Abstract
Carcinoembryonic antigen (CEA) has been shown to be associated with tumor burden in patients with colorectal cancer. However, it is also elevated to a significant degree in a number of other malignant and non-malignant conditions. We report a case of reversible CEA elevation in a patient using lithium for bipolar disorder.A 58-year-old female with a longstanding smoking history and a past medical history of chronic obstructive pulmonary disease (COPD), bipolar illness, hypothyroidism, and obesity was found to have an elevated CEA level of 11.2 ng/ml (normal level <5 ng/ml) in the workup for postmenopausal bleeding. Her history was not positive for malignancy of colorectum, ovaries, thyroid, or breast. She underwent a large number of imaging and endoscopic studies to evaluate for colorectal, breast, ovarian, and lung cancer; however, it did not reveal any evidence of malignancy. Upon review of her medications, she reported that she had recently started lithium for her bipolar illness. We followed up her CEA level while her dose of lithium was reduced from 450 to 300 mg per day. Her CEA level decreased from 25 mg/dl to 6.1 mg/dl and remained stable over the course of the next eight months.Our case is the first case report that identifies lithium as a potential cause of reversible CEA elevation. The underlying mechanism is yet to be elucidated, but it underscores the importance of investigating the medications as part of the workup.
Highlights
Carcinoembryonic antigen (CEA) is an oncofetal glycoprotein that is normally expressed by mucosal cells
There are a number of benign conditions that may lead to elevations in serum CEA level including cigarette smoking, pancreatitis, biliary obstruction, peptic ulcer disease, and hypothyroidism, but the extent of elevation is substantially less, and it is rare to see an elevation of >10 ng/ml in this context
We report the case of a patient with an elevated CEA level who underwent an extensive investigation for underlying malignancy which was later found to be related to lithium prescribed to the patient for bipolar disorder
Summary
Carcinoembryonic antigen (CEA) is an oncofetal glycoprotein that is normally expressed by mucosal cells It is overexpressed by a variety of malignancies. We report the case of a patient with an elevated CEA level who underwent an extensive investigation for underlying malignancy which was later found to be related to lithium prescribed to the patient for bipolar disorder. Given the degree of elevation, it was decided to evaluate for underlying malignancy She did not report any weight loss, chronic diarrhea or constipation, hematochezia, melena, or abdominal pain. She had gastrointestinal evaluation including an upper gastrointestinal (GI) endoscopy and colonoscopy which did not reveal any polyps or evidence of inflammatory bowel disease. No reference to the patient's identity was made at any stage during data analysis or in the report
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