Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.7124
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
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.
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.
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.