Chronic pancreatitis is longstanding inflammation of the pancreas that causes scarring and damage to the organ which eventually leads to alteration in its structure and function. Chronic pancreatitis can cause severe vitamin D deficiency, which could be significant, causing secondary hyperparathyroidism and bone lesions. Clinicians should be aware of the causes of bone lesion found incidentally. Most common differential for a patient with Bone lesion is malignancy. Other causes not uncommon but to be considered as seen in our patient are vitamin D deficiency secondary to causes such as chronic pancreatitis. 49 year-old African American inmate presented to our hospital, as a transfer from outside facility with a concern of metastatic cancer after bone scan showed evidence of osteoplastic lesions in the humeri and ribs. Patient has history of significant weight loss, night sweats, generalized weakness and bone pain over a course of one year. He also has a history of rib fracture secondary to simple fall. He reported a history of heavy alcohol abuse before he was incarcerated in prison in 1995. On Physical exam he looked cachectic, clinically anemic. Chest was clear to auscultation with chest wall tenderness. Abdomen is soft with no organomegally. Rectal exam was negative. His admission labs were remarkable for Calcium 5.9 mg/dl, Vitamin D level was undetectable. His HIV serology was negative. Repeated bone scan shows pathologic radio tracer uptake in the ribs and pubic bones. Malignancy work up including CT scan chest, abdomen and pelvis was unremarkable. Tumor markers including PSA were negative. Pancreas was noted to be atrophic with calcification in the abdominal CT scan. On further questioning, patient gave history of chronic abdominal pain and diarrheal episodes. We ordered PTH. It was 1590 pg/ml. It was concluded that his clinical manifestation is related to severe pancreatitis with subsequent malabsorption syndrome and severe vitamin D deficiency which have led to what's called brown tumors of the bone with pathological fracture. Patient then was started on pancreatic enzymes replacement, Vitamin D and calcium.Figure 1Figure 2We are reporting a rare presentation of chronic pancreatitis. Clinical manifestation such bone pain, fractures, and weight loss with bone lesions in bone scan could be misleading of cancer diagnosis and could lead to ordering complex and expensive tests. Clinician should be alert to the late and severe presentation of chronic pancreatitis causing vitamin D deficiency with subsequent secondary hyperparathyroidism leading to Brown tumors particularly in patient who have dark skin, prisoners with limited sun exposure such as in our patient. These patients will benefit with simple lab tests such as vitamin D levels and if low, then PTH levels. We can cut back on malignancy workup and save lot on financial burden in Health Care.