Auto brewery syndrome from the perspective of the neurologist

• Published in: Journal of forensic and legal medicine 2023-05, Vol.96, p.102514, Article 102514
• Main Authors: Ser, Merve Hazal, Çalıkuşu, Fatma Zehra, Erener, Nursena, Destanoğlu, Orhan, Kıykım, Ertuğrul, Siva, Aksel
• Format: Article
• Language: English
• Subjects: Blood Alcohol Content; Driving Under the Influence; Ethanol; Female; Humans; Middle Aged; Neurologists; Syndrome
• ISSN: 1752-928X; 1878-7487
• DOI: 10.1016/j.jflm.2023.102514

Auto-brewery syndrome (ABS) is a rare condition that causes the digestive system to produce intoxicating amounts of alcohol due to abnormal growth of the gut microbiota. Medicolegal inferences of ABS have two distinct edges. First, malingering in drunk-driving and abusing the syndrome as a factitious disorder may occur. Second, patients suffering from the syndrome may face medicolegal and social problems. Moreover, chronic exposure to alcohol due to undiagnosed ABS might result in cognitive and behavioral disturbances. Here, we present a patient with recurrent encephalopathy episodes and chronic cognitive disturbances, who was diagnosed with the auto-brewery syndrome, to emphasize the neurocognitive consequences of the syndrome. A 58 years old female presented with mild cognitive impairment, behavioral disturbances, and recurrent encephalopathy episodes. The history of hemicolectomy, an odd smell on her breath, and cravings for high carbohydrate meals during the paroxysmal episodes raised the suspicion of ABS. Her blood ethanol concentration reached 315 mg/dL following an oral glucose tolerance test (OGTT), and stool analysis revealed increased colonization with C. krusei and C. parapsilosis. She was free of the acute episodes, cognitive and behavioral disturbances improved, and C. krusei and C. parapsilosis were eliminated from the intestinal flora with dietary recommendations and nystatin treatment. The auto brewery syndrome is a rare disorder of dysbiosis leading to a disturbed gut-brain axis. Being a treatable and relatively benign diagnosis, presentation of the ABS with neurocognitive disturbances necessitates highlighting. •The auto-brewery syndrome is a rare disorder of dysbiosis leading disturbed gut-brain axis.•Patients might falsely be punished due to drunk-driving or be involved in a traffic accident. The syndrome might be abused as a malingering tool to evade prosecution regarding the driving license.•Presentation of ABS with mild cognitive impairment along with recurrent encephalopathy episodes is not emphasized well from the neurological point of the view.•ABS-related cognitive and behavioral disturbances can lead to significant medicolegal consequences.•ABS should be in the differential diagnosis of recurrent encephalopathy episodes along with mild cognitive and behavioral disturbance.