Severe hypertriglyceridemia presenting with abdominal pain and peripheral neuropathy in a patient with uncontrolled diabetes and chronic alcohol use: a case report

Abstract

Severe hypertriglyceridemia (triglyceride levels >1000 mg/dl) is a recognized high risk metabolic condition, particularly when associated with pancreatitis and the third most common cause of acute pancreatitis. However, its presentation without pancreatic involvement poses substantial diagnostic challenges and may delay appropriate management. We report a case of a 42-year-old male with chronic alcohol consumption (approximately 180 ml whiskey daily) and poorly controlled type 2 diabetes mellitus who presented with abdominal pain, right scapular pain, and a six-month history of peripheral neuropathy. Laboratory evaluation revealed markedly elevated triglycerides (>2000 mg/dl), preserved pancreatic enzymes, and imaging demonstrating a normal pancreas with grade 1 fatty liver on CT scan. Upper gastrointestinal endoscopy revealed mild antral gastritis. The patient was managed with lipid-lowering therapy (fenofibrate-statin combination), aggressive glycemic control with insulin, injectable thiamine, alcohol cessation, and dietary modification, resulting in significant biochemical improvement with triglycerides declining from 2158 to 1054 mg/dL within one week. This case illustrates the synergistic role of insulin resistance and alcohol-induced dyslipidemia in precipitating extreme triglyceride elevation and underscores the importance of early recognition and intervention to prevent catastrophic complications such as acute pancreatitis and chylomicronemia syndrome.