University of Texas Health Science Center at Tyler Tyler, TX, United States
Award: Presidential Poster Award
Omer Chowdhury, DO, John Martino, DO, Umair Sohail, MD University of Texas Health Science Center at Tyler, Tyler, TX
Introduction: Auto-brewery syndrome (ABS), also known as gut-fermentation syndrome is a rare condition in which endogenous ethanol is produced in excess amounts from carbohydrate breakdown by fungi or bacteria in the gastrointestinal tract. In this report, we present a patient with recurrent admissions from alcohol intoxication in the absence of alcohol intake leading to a progressive decline in synthetic liver function.
Case Description/Methods: A 63-year-old male with a past medical history of non-alcoholic fatty liver disease and hyperlipidemia presented to the hospital with altered mental status and signs of intoxication. He had a similar episode 10 years ago, but his symptoms spontaneously resolved, and he did not suffer another episode until December 2018. On this admission, his vitals were stable, and examination did not reveal any signs of chronic liver disease. His blood alcohol level was 403 mg/dl but he vehemently denied alcohol consumption. His LFTs were normal except for an elevated AST of 112. His hemoglobin, platelet count, ammonia, and INR were normal. He had an elevated MCV of 108.0 fL. His workup was negative for viral hepatitis serologies, autoimmune serologies, EGD, and screening colonoscopy which were all unremarkable except for findings of non-alcoholic steatohepatitis on abdominal ultrasound. A glucose challenge test with 200 gram of glucose was performed which was positive. Patient was then treated empirically with a 30-day regimen of Fluconazole and advised to modify his diet to avoid simple carbohydrates and incorporate high-protein foods. He had another admission in December 2019 with similar symptoms and yet again, had an elevated blood alcohol level. He did not have any signs of chronic liver disease on this exam either. However, his INR had increased to 1.8 on this admission, with normal hemoglobin and platelet counts. He was treated with a 14-day regimen of Itraconazole.
Discussion: Auto-brewery syndrome (ABS) is a well-known entity, however, to the best of our knowledge, this is the first report to document recurrent episodes. In our patient, his INR increased from 1.1 to 1.8 since his initial presentation. His MCV also remained elevated despite having normal values of vitamin B12 and folate, which points to bone marrow toxicity from chronic endogenous alcohol production. Overall, ABS remains an underdiagnosed condition given its rarity, and laboratory markers, such as INR and MCV, may objectively quantify disease progression.
Omer Chowdhury indicated no relevant financial relationships.
John Martino indicated no relevant financial relationships.
Umair Sohail indicated no relevant financial relationships.
Omer Chowdhury, DO, John Martino, DO, Umair Sohail, MD. P1944 - Recurrent Episodes of Auto-Brewery Syndrome in the Setting of Worsening Synthetic Liver Function, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.