Diabetes mellitus (DM) after an episode of chronic pancreatitis, known as type 3c diabetes, is becoming an exceedingly common entity. Not only endocrine but also chronic pancreatitis-associated exocrine pancreatic insufficiency (EPI) is being increasingly described. After pancreatitis, EPI usually manifests as malabsorption with steatorrhea detected by fecal elastase; a high index of suspicion is required to diagnose exocrine sequelae. In fact, clinically symptomatic vitamin E deficiency is especially rare and almost overlooked and underrecognized. Furthermore, subclinical fat-soluble vitamin E deficiency due to EPI is seldom recognised. We report a case of chronic pancreatitis-related sensorimotor peripheral neuropathy due to vitamin E deficiency, which resolved on administration of vitamin E. To the best of our knowledge, chronic pancreatitis-related EPI fat-soluble vitamin E deficiency-associated neurological sequelae have been overlooked and rather neglected in medical literature. In diabetic patients, neuropathy-related symptoms are always clinically attributed as a complication of diabetes per se.
Chanday et al. (Fri,) studied this question.