Context It is well-known that subjects with diabetes resulting from tropical chronic pancreatitis are prone to diabetic microvascular complications (neuropathy, nephropathy and retinopathy). However, macrovascular complications (coronary artery disease, stroke and peripheral vessel disease) are rare, as these subjects are younger, leaner and have lower cholesterol levels. Case report We report the case of a 51-yearold male who had tropical chronic pancreatitis, diabetes and severe peripheral vessel disease with gangrene. He was lean, had borderline lipid levels and was normotensive. His ECG was normal. Conclusions Peripheral vascular disease can occur in these diabetic subjects, even without additional risk factors for atherosclerotic vascular disease. All subjects with tropical chronic pancreatitis and diabetes should have a complete foot examination once a year, in addition to screening for other vascular complications.