INTRODUCTION: Acute pancreatitis is one of the most frequent gastrointestinal causes of hospital admission in the US. While almost 80% of cases are associated with alcohol or gallstones, the remainder often remain idiopathic with no identifiable cause. Here, we present the case of 74-year old male who presented with severe pancreatitis after topical cannabinoid use who eventually expired from complications of the disease. CASE DESCRIPTION/METHODS: 74 year-old male with history of HTN, ischemic cardiomyopathy, stage 3 CKD, multiple strokes and lumbar spinal stenosis presented with sudden onset of abdominal pain. The pain began one day prior and was described as a sharp sensation in the epigastrium radiating to the chest. It was associated with dry heaving but no vomiting. The patient was having non-bloody diarrhea since the pain began. No fevers, but chills and diaphoresis were present. He denies any recent alcohol use and is s/p cholecystectomy. He endorses recently using topical cannabinoid oil for chronic low back pain. He was afebrile on arrival but hypertensive to 214/97. His labs were remarkable for WBC 23, H&H 17/54, lipase 47082, Cr 1.56, Tbili 1.9, ALT 210, AST 330, Alk Phos 211, EtOH level <5. CT abdomen/pelvis showed moderate acute, interstitial pancreatitis with small, non-loculated fluid collections. Despite aggressive fluid resuscitation, the patient required pressor support and was intubated. Abdomen US revealed no pancreatic or biliary dilation and surgically absent gallbladder. His condition continued to worsen and Nephrology initiated CRRT for anuric renal failure. He developed atrial fibrillation with hypotension requiring continuous amiodarone infusion. H&H began to drop and DIC developed rapidly. The patient expired after 10 days. DISCUSSION: After extensive work-up, no specific etiology was found for acute pancreatitis in this patient. The recent use of topical cannabinoid oil for chronic back pain showed a temporal correlation with the patient's medical condition and was thought to be the inciting factor leading to this patient's demise. Given the increased availability of cannabis in managing chronic pain, patients should be aware of the association between cannabis and acute pancreatitis. Additionally, health care providers should include cannabis (including all marijuana varieties and methods of consumption) in the differential diagnosis of acute pancreatitis cases with unknown etiology.