A rare cause of acute pancreatitis and hepatitis syndrome

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CONTEST DISCLAIMER

Case description

Our patient was a 40-year-old man. His medical history included multiple hospitalizations due to acute edematous pancreatitis, attributed to alcohol consumption and dyslipidemia. Fluctuating blood fat levels were observed despite the patient’s diet and fenofibrate therapy. Single plasmapheresis was also performed. A few months later the patient was admitted to a hospital because of hepatitis syndrome with extremely high gamma-glutamyl transferase levels. Abdominal ultrasound showed a diffuse hepatic lesion.

We conducted hepatological examination due to elevated liver enzyme activity, diffuse liver lesions, and fluctuating malaise. Viral serology, immune markers, and tumor markers were negative, but liver elastography indicated F3 fibrosis without steatosis. Additionally, the patient experienced nausea, headaches, speech difficulties, and altered behavior. Blood fat levels began to rise again. Detailed medical history mentioned no contact with any toxic agents. Total abstinence was confirmed by heteroanamnesis. Further tests ruled out enzyme defects. Due to unknown cirrhosis, we performed a core biopsy, which showed histological signs of alcoholic liver disease. There were no signs of a storage disorder.

Looking at both the clinical and histological results, we diagnosed the patient with auto-brewery syndrome. Since then, he has been on a strict diet and his complaints have significantly decreased, his laboratory values have normalized, and the fibrosis has regressed to a mild F1 status. After months of dieting, provocation tests with per os glucose, protein, starch, and white flour were performed. Higher exhalation values were detected only during the white flour test, but blood alcohol levels remained negative. According to the patient’s diary, higher breathalyzer values appear as a result of starvation and stress. To confirm the diagnosis, a stool microbiome analysis was performed, and it showed overgrowth of Proteobacteria, Gammaproteobacteria, Enterobacterales, and Enterobacteriaceae families, which are capable of alcoholic fermentation.

About Best Case Report Contest 2024

Young Talents in Internal Medicine World Contest—previously Best Case Report Contest—is a contest for internal medicine specialists or trainees in internal medicine up to 35 years of age. Every year the most engaging submissions from around the world are presented by authors during a special session at the McMaster International Review Conference of Internal Medicine (MIRCIM). Visit youngtalents.one to learn more.

To browse all abstracts from Best Case Report Contest 2024, visit Polish Archives of Internal Medicine.