There is a condition currently called auto-brewery syndrome when the microbes in the gastrointestinal tract convert carbs to alcohol without having a drop of the drink. Recently, after a woman in Pennsylvania needed a life-saving liver transplant, she was testing positive for alcohol which prevented her from getting the surgery even though she does not drink. This is the first recorded moment in which microbes in the woman’s bladder were fermenting alcohol. 

How Did This Woman Discover Her Condition?

A 61-year-old woman went to the University of Pittsburgh Medical Center Presbyterian Hospital for cirrhosis and needed to be on the liver transplant list. At a previous hospital, she tested positive for alcohol based on her urine and was told she needed treatment for alcoholism. At UPMC Presbyterian Hospital, she got the same results but repeatedly denied that she drank alcohol. 

The doctors noticed that two metabolites of alcohol, ethyl glucuronide, and ethyl sulfate, were negative. Usually, one of these metabolites is present in the urine for several days after a person drinks alcohol. The woman’s blood tests for ethanol were also negative. Dr. Kenichi Tamama noticed the woman had high levels of glucose in her urine from diabetes and high levels of yeast. This made Dr. Tamama wonder if the microbes colonizing the woman’s bladder was fermenting that sugar into alcohol.

How was Dr. Tamama’s Theory Tested Out?

Researchers took a sample of the woman’s urine and put it in ice. The sample was incubated in a test tube at body temperature and saw high levels of ethanol production. This production did not happen when the sample was incubated at a lower temperature or if the researchers added a chemical to block the fermentation. 

What Were the Results of the Study?

The results were best explained by yeast fermenting sugar in the bladder. They also identified the yeast Candida glabrata which is part of the normal microbe in people and related to brewer’s yeast. After obtaining these results, the woman was reconsidered for live retransplantation. This syndrome is now called “urinary auto-brewery syndrome” or “bladder fermentation syndrome.” This is a very rare study in that there were few reports of people with diabetes who had ethanol in their urine because of yeast fermenting sugar into alcohol. This study shows how important it is for doctors to recognize this syndrome to avoid anyone being kicked off an organ transplant list. 

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