Immunoglobulin G4 associated autoimmune cholangitis and pancreatitis following the administration of nivolumab: A case report

Rohit Agrawal, Grace Guzman, Saman Karimi, Pier Cristoforo Giulianotti, Alfredo Jose Mena Lora, Shikha Jain, Meshaal Khan, Brian R. Boulay, Yolande Chen

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND Immune checkpoint inhibitors have significantly improved survivals for an increasing range of malignancies but at the cost of several immune-related adverse events, the management of which can be challenging due to its mimicry of other autoimmune related disorders such as immunoglobulin G4 (IgG4) related disease when the pancreaticobiliary system is affected. Nivolumab, an IgG4 monoclonal antibody, has been associated with cholangitis and pancreatitis, however its association with IgG4 related disease has not been reported to date. CASE SUMMARY We present a case of immune-related pancreatitis and cholangiopathy in a patient who completed treatment with nivolumab for anal squamous cell carcinoma. Patients IgG4 levels was normal on presentation. She responded to steroids but due to concerns for malignant biliary stricture, she opted for surgery, the pathology of which suggested IgG4 related disease. CONCLUSION We hypothesize this case of IgG4 related cholangitis and pancreatitis was likely triggered by nivolumab.

Original languageEnglish (US)
Pages (from-to)7124-7129
Number of pages6
JournalWorld Journal of Clinical Cases
Volume10
Issue number20
DOIs
StatePublished - Jul 16 2022
Externally publishedYes

Keywords

  • Biliary stricture
  • Case report
  • Cholangitis
  • Immunoglobulin g4 related disease
  • Nivolumab
  • Pancreatitis

ASJC Scopus subject areas

  • General Medicine

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