Case of ‘autobrewery syndrome’ effectively treated with fecal transplant

The 47-year-old man in Belgium had been experiencing intermittent episodes when he felt drunk despite not consuming any alcohol.

Fecal transplant was successfully used to treat a case of “autobrewery syndrome,” or gut fermentation syndrome, in a 47-year-old man in Belgium, researchers recently reported.

According to a case report published Aug. 18 by Annals of Internal Medicine, the patient had had intermittent episodes during the previous two months when he had felt drunk, even when he hadn't consumed any alcohol. The symptoms had started a month after he had finished two consecutive courses of amoxicillin-clavulanic acid and moxifloxacin for a respiratory tract infection. The patient reported that he drank socially and that his maximum weekend intake was five to six units of alcohol. Although he said he had not had any alcohol for more than four days before his visit, his ethanol level in a blood sample was 34.7 mmol/L (normal range, <2 mmol/L). He had a slightly increased level of aspartate aminotransferase (40 U/L [normal range, 0 to 37 U/L]) and an elevated gamma-glutamyltransferase level (334 U/L [normal range, <64 U/L]). The physicians performed a series of tests that ruled out other conditions and suspected gut fermentation syndrome.

The patient was prescribed a low-carbohydrate diet and antimycotic drugs but continued to show signs of alcohol intoxication without consuming any alcohol. His physicians performed a fecal microbiota transplantation in June 2017, after which symptoms of ethanol intoxication disappeared immediately. The man resumed his normal carbohydrate-rich diet and reported drinking on occasion. He has remained free of symptoms for 34 months, with normal ethanol levels and normal results on liver function tests.

“On the basis of our experience with this patient, we advise other clinicians who have patients with gut fermentation syndrome to consider treatment with fecal microbiota transplantation, especially if more traditional therapy has failed,” the authors wrote. “Moreover, we can imagine a future point—after additional research to evaluate the safety of fecal microbiota transplantation—at which this approach might become standard therapy for gut fermentation syndrome.”