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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Rohit Agrawal, Department of Gastroenterology and Hepatology, University of Illinois, Chicago, IL 60607, United States
Grace Guzman, Saman Karimi, Department of Pathology, University of Illinois, Chicago, IL 60607, United States
Pier Cristoforo Giulianotti, Department of Surgery, University of Illinois, Chicago, IL 60607, United States
Alfredo Jose Mena Lora, Department of Infectious Disease, University of Illinois, Chicago, IL 60607, United States
Shikha Jain, Meshaal Khan, Yolande Chen, Department of Hematology and Oncology, University of Illinois, Chicago, IL 60607, United States
Brian R Boulay, Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, United States
Author contributions: Agrawal R and Khan M wrote the case report; Guzman G and Karimi S, pathologists who helped with diagnosis and review of manuscript; Giulianotti PC involved in the case, provided valuable insight into diagnosis and management, reviewed paper; Lora AJM as an ID specialist on case, reviewed paper and provided valuable comments; Jain S and Chen Y, they are oncologists who made the diagnosis and were involved in management, wrote paper and reviewed it; Boulay B as a gastroenterologist on the case, provided insight into diangosis and management, helped with writing and reviewing the paper.
Informed consent statement: Informed written consent was not obtained from the patient for publication of this report and any accompanying images as no personal information has been documented.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Rohit Agrawal, MBBS, Doctor, Department of Gastroenterology and Hepatology, University of Illinois, 1200 West Harrison Street, Chicago, IL 60607, United States.
ragraw7@uic.edu
Received: January 5, 2022
Peer-review started: January 5, 2022
First decision: March 9, 2022
Revised: March 21, 2022
Accepted: May 22, 2022
Article in press: May 22, 2022
Published online: July 16, 2022
Processing time: 180 Days and 20 Hours
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.
Core Tip: Although immune checkpoint inhibitors are a game changer in the management of several cancers, they have been associated with immune related side effects due to their basic mechanism of immune hyperactivity. We hypothesize in our case report that nivolumab resulted in the overt expression of immunoglobulin G4 (IgG4) related pancreatitis and cholangitis. To our knowledge, this is the first report that documents a possible association between immune related side effects and IgG4 related disease.
