[Endogenous Alcohol Production in the Human Micro- and Mycobiome: Auto-Brewery Syndrome].

Pathological changes in the human microbiome and mycobiome can lead to endogenous production of toxic metabolites, including alcohol. Auto-brewery syndrome (ABS) is characterized by endogenous alcohol formation after high-carbohydrate intake in cases of dysbiosis or underlying disease.Cases described since 1948 were analyzed up to May 2025 via selective literature review regarding symptoms, pathophysiology, diagnostics, and therapy. Syndromes not clearly attributable to endogenous alcohol (e.g., autointoxication, intestinal fermentation syndrome) were excluded.Around 30 cases show variable clinical features with neuropsychiatric, gastrointestinal, and hepatological symptoms, sometimes causing emergencies or accidents. Alcohol is produced by microbial or mycotic overgrowth (e.g., E. coli, Klebsiella, Saccharomyces, Candida) following carbohydrate intake. Diagnosis requires detailed personal and external history, exclusion of other causes, and, if needed, monitored carbohydrate challenge with alcohol measurement. Treatment focuses on carbohydrate reduction, antibiotics or antifungals, and management of underlying conditions.ABS is rare but causes endogenous alcohol-related symptoms that must be considered in medical and legal evaluation of unexplained symptoms or incidents.