Rituximab therapy for refractory biliary strictures in immunoglobulin G4-associated cholangitis

Clin Gastroenterol Hepatol. 2008 Mar;6(3):364-6. doi: 10.1016/j.cgh.2007.12.020.


Background & aims: 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.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20
  • Cholangiopancreatography, Endoscopic Retrograde
  • Cholangitis / complications*
  • Cholangitis / diagnosis
  • Cholangitis / metabolism
  • Cholestasis, Extrahepatic / diagnosis
  • Cholestasis, Extrahepatic / drug therapy*
  • Cholestasis, Extrahepatic / etiology
  • Follow-Up Studies
  • Humans
  • Immunoglobulin G / metabolism*
  • Immunologic Factors / therapeutic use*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Pancreatic Ducts*
  • Rituximab
  • Tomography, X-Ray Computed


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20
  • Immunoglobulin G
  • Immunologic Factors
  • Rituximab