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Medicine, Psychology & Health
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The Unbelievable Case of the Woman Who Brewed Alcohol in Her Bladder
A 61-year-old woman seeking a liver transplant was found to have yeast in her bladder fermenting sugar into alcohol. This rare condition, Urinary Auto-Brewery Syndrome, caused positive alcohol tests despite her sobriety, nearly costing her a new organ.
Imagine being on a waiting list for a life-saving organ transplant, only to be repeatedly accused of alcoholism despite swearing you haven't had a drink. This was the baffling and distressing reality for a 61-year-old woman whose body was hiding an incredible secret: her bladder had become its own microbrewery.
A Medical Mystery
In 2020, physicians at the University of Pittsburgh Medical Center were puzzled. Their patient, who suffered from diabetes and liver cirrhosis, was in desperate need of a transplant. However, routine urine tests consistently came back positive for high levels of alcohol. The woman insisted she was abstinent, a claim clinicians are often skeptical of, especially in cases of liver disease. Her medical team and counselors believed she was hiding a drinking problem, and she was at risk of being removed from the transplant list entirely.
The Doctor Becomes a Detective
Fortunately, the doctors decided to dig deeper. They noticed a strange discrepancy. While her urine tested positive for ethanol, more sophisticated tests that check the blood for alcohol and its specific metabolic byproducts (ethyl glucuronide and ethyl sulfate) were consistently negative. This meant alcohol was present in her bladder, but it wasn't being absorbed into her bloodstream. It was a crucial clue that something highly unusual was happening.
As Dr. Kenichi Tamama, a clinical pathologist involved in the case, noted:
The lesson we learned is to be a detective and not just to accept the first result... We need to have an open mind.
An Astonishing Diagnosis: Urinary Auto-Brewery Syndrome
After further investigation, the team discovered large amounts of yeast in her urine. The culprit was identified as Candida glabrata, a yeast naturally found in the body that can overgrow under certain conditions. The pieces of the puzzle fell into place. The patient's poorly controlled diabetes meant she had high levels of sugar (glucose) in her urine. The yeast in her bladder was feasting on this sugar and fermenting it into ethanol—the same process used to make beer and wine.
The doctors had discovered a new phenomenon, which they dubbed Urinary Auto-Brewery Syndrome (UABS). It's an exceptionally rare variant of the better-known Auto-Brewery Syndrome (ABS), where fermentation occurs in the gut and leads to intoxication. In this woman's case, the alcohol production was contained entirely within her bladder, which is why she never felt drunk and her blood tests were clean.
Resolution and A Lesson Learned
Once diagnosed, the woman was treated with antifungal medications to eliminate the yeast. Her case was re-evaluated, and she was reconsidered for the liver transplant she so desperately needed. This remarkable story serves as a critical reminder in the medical world that the human body is capable of extraordinary things and that patient testimony should never be dismissed without thorough investigation. It highlights the danger of assumptions and the life-saving importance of medical curiosity.