A medicolegal approach to the very rare Auto-Brewery (endogenous alcohol fermentation) syndrome

Objective: Auto-Brewery Syndrome is defined as the production of ethanol by microorganisms becoming dominant when inhabiting the gastrointestinal system or through the impairment of flora because of carbohydrate-rich nutrition, and the elevation of levels of measured ethanol. This study aimed to consider medicolegal approaches to individuals with Auto-Brewery Syndrome.Methods: A 38-year-old male patient who was involved in a traffic accident about two months ago and whose driving license was taken away due to his blood alcohol level measuring above the legal limits was referred to our department for the detection of any condition which might cause the elevation of blood alcohol levels without alcohol intake, in consequence of his objection submitted to the judicial authorities claiming that he had not drunk alcohol on the day of the event.Results: After the informed consent of the individual was obtained, he was admitted under supervision to an inpatient unit with a visitor ban in a manner which inhibited his intake of alcohol, and during admission his blood alcohol levels were measured at intervals. His blood alcohol level was measured as 160 mg/dl at the time of admission for monitoring and as 141 mg/dl, 322 mg/dl, 208 mg/dl and 279 mg/dl after two hours, six hours, 12 hours and 20 hours, respectively. His liver function test results were high and neurological examination was normal. The individual was diagnosed with Auto-Brewery Syndrome.Conclusion: Various gastrointestinal system abnormalities such as through laparotomy, gastrectomy are reported in most of Auto-Brewery syndrome cases. There are cases, although rare, where gastrointestinal disorders are not detected and secondary disorders of normal intestinal flora due to frequent antibiotic use seem to be a factor. Such a condition is present in the current case. Those who are aware of this condition may falsely rely on it as a method to avoid penalties. On the other hand, genuine patients suffering from this condition may be caught by traffic control and become victims of the condition. For that reason, a meticulous and planned approach should be taken to verify the condition and to ensure that it is not overlooked.