P3942 - Advanced Cirrhosis in a Patient with Suspected Auto-Brewery Syndrome and Recurrent Alcohol Intoxication-Like Episodes

Wael T. Mohamed, MD¹, Kyle Rowe, MD¹, Nathan Tofteland, MD¹, William J.. Salyers, MD, MPH²
1University of Kansas School of Medicine, Wichita, KS; 2University of Kansas School of Medicine - Wichita, Wichita, KS

Introduction: Auto-brewery syndrome (ABS) is a rare and controversial condition where endogenous fermentation leads to elevated blood alcohol levels in the absence of intake. Its diagnosis is particularly challenging in patients with known alcohol use disorder (AUD).

Case Description/

Methods: A 39-year-old woman with reported ABS and known AUD presented with abdominal pain, nausea, fatigue, and drowsiness. Her blood alcohol level on arrival was 493 mg/dL, declining to undetectable without documented ingestion. She developed withdrawal symptoms and was treated with CIWA protocol. Urine toxicology was positive for opiates. She was taking fluconazole, nystatin, and Lactobacillus at presentation.

Prior GI evaluations were inconclusive, with a failed carbohydrate challenge and no biopsy-proven ABS. Imaging revealed cirrhosis with portal hypertension and splenomegaly. Labs showed hepatocellular injury (AST:ALT 2:1), hyperbilirubinemia (3.0), coagulopathy (INR 1.4), hypoalbuminemia (2.4), and thrombocytopenia (33). MELD-3.0 was 17. She exhibited grade II hepatic encephalopathy and was started on lactulose. Workup for alternative liver disease etiologies was inconclusive. Psychiatry and infectious disease were consulted for evaluation of antifungal/probiotic use and underlying behavioral concerns.

Discussion: This case underscores the difficulty of diagnosing ABS in patients with coexisting AUD and advanced liver disease. A multidisciplinary approach is vital in evaluating unexplained alcohol levels and safely managing cirrhosis-related complications.


Figure: Portal hypertension is evidenced by cirrhotic liver with splenomegaly.

Disclosures:
Wael Mohamed indicated no relevant financial relationships.
Kyle Rowe indicated no relevant financial relationships.
Nathan Tofteland indicated no relevant financial relationships.
William Salyers indicated no relevant financial relationships.

Wael T. Mohamed, MD¹, Kyle Rowe, MD¹, Nathan Tofteland, MD¹, William J.. Salyers, MD, MPH². P3942 - Advanced Cirrhosis in a Patient with Suspected Auto-Brewery Syndrome and Recurrent Alcohol Intoxication-Like Episodes, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.