SHM Converge Scientific Abstract ePoster Gallery-Auto-Brewery Syndrome-Induced Pancreatitis

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Auto-brewery syndrome is a rare disorder in which ethanol is produced endogenously by GI microorganisms, causing intoxication-like symptoms without alcohol intake. This case describes a 23-year-old man with recurrent epigastric pain and chronic pancreatitis previously attributed to type 2 autoimmune pancreatitis (AIP). On admission, he had abdominal tenderness, lactic acidosis, and an unexpected serum ethanol level of 23 mg/dL, which rose again later despite his firm denial of drinking.<br /><br />Over the prior two years, extensive workup had not supported type 1 AIP, and treatments such as steroids, azathioprine, celiac plexus block, sphincterotomy, and pancreatic duct stenting had not helped. Imaging showed pancreatic atrophy and ductal prominence but no findings typical of autoimmune pancreatitis. A Coca-Cola carbohydrate challenge confirmed endogenous ethanol production, with blood alcohol levels rising from 155 to 214 mg/dL over three hours after ingestion.<br /><br />Because symptoms worsened after carbohydrate intake, the team suspected auto-brewery syndrome as the driver of his pain and presumed chronic pancreatitis flares. Dietary management with a high-protein, low-carbohydrate diet was initiated. Empiric fluconazole was started based on common fungal causes, but symptoms did not improve and cultures did not grow yeast. Later gastric and jejunal aspirates grew Klebsiella pneumoniae and oral streptococcal species, while fungal cultures remained negative. Given persistent symptoms, infectious disease consultants recommended empiric neomycin.<br /><br />The authors conclude that this may be the first documented case of acute-on-chronic pancreatitis due to ethanol produced by Klebsiella. Clinicians should consider auto-brewery syndrome in patients with pancreatitis or intoxication-like findings who deny alcohol use.

Asset Subtitle

James S. Kim

Meta Tag

Author List Annie Massart, James S. Kim, Karen A. Clarke, Kathleen D. Aldrich

Category Clinical Vignettes

Concept Auto-brewery Syndrome

Concept Endogenous Ethanol Production

Concept Carbohydrate Challenge Test

Concept Carbohydrate Restriction

Concept Blood Alcohol Measurement

Distinguished Non-Finalist

Presenter Organization Emory University

Presenting Author James S. Kim

Track Adult

Keywords

auto-brewery syndrome

endogenous ethanol production

chronic pancreatitis

Klebsiella pneumoniae

carbohydrate challenge

autoimmune pancreatitis

serum ethanol

intoxication-like symptoms

low-carbohydrate diet

fluconazole

Auto-brewery Syndrome

Endogenous Ethanol Production

Carbohydrate Challenge Test

Carbohydrate Restriction

Blood Alcohol Measurement