Extremely elevated CA19-9 in acute cholangitis

A 68-year-old women was admitted with the chief complaints of epigastralgia with radiation to the back and jaundice. Fever and chills were also noted. The laboratory data showed alkaline phosphatase, 245 U/L (normal range: 28-94); Direct Bilirubin, 5.29 mg% (0-0.4); Total Bilirubin, 8.4 mg% (0.2-1.4). Surprisingly, the serum CA19-9 was 5673.8 U/ml (normal value: < 37). Abdominal sonography showed dilated common hepatic duct. MRCP demonstrated diffuse biliary tree dilatation with a very low signal intensity in distal common bile duct. Surgical intervention reveled a black stone at distal common bile duct and was successfully retrieved. After operation, the CA19-9 fell to 63.1 u/ml two weeks later and returned to normal (10.4 U/ml) one month later.