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Simultaneous occurrence of autoimmune pancreatitis and sclerosing cholangitis as immune-related adverse events of pembrolizumab
  1. Tsuyoshi Suda1,
  2. Masako Kobayashi2,
  3. Koji Kurokawa3 and
  4. Eiki Matsushita1
  1. 1Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
  2. 2Department of Pathology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
  3. 3Department of Respiratory Medicine, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
  1. Correspondence to Dr Tsuyoshi Suda; t.suda1112{at}gmail.com

Abstract

A 57-year-old man with lung cancer, previously treated with the programmed death-1 inhibitor pembrolizumab, was evaluated for liver injury and acute pancreatitis. Serum IgG4 levels were not elevated. Contrast-enhanced CT showed pancreatic swelling, contrast unevenness in the liver and thickening of the common bile duct and gall bladder. Magnetic resonance cholangial pancreatography revealed beads in the left intrahepatic bile duct and localised narrowing of the head and body of the central pancreatic duct. Endoscopic ultrasound-guided fine-needle and liver needle biopsy showed CD8+ and CD4+ T lymphocyte aggregates, whereas immunostaining revealed greater infiltration by CD8+ cells than CD4+ cells. IgG4-related disease was ruled out based on serum and pathological findings. The patient simultaneously presented with immune-related adverse events, autoimmune pancreatitis-like features and sclerosing cholangitis, which were ameliorated by steroid therapy. CD8+ lymphocytes were the dominant infiltrating cells in autoimmune pancreatitis and sclerosing cholangitis.

  • oncology
  • pancreas and biliary tract
  • liver disease

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Footnotes

  • Contributors TS cared for the patient, edited the manuscript, prepared the figures and obtained the written informed consent from the patient. MK made the pathological diagnosis, edited the manuscript and prepared the figures. KK cared for the patient, edited the manuscript and gave the expert opinion on immune checkpoint inhibitors treatment and immune-related adverse events. EM edited the manuscript and gave expert opinions on gastroenterology and hepatology.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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