Co-amoxicillin-induced reactivation of auto-brewery syndrome in a patient treated for community acquired pneumonia: a clinical case report.

Auto-Brewery Syndrome (ABS) is a rare metabolic condition characterized by endogenous ethanol production through fermentation of ingested carbohydrates by intestinal microorganisms. Clinical manifestations resemble alcohol intoxication, including ataxia, dysarthria, gastrointestinal symptoms, and altered mental status, despite the absence of alcohol intake. We report a case of a patient in his mid-40s who developed ABS reactivation following treatment with Amoxicillin/Clavulanic acid for community-acquired pneumonia. The patient was successfully managed with targeted antimicrobial therapy, dietary carbohydrate restriction, and probiotic supplementation, resulting in clinical improvement. This case highlights a rare instance of antibiotic-associated ABS relapse and underscores the diagnostic challenge of this unrecognized microbial condition.