By Amy Orciari Herman
Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD
Clinicians have identified a case in which yeast colonizing a woman's bladder fermented sugar to produce ethanol — causing her to have high urinary ethanol levels without consuming alcohol. In the Annals of Internal Medicine, they propose calling this occurrence "urinary auto-brewery syndrome" or "bladder fermentation syndrome."
The woman, who had cirrhosis and poorly controlled diabetes, was denied placement on a hospital's liver transplant list because she consistently had high urinary levels of ethanol. When she presented to another hospital, clinicians again noticed positive urine tests for ethanol — but also negative blood tests for ethanol and negative urine tests for ethanol metabolites. The woman also denied consuming alcohol.
The clinicians then noticed her urine contained high levels of budding yeast, which, during subsequent experiments, appeared to produce high levels of ethanol. The yeast was Candida glabrata — a species closely related to brewer's yeast.
The clinicians note "how easy it is to overlook signals that urinary auto-brewery syndrome may be present." They advise providers to "be diligent about paying close attention to medical record documentation and laboratory results and ... always investigate in the event of incongruences."
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