The objective of this study was to determine the prevalence and clinical significance of acute pancreatitis in patients in whom hemorrhagic fever with renal syndrome (HFRS) has been diagnosed. We retrospectively reviewed all patients with a diagnosis of HFRS at our institution from 1994 to 1998. The review included medical records, laboratory results, radiologic examinations, and one autopsy report. From 1994 to 1998, 13 patients received diagnoses of HFRS that were confirmed by serology. In 9 patients (69%), serum amylase, serum lipase, or both were assessed during hospitalization. Seven (78%) of the 9 patients had pancreatitis. Four (57%) of these 7 patients with HFRS and pancreatitis had associated pulmonary edema, and 1 patient had rhabdomyolysis. In our small retrospective case series, acute pancreatitis in patients with HFRS was much more common than previously recognized. Patients with HFRS and pancreatitis had increased morbidity. However, the treatment for the associated pancreatitis was conservative.