The condition, which researchers propose to call either ‘bladder fermentation syndrome’ or ‘urinary auto-brewery syndrome‘, is analogous to a different incredibly rare condition, auto-brewery syndrome, where simply ingesting carbohydrates are often enough to form you inebriated, even without consuming any alcohol via regular means.
In the case, doctors became conscious of what seems to be a related syndrome, after attending upon a 61-year-old patient who presented with liver damage & poorly controlled diabetes.
The woman visited University of Pittsburgh Medical Centre Presbyterian Hospital for placement on a liver transplant waitlist, with doctors having previously suspected her problems stemmed from alcoholism , thanks to repeated urine tests for alcohol showing consistently positive.
“Initially, our encounters were similar, leading our clinicians to believe that she was hiding an alcohol use disorder,” her doctors explain during a case report published in February last year.
“However, we noted that plasma test results for ethanol & urine test results for ethyl glucuronide & ethyl sulfate, which are the metabolites of ethanol, were negative, whereas urine test results for ethanol were positive.”
Furthermore, additionally to consistently denying having consumed alcohol, the patient didn’t appear to point out signs of intoxication during visits to the clinic, albeit her urine showed high levels of ethanol content.
Another mystery was the presence of huge amounts of glucose in her urine – a condition called hyperglycosuria – with abundant levels of budding yeast seen in urine samples.
“These findings led us to check whether yeast colonizing within the bladder could ferment sugar to-produce-ethanol,” the researchers wrote.
Running tests on her urine, the team confirmed remarkably high levels of ethanol production, suggesting her strange results were thanks to yeast fermenting sugar within the bladder.
The yeast in question was identified as Candida glabrata, a natural yeast found within the body and associated with brewer’s yeast, but not normally discovered in such abundance.
Unfortunately, efforts to eliminate the yeast with antifungal treatments failed, perhaps thanks to the patient’s poorly controlled diabetes. In light of the woman’s seemingly unique predicament, the doctors note that she was reconsidered for liver transplantation, although their report doesn’t explain what ultimately became of the patient.
While researching the woman’s case, the doctors became conscious of other reports involving similar production of ethanol in urine, but only in one postmortem case, and in experiments run in vitro.
That said, it’s possible other patients have presented with this rare medical condition before, but the symptoms weren’t recognised, thanks to the weird & largely unknown nature of the pathology.
“The experience we describe here of two liver transplant teams at different institutions demonstrates how easy it’s to overlook signals that urinary auto-brewery syndrome could also be present,” the doctors said.
“Clinicians must be diligent about paying close attention to medical history documentation & laboratory results and should-always investigate within the event of incongruences.”
The findings were reported in Annals of Internal Medicine.