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Auto-brewery syndrome (ABS), also known as gut fermentation syndrome, is a rarely diagnosed medical condition where ingested carbohydrates are converted to alcohol by fungi in the gastrointestinal tract. Patients with this condition become inebriated and suffer all the medical and social implications of alcoholism, including arrest for drunken driving. This report details the case of a patient who manifested many of the alcohol-related symptoms yet claimed repeatedly that he had not ingested any alcohol.
A previously active, healthy, 46-year-old man (height, 6 feet 2 inches; weight, 230 lbs; body mass index, 30 kg/m2) with no significant medical or psychiatric history sought our help for the confirmation and treatment of ABS.
He complained of having had memory loss, mental changes, and episodes of depression for over 6 years starting in January of 2011. These changes started to occur after he received antibiotic therapy (cephalexin 250 mg orally three times a day for 3 weeks) for a complicated traumatic thumb injury. One week after the completion of his antibiotic therapy, personality changes with episodes of depression, ‘brain fog’, and aggressive behaviour became apparent...
One morning, he was arrested for presumed driving while intoxicated (DWI). He refused a breathalyser analysis and was hospitalised. His initial blood alcohol level was 200 mg/dL. The hospital personnel and police refused to believe him when he repeatedly denied alcohol ingestion.