Reading time: 2 min – Spotted on Science Alert
This pathology, which the researchers propose to call “bladder fermentation syndrome” or “urinary self-brewing” is extremely rare. It’s similar to auto-brewing syndrome, where just ingesting carbohydrates can be enough to make you drunk, even without consuming alcohol.
Doctors learned of the case of a 61-year-old patient who presented with liver damage and poorly controlled diabetes. The woman went to the Presbyterian Hospital at the University of Pittsburgh Medical Center in Pennsylvania to be placed on a waiting list for a liver transplant. Doctors had previously suspected that his problems stemmed from an alcohol addiction, as his repeated urine tests were consistently positive. “Initially, our conclusion was the same: this patient has diabetes. This is what led our clinicians to believe that it was hiding an alcohol consumption disorder ”, explain the doctors in a report published in February 2020.
“However, they continue, we noticed that plasma test results for ethanol and urine test results for ethyl glucuronide and ethyl sulfate, which are the metabolites of ethanol, were negative, while urine test results for ethanol were positive. “ In addition to systematically denying having consumed alcohol, the patient did not appear to show any signs of intoxication during her visits to the clinic, even though her urine had high levels of ethanol.
The bladder, a real distillery
Another mystery was the presence of large amounts of glucose in his urine – a condition called hyperglycosuria – with abundant levels of budding yeast seen in urine samples. “These results led us to verify whether the yeasts colonizing the bladder could ferment sugar to produce ethanol”, wrote the researchers. By performing tests on his urine, the team confirmed remarkably high levels of ethanol production, suggesting the bizarre results were due to yeast fermenting sugar in the bladder. The yeast in question has been identified as Candida glabrata, which occurs naturally in the body and resembles brewer’s yeast, but which is not normally found in such large quantities in the bladder.
Unfortunately, efforts to eliminate the yeast with antifungal treatments failed, possibly due to the patient’s poorly controlled diabetes. In light of the woman’s seemingly unique situation, doctors note that she was reconsidered for a liver transplant, although their report does not specify what happened to her. While studying this particular case, doctors became aware of other reports of similar production of ethanol in urine, but only in a post-mortem case and in in vitro experiments. That said, it is possible that other patients have experienced this rare condition in the past, but the symptoms have not been recognized, due to the unusual and largely unknown nature of the condition.
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