A woman in Pittsburgh has become the first documented case in a living person of an unusual medical condition where alcohol naturally ferments in the bladder from the fermentation of yeast.
The condition, which researchers propose to call either bladder fermentation syndrome or urinary auto-brewery syndrome, is similar to another amazingly rare condition, auto-brewery syndrome, where just ingesting carbohydrates can be enough to make you intoxicated, even without consuming any alcohol through conventional means.
In the case, doctors became aware of what appeared to be a similar syndrome, after attending upon a 61-year-old patient who presented with liver damage and poorly controlled diabetes.
The woman visited the University of Pittsburgh Medical Centre Presbyterian Hospital for placement on a liver transplant waitlist, with doctors having previously suspected her problems derived from alcohol dependence, due to repeated urine tests for alcohol showing constantly positive.
Her doctors explained in a case report published in February last year that initially, their encounters were similar, leading their clinicians to think that she was covering an alcohol use disorder.
However, they noted that plasma test results for ethanol and urine test results for ethyl glucuronide and ethyl sulfate, which are the metabolites of ethanol, were negative, whereas urine test results for ethanol were positive.
Furthermore, in addition to consistently denying having consumed alcohol, the patient didn’t seem to display symptoms of inebriation during visits to the clinic, even though her urine revealed high levels of ethanol content.
Another mystery was the presence of large amounts of glucose in her urine, a condition described as hyperglyosuria, with abundant levels of budding yeast seen in urine specimens, and the researchers recorded that those findings led them to examine whether yeast colonising in the bladder could ferment sugar to produce ethanol.
Running tests on her urine, the team confirmed very high levels of ethanol production, suggesting her novel results were due to yeast fermenting sugar in the bladder.
The yeast in question was identified as Candida glabrata, a natural yeast seen in the body and related to brewer’s yeast, but not commonly seen in such abundance.
Unfortunately, efforts to eliminate the yeast with antifungal treatments failed, perhaps due 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 make clear what eventually became of the patient.