Acute pancreatitis has been the cause of death in several patients with AIDS and AIDS-related complex (ARC). Documented etiologies include several microorganisms and adverse drug reactions. We present a case of an HIV-positive prison inmate who died of acute necrotizing pancreatitis. Although he was infected with Mycobacterium avium-intracellulare, it is more likely that 2‘,3’-dideoxyinosine, an antiretroviral agent, induced pancreatitis. It is important to obtain a thorough pharmaceutical history in HIV-positive patients. Fatal medicinal reactions may result in death in ARC or AIDS patients. Documentation of opportunistic infection in AIDS patients may prove difficult and expensive, but costs may be minimized and diagnostic accuracy optimized if appropriate tissue samples, including lymph nodes, are submitted for histologic analysis.