A 57 year old man presents with persistent burning pain and altered sensation in the right chest and abdomen for 3 months. During the same time period, he also experienced weakness of the right lower limb, and bulging out of the right abdomen after large meals.

He was diagnosed with diabetes 3 years ago, but defaulted on treatment. He is not on any drugs currently, including over the counter medications and herbal remedies. His surgical and family histories are unremarkable. There is no history of contact with tuberculosis.

A complete blood count, ESR, CRP, biochemical profile and toxicology screen are normal. His HbA1c level is 8.9%