AL

Introduction: Auto brewery syndrome also known as gut fermentation syndrome/endogenous ethanol fermentation is a diagnosis of exclusion and is often underdiagnosed. Although relatively unknown, ABS was first reported several decades back in 1940s. ABS is produced when ingested carbohydrates are converted to alcohol by fungi or high alcohol producing bacteria in the GI tract(eg: klebsiella). Most patients present with disorientation and memory fog and are found to have high blood alcohol levels without alcohol intake but consume a high carbohydrate/sugar diet.

Case Description/Methods: A 61-year-old man with a past medical history of hypertension who presented to the ED with complaints of altered mental status, he was found to have elevated alcohol level of 287 on admission. Family stated that he drinks about one glass of bourbon every week. However they denied any alcohol intake in the past week. About 6 weeks after he completed a round of levofloxacin for acute prostatitis he started complaining of intermittent encephalopathy after eating associated with significant abdominal distention and bloating. He denied any history of Crohn’s disease, ulcerative colitis or diabetes. All routine laboratory tests were unremarkable except ethanol levels as serial blood alcohol levels remained elevated. Stool cultures were negative for any fungal elements and bacteria. Patient was found to have a positive carbohydrate challenge test and an abnormal sucrose breath test. He was treated with Diflucan for 10 days and was later found to have a yeast infection on the skin for which he was continued on monthly diflucan by the dermatologist which seemed to help him. On discharge, the patient was recommended to continue with a high protein and low carbohydrate diet. Outpatient Endoscopy and colonoscopy showed gastritis and colonic polyps with cultures negative for bacteria and fungi.

Discussion: ABS is a rare and underdiagnosed medical condition often seen in conjunction with antibiotic use and malabsorption syndromes. Patients are recommended to avoid alcohol, eat a low sugar/ carbohydrate diet. Antifungals have been implicated in their treatment. They should also carry breathalyzers with them to avoid driving when inebriated.


Disclosures:


Bhoomi Shah, MD, Maria F. Kewish, MD. P0545 - Underdiagnosed Medical Condition: Auto-Brewery Syndrome, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.