Medical Mystery: Beer-linked kidney failure and paralysis
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A middle-aged man with abdominal pain, vomiting, constipation, and unexplained acute kidney injury had just arrived from a smaller hospital 80 miles away as reported by Eduardo Valle, MD, a second-year medical resident in Brazil. A few miles away, the man's son-in-law was in the ICU of another hospital in the city with identical symptoms but progressing faster than the older man's.

Testing showed the older man had normal blood cell counts, elevated lactic acid, and hepatitis without liver dysfunction. His cranial CT scans appeared normal. After a few days, none of the team's leads had panned out and the father's limbs started to lose function. Meanwhile, three other people from the son-in-law's neighborhood were also admitted to the ICU with similar symptoms.

The strange, linked cases were the start of a medical mystery that took the doctors' intense collaboration to solve as they tried to save their patients.

Valle posted the case on a social media platform as "Is this an unknown infection or intoxication? Any thoughts?" Doctors from around the world responded to his case suggesting botulism, rhabdomyolysis, and lead poisoning, but none of the suggestions could fully explain the patients' symptoms. Then the patients' family mentioned that the men had shared some beer over the Christmas holiday. This confirmed that all five patients drank the same brand of beer before their symptoms started.

A toxicology investigation by police confirmed their suspicion: Diethylene glycol, a poisonous industrial solvent used in antifreeze, was found in beer bottles from the patients' homes and blood samples from four of the patients. But the resolution came too late for Valle's patient. The man died; his kidney biopsy showed acute tubular necrosis and his blood contained diethylene glycol.

Police identified the source as a craft brewer, Belorizontina Backer. Brazil's Ministry of Agriculture called the contamination systemic in a statement and stopped all production at the brewery until it could be remedied.

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