In a 61-year-old American woman, doctors diagnosed a unique bladder fermentation syndrome. Because of this pathology, alcohol was constantly produced in the body of the pensioner, which was excreted in the urine. The description is in the Annals of Internal Medicine.
A Pittsburgh resident with cirrhosis was on a waiting list for a liver transplant at Presbyterian Hospital at the University Medical Center. Alcohol intake is categorically contraindicated in such patients, however, doctors suspected the woman's alcohol dependence, since urine tests for alcohol each time showed a positive result.
An elderly American woman had to prove to doctors that she did not drink alcohol until they conducted a detailed study and identified the true cause.
The first thing that alerted the scientists was that the results of blood tests for ethanol and urine tests for ethyl glucuronide and ethyl sulfate, which are metabolites of ethanol, were negative, while the results of urine tests for ethanol were positive. In addition, the patient had no signs of alcohol intoxication.
Another oddity was the presence of large amounts of glucose in urine - a condition called hyperglucosuria - combined with abundant budding yeasts that have been identified as Candida glabrata - natural analogs of brewer's yeast not normally found in such abundance in the human body. These results have led doctors to a clue.
For the first time in the history of modern medicine, scientists are faced with a bladder pathology provoked by the yeast Candida glabrata, which, by processing sugar entering the body, produce ethanol.
Yeast fermentation, or autobrewing syndrome, is a rare condition in which enough ethanol to become drunk is produced by certain types of yeast or bacteria as a result of endogenous fermentation in the digestive system. Previously, cases of yeast fermentation in the intestine were described, but the case when the fungi settled in the bladder was identified for the first time.
Perhaps there was a coincidence of two factors: the presence of fungi in the bladder and the constant presence of a large amount of sugar in the body of the patient, who had suffered from diabetes for a long time.
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“Candida glabrata is a fungus that closely resembles Saccharomyces cerevisiae, commonly known as brewer's yeast. We were faced with a unique situation when the yeast that produces ethyl alcohol settled in the patient's bladder and led to the development of alcoholic cirrhosis of the liver,”the authors of the study explain in the article.
The doctors prescribed the patient antifungal treatment, which, however, was unsuccessful, possibly due to the patient's poorly controlled diabetes.
During the course of the study, the authors reviewed publications related to the production of ethanol in urine, and found one report describing a similar case, unfortunately, identified posthumously.
Scientists believe that there may have been more cases, but the symptoms were not recognized due to the unusual and previously unknown nature of the pathology.
“The experience we are describing demonstrates how easy it is to miss the signals that autobrewing syndrome may be present in the urinary system,” the authors note.
