Inexplicably Drunk: A Case Of An Underdiagnosed Condition?
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A 46 year old man was arrested in suspicion of drunk driving even after he refused the charges. Later he was diagnosed with condition known as auto brewery syndrome (ABS) which is a rarely diagnosed gastrointestinal condition that causes patients to appear drunk and suffer all the medical and social implications of alcoholism.

He was pulled over on suspicion of drunk driving, vehemently denied consuming alcohol. He was hospitalized and doctors confirmed what police suspected his blood alcohol level was 0.20, two-and-a-half times the state's legal limit.

ABS occurs when ingested carbohydrates are converted to alcohol by fungi in the gastrointestinal tract. His stool testing revealed the presence of two strains of yeast Saccharomyces cerevisiae, commonly used in winemaking, baking, and beer brewing, and Saccharomyces boulardii.

To confirm his diagnosis, he received a carbohydrate meal and his blood alcohol level was monitored. He was treated with antifungals and discharged on a strict carbohydrate-free diet along with special supplements. Although the patient adhered to his prescribed treatment regimen, after a few weeks of no symptoms, intermittent "flares" returned.

Antibiotics the Culprit?

Disheartened by the continuation of his symptoms, the patient consulted Fahad Malik, MD and gastroenterologist Prasanna Wickremesinghe, MD, who had treated a complicated, very similar case of ABS.

They believed that the antibiotics prescribed all those years ago is the culprit. "We were postulating that the antibiotics had changed the microbiome of his gut and allowed the fungi to develop," Malik said.

The physicians asked the patient to monitor his breath alcohol levels twice a day during treatment and immediately report any increases. Over time, he also received treatment with various probiotics to help normalize his gut flora.

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