A retired US Marine officer in Massachusetts, plagued by a gut that brewed its own alcohol, has seen his symptoms resolve after receiving faecal transplants from a healthy donor. The treatment targeted the rare auto-brewery syndrome, where gut microbes ferment sugars into intoxicating levels of alcohol. This case highlights potential new avenues for managing the condition triggered by antibiotic use.
The man, in his 60s and previously healthy with only occasional drinks, began experiencing severe intoxication-like symptoms—feeling drunk, disoriented, and sleepy—after multiple antibiotic courses for an inflamed prostate. Despite denials of alcohol consumption, emergency department visits yielded skepticism until he was diagnosed with auto-brewery syndrome (ABS), a condition where gut bacteria produce excessive alcohol.
His symptoms disrupted daily life, necessitating a breathalyser lock on his car to prevent driving under the influence. Inspired by a patient support group, he persistently contacted Elizabeth Hohmann, a physician at Massachusetts General Hospital specializing in faecal transplants. Initially dismissive due to his intoxicated-sounding messages, Hohmann engaged after his wife explained the situation. She consulted Bernd Schnabl, a gastroenterologist and ABS expert at the University of California, San Diego, leading to a decision to trial the treatment.
Prior to the procedure, the team analyzed stool samples from 22 ABS patients and 21 household partners, finding that ABS samples generated high alcohol levels in lab cultures, linked to elevated Escherichia coli and Klebsiella pneumoniae—bacteria that ferment sugars into alcohol. Unlike prior cases often tied to yeast overgrowth, this pointed to bacterial dominance, sometimes exacerbated by antibiotics disrupting the gut microbiome.
Treatment involved multiple oral capsules derived from faeces of a rigorously healthy donor—a fitness-focused personal trainer and gym manager whose microbiome impressed researchers. Over time, the man's harmful bacteria were supplanted by the donor's beneficial ones, resolving his ABS. Hohmann recounted a touching moment: his daughter, graduating medical school, expressed gratitude, saying her "old dad is back."
Schnabl noted that trace alcohol production occurs in most guts from these bacteria, but imbalance post-antibiotics can tip it into intoxication. The team now pursues a larger trial of capsule-based faecal transplants for ABS patients.
This breakthrough, detailed in Nature Microbiology (DOI: 10.1038/s41564-025-02225-y), underscores faecal microbiota transplantation's promise for microbiome-related disorders.
