Significant Elevation of CA 19-9 Levels Due to Acute Xanthogranulomatous Cholecystitis and Following mRNA COVID-19 Vaccination: A Case Report and Literature Review

Abstract

Objectives: Carbohydrate antigen (CA 19-9) is a tumour marker usually elevated in upper-gastrointestinal and pancreaticobiliary malignancies, yet some studies reported pathological increments in patients with biliary obstruction. However, extremely high levels of CA 19-9 in the absence of biliary obstruction and malignancy represent a very rare occurrence. Methods:We report a case of a 61-year-old patient presenting with acute cholecystitis, a segment IVb liver lesion next to the gallbladder and very high CA 19-9 levels (12.500 IU/ml). Results: The patient underwent laparoscopic cholecystectomy, with liver biopsy, due to the suspicion of malignancy. The histopathology showed xanthogranulomatous cholecystitis penetrating the posterior gallbladder wall and entrenched in the liver as a hepatic abscess. After complete remission of the disease, CA 19-9 reached normal values. However, after the third dose of the mRNA vaccine against SARS-CoV-2, CA 19-9 levels incremented abnormally and gradually declined to normal weeks later.Conclusions: CA 19-9 should never be regarded as a gold standard but rather as a helpful marker in the workup, especially in biliary pathology. Regarding the impact of COVID-19 vaccines on the tumour markers, and especially on CA 19-9, further studies should be performed to investigate this prospect.