title: Rituximab therapy for refractory biliary strictures in immunoglobulin G4-associated cholangitis.
abstract: OBJECTIVE
  Biliary strictures occur in a third of patients with autoimmune pancreatitis and have been termed immunoglobulin G subclass 4 (IgG4) associated cholangitis (IAC). IAC often responds to steroid therapy.
  
  
  METHODS
  A patient with autoimmune pancreatitis and (IAC) refractory to steroids and 6-mercaptopurine was treated with rituximab, a monoclonal antibody directed against the CD20 antigen on B lymphocytes.
  
  
  RESULTS
  The patient's biliary strictures improved after rituximab therapy, permitting removal of his biliary stents. Systemic manifestations of IgG4-associated disease also improved.
  
  
  CONCLUSIONS
  Rituximab may be a treatment option for patients with refractory or recurrent autoimmune pancreatitis or IAC.
authors.affiliation: Miles and Shirley Fiterman Center for Digestive Diseases, Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55906, USA. topazian.mark@mayo.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Topazian
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.forename: Jose S
authors.initials: JS
authors.lastname: Pulido
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.forename: Suresh T
authors.initials: ST
authors.lastname: Chari
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism*; D007155:Immunologic Factors / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D000069283:Rituximab; D014057:Tomography, X-Ray Computed
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007074:Immunoglobulin G; D007155:Immunologic Factors; D000069283:Rituximab