Brief communicationRituximab Therapy for Refractory Biliary Strictures in Immunoglobulin G4–Associated Cholangitis
Section snippets
Case Report
A 64-year-old man developed pancreatitis in the fall of 2004. Serum liver tests were normal except for an alkaline phosphatase level of 130 U/L (normal, 80–120 U/L). History, laboratory evaluation, abdominal ultrasound, and computerized tomography scan did not reveal an etiology. Magnetic resonance imaging showed an irregular main pancreatic duct with a stenosis in the neck. His serum IgG4 level was 568 mg/dL (normal, 8–140 mg/dL). Endoscopic ultrasound showed a hypoechoic, enlarged pancreas.
Discussion
AIP is an inflammatory disorder characterized by pancreatic enlargement, multifocal pancreatic duct strictures, increased serum IgG4 levels, and a pancreatic IgG4-positive lymphoplasmacytic infiltrate with narrowing of small ducts and obliterative phlebitis. Bile duct strictures are reported in a third of patients with AIP and have been termed IAC.3 IAC also may occur in patients without pancreatitis. Stenoses may occur in the intrapancreatic bile duct, biliary confluence, and/or peripheral
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Dr Witzig serves on the Genentech and BiogenIDEC advisory boards and receives research support from these companies for clinical trials. This information was disclosed to participants.