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Although she had not consumed any alcoholic beverages, a 61-year-old American woman had very high levels of alcohol in her urine. An extremely rare case due to fermentation by a certain yeast in his bladder.
Incredible but true: a 61-year-old woman suffering from “urinary self-fermentation syndrome” naturally produced alcohol in her bladder. Deciphering this extremely rare phenomenon, reported in the journal Annals of Internal Medicine.
The patient shows no signs of intoxication
Initially, doctors thought the patient was hiding an alcohol use disorder. Except that even sober, his analyzes systematically reveal very high alcohol levels in the urine, greater than 39.1 mmol/L (180 mg/dL).
The doctors therefore begin to wonder but nevertheless invite the sixty-year-old to follow a detoxification treatment. At the same time, she was removed from the liver transplant waiting list even though she suffered from advanced cirrhosis and severe diabetes (a very high level of glucose was found in her urine; ≥ 55.5 mmol/L).
Through persuasion, the patient finally makes herself heard. Doctors at the University Hospital of Pittsburgh gave him a battery of tests and noticed inconsistencies in the results.
Urinary dosages of ethyl glucuronide (EtG) and ethyl sulfate, molecules involved in the degradation of ethanol, are indeed negative. And this, despite the presence of ethanol in the urinary tract. In addition, the patient did not present any symptoms of alcohol poisoning.
Doctors also notice that yeast is present in large quantities in urine samples.
“All these clues led us to test whether the yeast colonizing the bladder could ferment sugar to produce ethanol.“, say the researchers.
Yeasts transform glucose into alcohol
This is how scientists discovered the unthinkable: urinary yeast colonies are at the origin of the fermentation of glucose in the bladder… fermentation itself responsible for the natural production of ethanol.
As for the yeast identified, it is “Candida glabrata” – a yeast common in the genitourinary tract. Usually harmless, it can be invasive in weakened patients (elderly, immunocompromised or hospitalized, etc.) and lead to a severe infection (invasive candidiasis).
The American patient was, in fact, quickly treated – the doctors administered an antifungal treatment orally. But these treatments prove ineffective in eliminating yeast and stemming the “urinary self-fermentation syndrome“.
Luckily, the patient was finally able to be treated because her case “was reconsidered for liver transplantation”conclude the authors.
Auto-brewery syndrome at the intestinal level
More common than this case discovered in the bladder, auto-brewery syndrome also called “alcoholic fermentation syndrome” develops in the intestinal level. It makes people who suffer from it drunk, after a meal rich in carbohydrates and without having consumed a single drop of alcohol. “Those are yeasts normally present in the intestine but developing abnormally in affected patients, which would be responsible for this disorder“, explained Jean-Christophe Saurin, gastroenterologist at the Edouard-Herriot hospital center in Lyon.