Rituximab therapy for refractory biliary strictures in immunoglobulin G4-associated cholangitis.
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.
Topazian
Mark
M
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
Witzig
Thomas E
TE
Smyrk
Thomas C
TC
Pulido
Jose S
JS
Levy
Michael J
MJ
Kamath
Patrick S
PS
Chari
Suresh T
ST
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
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007074:Immunoglobulin G; D007155:Immunologic Factors; D000069283:Rituximab