Clinically Symptomatic Vitamin E-Associated Peripheral Neuropathy: An Overlooked Reversible Neurological Sequela of Exocrine Insufficiency of Chronic Pancreatitis With Type 3c Diabetes

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.