Gut fermentation syndrome as an alibi for a driver tested positive for alcohol: a case-based discussion

The intestinal fermentation syndrome (IFS) also known as the auto-brewery syndrome (ABS), is an extremely rare diagnosis. This syndrome involves the endogenous production of alcohol by microorganisms in the digestive system after consuming a high-carbohydrate meal. The article describes the case of a 65-year-old driver who was found to have 0.24 mg/l of alcohol during a sobriety test, which, according to Polish law, is defined as a state after consuming alcohol and is considered a misdemeanour. He explained his condition by the occurrence of the intestinal fermentation syndrome. After a thorough analysis of the documentation submitted, it was concluded that there was no basis for assuming that the ethyl alcohol found in the exhaled air resulted from the accused’s health condition, medications taken by him or meals consumed, and the presence of the discussed disease was excluded. The specificity of the intestinal fermentation syndrome encourages the use of the diagnosis as an alibi for alcohol detected in the body. Hence, in such cases, it is important to carefully conduct diagnostics, including differential diagnosis, microbiological tests and, above all, a provocation test with glucose with simultaneous monitoring of the alcohol level in the body. During diagnostics, the possibility of additional alcohol intake should also be excluded to avoid false results and misdiagnosis.