{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T06:37:22Z","timestamp":1776926242923,"version":"3.51.2"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>IgG4-SC typically requires long-term corticosteroid therapy. We report a distinctive case of a 65-year-old woman with biopsy-supported IgG4-SC that closely mimicked malignancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>The patient presented with 10\u00a0kg weight loss and CA19\u20139 of 315 U\/mL. She achieved sustained clinical and biochemical remission after repeated endoscopic mechanical decompression alone, with no recurrent obstructive cholestasis during long-term clinical and biochemical follow-up. However, serum IgG4 remained elevated at long-term reassessment, and complete immunologic remission could not be assumed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case raises the possibility of an \u201cobstruction-dominant\u201d presentation of IgG4-SC and suggests that intensive endoscopic biliary decompression may serve as a temporary or, in selected cases, sustained steroid-sparing strategy in carefully selected high-risk patients, without challenging the current role of corticosteroids as standard first-line therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1803019","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T05:38:00Z","timestamp":1776922680000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A steroid-sparing mechanical management of IgG4-related sclerosing cholangitis mimicking cholangiocarcinoma"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhenchao","family":"Liu","sequence":"first","affiliation":[{"name":"School of Pharmacy, Qingdao University","place":["Qingdao, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aihua","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Linyi People\u2019s Hospital","place":["Linyi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Cao","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, The Affiliated Hospital of Qingdao University","place":["Qingdao, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinbo","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Linyi People\u2019s Hospital","place":["Linyi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.5114\/ceh.2018.78126","article-title":"A good response to steroid therapy in IgG4-related sclerosing cholangitis: a case report","volume":"4","author":"Zhang","year":"2018","journal-title":"Clin Exp Hepatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s00535-016-1163-7","article-title":"IgG4-related sclerosing cholangitis: all we need to know","volume":"51","author":"Zen","year":"2016","journal-title":"J Gastroenterol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1002\/jhbp.793","article-title":"Epidemiological features of immunoglobulin G4-related sclerosing cholangitis in Japan","volume":"27","author":"Tanaka","year":"2020","journal-title":"J Hepatobil Pancreat Sci"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000002052","article-title":"Extensive metastatic cholangiocarcinoma associated with IgG4-related sclerosing cholangitis misdiagnosed as isolated IgG4-related sclerosing cholangitis: a case report and literature review","volume":"94","author":"Zhang","year":"2015","journal-title":"Med (Balt)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2008.04.002","article-title":"Persistent elevation of serum CA 19\u20139 with no evidence of Malignant disease","volume":"41","author":"Ventrucci","year":"2009","journal-title":"Dig Liver Dis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1186\/s12885-021-08204-w","article-title":"Dynamic change of serum CA19\u20139 levels in benign and Malignant patients with obstructive jaundice after biliary drainage and new correction formulas","volume":"21","author":"Zhao","year":"2021","journal-title":"BMC Cancer"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1299451","article-title":"IgG4-related sclerosing cholangitis mimicking cholangiocarcinoma","volume":"50","author":"Nguyen-tat","year":"2012","journal-title":"Z Gastroenterol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.913","article-title":"Clinical diagnostic criteria for IgG4-related sclerosing cholangitis 2020: (Revision of the clinical diagnostic criteria for IgG4-related sclerosing cholangitis 2012)","volume":"28","author":"Nakazawa","year":"2021","journal-title":"J Hepatobil Pancreat Sci"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s12664-016-0672-x","article-title":"IgG4-associated sclerosing cholangitis masquerading as hilar cholangiocarcinoma","volume":"35","author":"Yadav","year":"2016","journal-title":"Indian J Gastroenterol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.gie.2011.03.1235","article-title":"Screening for pancreatic cancer in a high-risk population with serum CA 19\u20139 and targeted EUS: a feasibility study","volume":"74","author":"Zubarik","year":"2011","journal-title":"Gastroint Endosc"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-011-1709-8","article-title":"The clinical utility and limitations of serum carbohydrate antigen (CA19-9) as a diagnostic tool for pancreatic cancer and cholangiocarcinoma","volume":"56","author":"Singh","year":"2011","journal-title":"Dig Dis Sci"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1177\/1756284820927292","article-title":"Challenging biliary strictures: pathophysiological features, differential diagnosis, diagnostic algorithms, and new clinically relevant biomarkers - part 1","volume":"13","author":"Dumonceau","year":"2020","journal-title":"Therap Adv Gastroenterol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2009.200972","article-title":"Possible involvement of T helper type 2 responses to Toll-like receptor ligands in IgG4-related sclerosing disease","volume":"59","author":"Akitake","year":"2010","journal-title":"Gut"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3390\/cells11030375","article-title":"Mast cells in immune-mediated cholangitis and cholangiocarcinoma","volume":"11","author":"Gonz\u00e1lez","year":"2022","journal-title":"Cells"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1189\/jlb.0313137","article-title":"Biliary obstruction results in PD-1-dependent liver T cell dysfunction and acute inflammation mediated by Th17 cells and neutrophils","volume":"94","author":"Licata","year":"2013","journal-title":"J Leukoc Biol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/s0165-5728(98)00232-x","article-title":"Antigen-specific immunosuppression: nasal tolerance to P0 protein peptides for the prevention and treatment of experimental autoimmune neuritis in Lewis rats","volume":"94","author":"Zou","year":"1999","journal-title":"J Neuroimmunol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21697","article-title":"Th2 and regulatory immune reactions are increased in immunoglobin G4-related sclerosing pancreatitis and cholangitis","volume":"45","author":"Zen","year":"2007","journal-title":"Hepatology"},{"key":"B18","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1002\/jhbp.596","article-title":"Clinical practice guidelines for IgG4-related sclerosing cholangitis","volume":"26","author":"Kamisawa","year":"2019","journal-title":"J Hepatobil Pancreat Sci"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1093\/mrcr\/rxae011","article-title":"Urinary bladder involvement in IgG4-related disease: a case-based review","volume":"8","author":"Vijayvergia","year":"2024","journal-title":"Mod Rheumatol Case Rep"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering11121233","article-title":"Multimodality fusion aspects of medical diagnosis: a comprehensive review","volume":"11","author":"Kumar","year":"2024","journal-title":"Bioeng (Basel)"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1803019\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T05:38:05Z","timestamp":1776922685000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1803019\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":20,"alternative-id":["10.3389\/fimmu.2026.1803019"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1803019","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]},"article-number":"1803019"}}