Abstract
Endogenous brewery syndrome, also known as “auto-brewery syndrome,” is a very rare condition in which the intestinal microbiota ferments ingested carbohydrates into ethanol, leading to episodes of alcohol intoxication in the absence of alcohol consumption. To date, only about one hundred cases have been reported, with clinical manifestations ranging from dizziness and ataxia to overt intoxication and medicolegal complications. Even rarer is urinary fermentation, characterized by ethanol presence in urine without corresponding blood elevation. Predisposing factors include dysbiosis, high-carbohydrate diets, diabetes, and immunosuppression. Diagnosis relies on a thorough medical history, carbohydrate challenge tests, and microbiological investigations. Treatment involves carbohydrate restriction, antifungal (or antibiotic) therapy, and microbiota-balancing strategies. This syndrome highlights the metabolic role of the microbiota and its clinical and legal implications.