Letter to the Editor Open Access
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 13146-13147
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.13146
Immunoglobulin G4 associated autoimmune cholangitis and pancreatitis and nivolumab
Beuy Joob, Consultant, Sanitation1 Medical Academic Center, Bangkok 106000, Thailand
Viroj Wiwanitkit, Community Medicine, Dy Patil University, Pune 7439393, India
ORCID number: Beuy Joob (0000-0002-5281-0369); Viroj Wiwanitkit (0000-0003-1039-3728).
Author contributions: Joob B gave ideas, wrote, analyzed, revised and approved for final submission; Wiwanitkit V gave ideas, revised, supervised and approved for final submission.
Conflict-of-interest statement: the authors declare for no conflict of interest.
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: Beuy Joob, PhD, Adjunct Professor, Senior Researcher, Consultant, Sanitation1 Medical Academic Center, Bangkok, Bangkok 106000, Thailand. beuyjoob@hotmail.com
Received: September 8, 2022
Peer-review started: September 8, 2022
First decision: October 12, 2022
Revised: October 18, 2022
Accepted: November 25, 2022
Article in press: November 25, 2022
Published online: December 16, 2022

Abstract

This letter to editor discussing on the publication on immunoglobulin G4 associated autoimmune cholangitis and pancreatitis following the administration of nivolumab. Concerns on confounding factors are raised and discussed.

Key Words: Immunoglobulin G4, Autoimmune, Cholangitis, Pancreatitis, Nivolumab

Core Tip: This letter to editor discussing on the publication on immunoglobulin G4 associated autoimmune cholangitis and pancreatitis following the administration of nivolumab. Concerns on confounding factors are raised and discussed.
TO THE EDITOR

We would like to share ideas on the publication “Immunoglobulin G4 associated autoimmune cholangitis and pancreatitis following the administration of nivolumab: A case report.” In a patient who had nivolumab treatment for anal squamous cell carcinoma, Agrawal et al[1] documented a case of immune-related pancreatitis and cholangiopathy. The patient's IgG4 Levels were normal at the time of presentation[1]. Nivolumab was probably what caused this case of IgG4-related cholangitis and pancreatitis, according to Agrawal et al[1].

We both believe that the clinical problem in this case may be related to the nivolumab. Recognizing the potential confounding impact of co-morbidity is necessary, though. For instance, a parasite infection may be the primary cause of pancreatitis and cholangitis in a tropical environment. For a conclusive diagnosis, a thorough study is required to rule out all alternative options[2]. It is challenging to draw a firm judgment without knowing the case's health or immune status prior to the injection of nivolumab.

In conclusion, IgG4-related cholangitis and pancreatitis developed after the administration of nivolumab, according to a case report that was mentioned. Nivolumab may have generated IgG4 Linked cholangitis and pancreatitis based on time course, however even pathologic evidence cannot prove the participation of IgG4-associated cholangitis and pancreatitis and nivolumab. In order to get a firm diagnosis, all potential treatments for comorbidities must be ruled out.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Immunology

Country/Territory of origin: Thailand

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): B

Grade C (Good): C

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Kaneko J; Notohara K, Japan S-Editor: Ma YJ L-Editor: A P-Editor: Ma YJ

References
1.  Agrawal R, Guzman G, Karimi S, Giulianotti PC, Lora AJM, Jain S, Khan M, Boulay BR, Chen Y. Immunoglobulin G4 associated autoimmune cholangitis and pancreatitis following the administration of nivolumab: A case report. World J Clin Cases. 2022;10:7124-7129.  [PubMed]  [DOI]  [Cited in This Article: ]
2.  Jani N, Buxbaum J. Autoimmune pancreatitis and cholangitis. World J Gastrointest Pharmacol Ther. 2015;6:199-206.  [PubMed]  [DOI]  [Cited in This Article: ]