The importance of gastrointestinal complications in systemic lupus erythematosus (SLE) has been evident since William Osier's description of gastrointestinal crises in erythema exudativum multi-forma in 1895 (46). Thirty-five to forty percent of patients with SLE develop signs or symptoms of gastrointestinal involvement during the course of their illness (6, 17, 26). Nearly 20 percent of these patients complain of abdominal pain at some point and 9.2 percent of Dubois's series of 520 patients presented with abdominal pain as their chief complaint (18). Peritonitis (8, 40, 51, 60), ulceration (36), bowel perforation (15), hemorrhage (15) and motility disturbance (6) are commonly recognized etiologies of gastrointestinal symptoms in patients with SLE. While pancreatitis is not mentioned in some reviews of gastrointestinal pathology in SLE (6, 15, 18), Pollak (51) found acute necrotizing pancreatitis in 4 of 14 patients with severe abdominal crisis, 3 of whom died. Since the first reported case by Reifen-stein (52) in 1939, pancreatitis complicating SLE has been reported in 26 patients (8, 10, 11, 14, 22, 23, 25, 27, 35, 42, 44, 51, 52, 54, 61).Patients with SLE may present with gastrointestinal crises (36) including pancreatitis prior to the administration of adrenocorticosteroids. An unresolved issue remains whether SLE, independent of steroid therapy, is a cause of pancreatitis. Reports of patients with pancreatitis prior to the use of steroids (10, 52) or off steroid therapy (44) have suggested that pancreatitis may result as a manifestation of active lupus vasculitis. The importance of vascular (37, 48, 49) and immunologic (39, 64, 65) processes in the development of pancreatitis has been previously emphasized.Corticosteroid therapy per se has also been implicated as a cause of acute pancreatitis (19, 41).Lupus is the most frequent underlying disorder in adults (41) when steroids are implicated as the cause of pancreatitis. No correlation regarding duration of therapy, dosage, or specific corticosteroid preparations has been noted in patients who develop pancreatitis on steroids (11, 19, 41).In view of these unanswered questions, the experience over a 6-year period at The New York Hospital was reviewed. An analysis of 20 cases of clinical pancreatitis associated with SLE is presented in this report.