纳武单抗治疗后发生的免疫球蛋白G4相关性自身免疫性胆管炎和胰腺炎：一例报告
Immunoglobulin G4 associated autoimmune cholangitis and pancreatitis following the administration of nivolumab: A case report.
作者信息
Agrawal Rohit, Guzman Grace, Karimi Saman, Giulianotti Pier Cristoforo, Lora Alfredo Jose Mena, Jain Shikha, Khan Meshaal, Boulay Brian R, Chen Yolande
机构信息
Department of Gastroenterology and Hepatology, University of Illinois, Chicago, IL 60607, United States.
Department of Pathology, University of Illinois, Chicago, IL 60607, United States.
出版信息
World J Clin Cases. 2022 Jul 16;10(20):7124-7129. doi: 10.12998/wjcc.v10.i20.7124.
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.
背景
免疫检查点抑制剂已显著提高了越来越多恶性肿瘤患者的生存率，但代价是出现了一些免疫相关不良事件。由于其表现类似于其他自身免疫相关疾病，如胰腺胆道系统受影响时的免疫球蛋白G4（IgG4）相关疾病，因此对这些不良事件的管理可能具有挑战性。纳武单抗是一种IgG4单克隆抗体，已被证实与胆管炎和胰腺炎有关，然而，迄今为止，其与IgG4相关疾病的关联尚未见报道。
病例摘要
我们报告一例接受纳武单抗治疗肛管鳞状细胞癌的患者发生免疫相关胰腺炎和胆管病。患者就诊时IgG4水平正常。她对类固醇治疗有反应，但由于担心恶性胆管狭窄，她选择了手术，手术病理提示为IgG4相关疾病。
结论
我们推测该例IgG4相关胆管炎和胰腺炎可能是由纳武单抗引发的。
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