Purpose Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly prescribed for the management of type 2 diabetes mellitus and obesity. Although generally well tolerated, concerns remain regarding their association with acute pancreatitis (1). This abstract describes a case of severe necrotising pancreatitis potentially triggered by semaglutide (Ozempic) therapy. Methodology We report a retrospective case analysis of a 64-year-old male with type 2 diabetes mellitus who presented with first episode of acute epigastric pain, nausea and vomiting. Clinical assessment, biochemical investigations and cross-sectional imaging were reviewed. Common aetiologies of pancreatitis, including cholelithiasis, alcohol use and hypertriglyceridaemia, were excluded. Results The patient had markedly elevated serum lipase (>3000 U/L) and imaging confirmed acute necrotising pancreatitis involving greater than 50% of the pancreas. His admission was complicated by diabetic ketoacidosis and bowel obstruction due to inflammation, requiring intensive care management. He was initially treated conservatively with intravenous fluids, analgesia, antibiotics and nutritional support. Ozempic was permanently discontinued. Despite initial improvement, he re-presented with walled-off pancreatic necrosis and required drainage of the collection and necrosectomy. The temporal relationship between symptom onset and recent initiation of semaglutide, in the absence of other identifiable causes, suggests a likely drug-induced aetiology. Conclusion This case highlights a potential association between semaglutide use and severe necrotising pancreatitis. With the rising use of GLP-1 receptor agonists, clinicians should maintain a high index of suspicion for medication-related pancreatitis and ensure appropriate patient counselling and monitoring. References 1.Masson W, Lobo M, Barbagelata L, Lavalle-Cobo A, Nogueira JP. Acute pancreatitis due to different semaglutide regimens: An updated meta-analysis. Endocrinol Diabetes Nutr (Engl Ed). 2024;71(3):124-32.