The bizarre case of a woman who pees alcohol

Clinicians encountered a case of previously unrecognized auto-brewery syndrome in which a substantial amount of alcohol was produced by yeast fermenting sugar in a patient's urinary system, even though the patient had not consumed alcohol. This is similar to but distinct from the traditional auto-brewery syndrome, that the clinicians propose calling 'urinary auto-brewery syndrome' or 'bladder fermentation syndrome." A brief case report is published in Annals of Internal Medicine.

Clinicians at the University of Pittsburgh Medical Center Presbyterian Hospital saw a 61-year-old woman for placement on the liver transplant waitlist who had cirrhosis and poorly controlled diabetes. She was advised to seek treatment for alcohol use disorder by two liver transplant teams rather than going on the waitlist because urine tests for alcohol were repeatedly positive even though she claimed not to have had anything to drink. The patient continued to deny alcohol use and the clinicians noted that plasma test results for ethanol and urine test results for ethyl glucuronide and ethyl sulfate, which are metabolites of ethanol, were negative, whereas urine test results for ethanol were positive. In addition, the patient had no symptoms of alcohol intoxication. The authors tested to see if yeast colonizing in the bladder could ferment sugar to produce ethanol and found that it could experimentally. Therefore, they were able to conclude that the patient had a novel form of auto-brewery syndrome and not alcohol use disorder.