A Case of Auto-brewery Syndrome Treated with Micafungin

Abstract

Auto-brewery syndrome is caused by alcohol brewing inside the human body; it is a rare clinical condition where the patient becomes inebriated without exogenous alcohol use. Yeast is responsible, and treatment requires an appropriate antifungal agent. If undiagnosed, the patient's life becomes a misery. We present a case of a 45-year-old male who suffered from this condition for over three years with two arrests for driving under the influence prior to being diagnosed. The patient stated that he felt the episodes were related to his meal intakes; therefore, he would skip most meals of the day. The patient visited several centers where he was told there was not much they could offer him and he was left without a diagnosis. A carbohydrate challenge test in a monitored setting showed elevated blood alcohol levels. He was treated with antifungals and a low carbohydrate diet which resulted in the resolution of his symptoms. Hence the importance of awareness among physicians is necessary along with a high index of suspicion.

Auto-Brewery Syndrome: A Clinical Dilemma

“…A list of cases reported in the literature along with the involved microorganism is shown in Table 1. This list includes different species of Saccharomyces and Candida such s S. cerevisiae, C. albicans, C. parapsilosis, C. glabrata, C. kefyr, and C. krusei [12][13][14][15][17][18][19][20][21][22][23]. The involvement of these yeasts in the production of ethanol was validated by Bivin and Heinen.…”

“…These include neurological, gastrointestinal, respiratory, and psychological abnormalities. The neurologic symptoms mentioned in the literature include seizures, slurring of speech, incoordination leading to falls, blurring of vision, faintness, and memory loss [17][18][19]. The gastrointestinal abnormalities include nausea, vomiting, diarrhea, and generalized abdominal discomfort [20,23].…”

“…As yeasts are commonly implicated in this syndrome, antifungals are frequently used. In our literature search, the common antifungals used for its treatment include fluconazole, nystatin, micafungin, trichomycin B, and voriconazole [13][14][15][17][18][19][20][21]. Antibiotics are used only if the involved agent is bacteria.…”

“…All of them produced ethanol in all the test solutions highlighting the underlying etiology of ABS syndrome [ 24 ]. Some cases of bacterial involvement are also available in the literature [ 18 ]. Baraona et al conducted the experiments on rats and demonstrated the ethanol formation by bacteria residing in the intestine [ 25 ].…”

“…Some reported cases in the literature were improved only by following the dietary guidelines and there was no need for drug therapy [ 12 ]. There is also a use of probiotics such as Lactobacillus in some cases, but its efficiency in this syndrome is yet to be studied [ 18 ].…”