We present the case of a 16. year old girl who developed an aggressive colitis in the context of a prior biopsy proven autoimmune pancreatitis, which presented with obstructive jaundice at the age of 13. year. This history prompted prospective investigation and the discovery of compelling evidence to make a diagnosis of IgG4-related sclerosing disease with extra-pancreatic colonic involvement on the basis of raised serum IgG4 levels and a florid colonic IgG4 plasma cell infiltrate with over 20 IgG4 positive plasma cells/hpf. The colitis was resistant to conventional therapy but responded dramatically to treatment with the anti-TNFα monoclonal antibody, adalimumab. This is the first case to report both the effectiveness of adalimumab in treating IgG4 positive colitis in a patient with IgG4-related sclerosing disease, and to prospectively record resolution of an IgG4 positive colonic infiltrate with immunosuppression. © 2012 European Crohn's and Colitis Organisation.
Naghibi, M., Ahmed, A., al Badri, A. M., Bateman, A. C., Shepherd, H. A., & Gordon, J. N. (2013). The successful treatment of IgG4-positive colitis with adalimumab in a patient with IgG4-related sclerosing disease - a new subtype of aggressive colitis? Journal of Crohn’s and Colitis, 7(3). https://doi.org/10.1016/j.crohns.2012.05.003