Significantly elevated CA 19-9 levels in a patient with choledocholithiasis

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

“…Without an adequate clinical context, the isolated results of the marker could incorrectly lead to costly and unnecessary investigations and misdiagnosis of pancreatic or biliary malignancy. Although the first diagnosis to be considered is a malignant disease, the possibility of benign diseases should not be ruled out [4][5][6][7][8][9]16,17]. In our case, an explanation for the abnormally high CA 19-9 levels could be the increased production of CA 19-9 from the biliary epithelial cells and its decreased hepatobiliary clearance due to cholestasis, which may have contributed to abnormal CA 19-9 elevation in the bloodstream.…”

“…It also explains why there was a gradual 3-week reduction of CA 19-9 levels after the cholecystectomy. Several authors reported high serum CA 19-9 levels in patients with benign biliary obstruction and jaundice due to choledocholithiasis, Mirizzi syndrome, or sclerosing cholangitis [4][5][6][7][8][9][10][11][12][14][15][16]. In addition, cases of acute cholecystitis, particularly xanthogranulomatous, have been reported with elevated levels of the marker [17,18].…”

“…Reports concerning the prognostic value of this marker are conflicting. Nevertheless, this analysis remains a valuable tool that can support diagnosis, detect recurrence in treated neoplasms and monitor treatment response, especially in chemotherapy [4][5][6][7]. Regarding its use in the differential diagnosis of biliary stenoses, serum CA 19-9 levels alone cannot differentiate between malignant and benign stenoses upon initial evaluation.…”

“…However, assessing serum CA 19-9 at specific time points, for example, after the resolution of the obstruction, along with clinical features and imaging results, might have significant potential diagnostic utility [8,9]. Few cases have reported such high levels of CA 19-9 in patients with no signs of malignancy [5,6,[8][9][10][11][12][13][14][15]. In this article, we report a case of abnormally high levels of CA 19-9 in a patient with an inflamed gallbladder ruptured to the liver due to multiple episodes of acute cholecystitis, as well as after the booster vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).…”

A Case of Choledocholithiasis and Obstructive Jaundice With a Very High Serum Carbohydrate Antigen 19-9 (CA 19-9) Level: A Case Report and Review of Literature

“…In 2010, Korkmaz et al [ 12 ] documented a case of cholelithiasis and choledocholithiasis with acute cholangitis that had extremely high serum levels of CA 19-9 (9586 IU/ml), which decreased sharply after therapy. Canete-Ruiz et al [ 13 ] reported a case of a 69-year-old patient who presented with severe abdominal pain and deep jaundice. The patient was diagnosed with choledocholithiasis with dilated bile ducts with significant elevation of CA 19-9 to >12,000 IU/ml.…”