Pancreatogenic diabetes mellitus (type 3cDM): Due to chronic alcoholic pancreatitis having hepatitis B antigen positivity presented with ketoacidosis-A case report

Pancreatogenic diabetes (T3cDM) is a secondary form of Diabetes mellitus (DM) where exocrine pancreas is the cause of disease. A case of young male, known diabetic and having alcohol use disorder (AUD),with features suggestive of T3cDM is presented here. He had generalized body ache, abdominal discomfort and loss of weight. On presentation he had diabetic ketoacidosis and severe hyperglycemia. His USG abdomen and CECT abdomen showed multiple small foci of calcifications in pancreas which was suggestive of chronic pancreatitis. His random C-peptide level was low and GAD antibodies were negative. He had hepatitis B antigen positivity. He had malabsorption and malnutrition suggestive of exocrine pancreatic dysfunction. The case is presented here for three reasons,(I)to highlight the possibility of misdiagnosis or under diagnosis,(ii) his presentation was with ketoacidosis which is not very usual and (iii) in view of searching evidence for possible association to hepatitis B antigen positivity.