diff --git a/sormas-api/src/main/java/de/symeda/sormas/api/i18n/Validations.java b/sormas-api/src/main/java/de/symeda/sormas/api/i18n/Validations.java
index 3a6f7e6d1a4..08b0b796a8e 100644
--- a/sormas-api/src/main/java/de/symeda/sormas/api/i18n/Validations.java
+++ b/sormas-api/src/main/java/de/symeda/sormas/api/i18n/Validations.java
@@ -51,6 +51,7 @@ public interface Validations {
 	String contactFollowUpUntilDateSoftValidation = "contactFollowUpUntilDateSoftValidation";
 	String contactWithoutInfrastructureData = "contactWithoutInfrastructureData";
 	String customizableEnumValueAllowedCharacters = "customizableEnumValueAllowedCharacters";
+	String customizableEnumValueAlreadyInUse = "customizableEnumValueAlreadyInUse";
 	String customizableEnumValueDuplicateLanguage = "customizableEnumValueDuplicateLanguage";
 	String customizableEnumValueDuplicateValue = "customizableEnumValueDuplicateValue";
 	String customizableEnumValueEmptyTranslations = "customizableEnumValueEmptyTranslations";
diff --git a/sormas-api/src/main/resources/validations.properties b/sormas-api/src/main/resources/validations.properties
index 00c7618f90e..c6eb627c51e 100644
--- a/sormas-api/src/main/resources/validations.properties
+++ b/sormas-api/src/main/resources/validations.properties
@@ -332,3 +332,4 @@ smsAuthKeyValueValidation = SMS Auth key value is not valid
 smsAuthSecretValueValidation = SMS Auth secret value is not valid
 systemConfigurationValueValidationInvalidBackgroundColor = Pre-defined values are: green, red, indigo, gray, default (case-sensitive) otherwise must match hexadecimal format (with or without hash "#"), example: #dd2b0e or #4AA or dd2b0e
 systemConfigurationValueValidationMenuSubtitle = Can be empty or up to 16 (any) characters. Can be used to define name of the environment: PRODUCTION - TEST etc.
+customizableEnumValueAlreadyInUse = The customizable value %s is being used by case IDs %s and therefore cannot be deleted or deactivated. Please remove all references to this value before attempting to deactivate.
diff --git a/sormas-backend/src/main/java/de/symeda/sormas/backend/customizableenum/CustomizableEnumFacadeEjb.java b/sormas-backend/src/main/java/de/symeda/sormas/backend/customizableenum/CustomizableEnumFacadeEjb.java
index 0705c1f1f4e..2c4b8b0f3c8 100644
--- a/sormas-backend/src/main/java/de/symeda/sormas/backend/customizableenum/CustomizableEnumFacadeEjb.java
+++ b/sormas-backend/src/main/java/de/symeda/sormas/backend/customizableenum/CustomizableEnumFacadeEjb.java
@@ -26,6 +26,7 @@
 import java.util.HashMap;
 import java.util.List;
 import java.util.Map;
+import java.util.Objects;
 import java.util.Optional;
 import java.util.Set;
 import java.util.concurrent.ConcurrentHashMap;
@@ -168,6 +169,25 @@ public CustomizableEnumValueDto save(CustomizableEnumValueDto dto) {
 		validate(dto);
 
 		CustomizableEnumValue existingEntity = service.getByUuid(dto.getUuid());
+		// if existingEntity disease removed and it is mapped to the cases, shouldn't allow to save the entity
+		
+		if (existingEntity != null && CollectionUtils.isNotEmpty(existingEntity.getDiseases())) {
+			Set<Disease> incomingDiseases = dto.getDiseases() != null ? dto.getDiseases() : Collections.emptySet();
+			for (Disease removedDisease : existingEntity.getDiseases()) {
+				if (!incomingDiseases.contains(removedDisease)) {
+					List<String> uuids = service.areCasesUsingCustomizableEnumValue(
+						removedDisease,
+						getEnumValue(dto.getDataType(), removedDisease, existingEntity.getValue()));
+					if (!uuids.isEmpty()) {
+						throw new ValidationRuntimeException(
+							I18nProperties.getValidationError(
+								Validations.customizableEnumValueAlreadyInUse,
+								removedDisease.getName(),
+								uuids.stream().filter(Objects::nonNull).collect(Collectors.joining(", "))));
+					}
+				}
+			}
+		}
 
 		for (Disease disease : dto.getDiseases()) {
 			List<String> dataTypeValues = enumValues.get(dto.getDataType()).getOrDefault(disease, Collections.emptyList());
diff --git a/sormas-backend/src/main/java/de/symeda/sormas/backend/customizableenum/CustomizableEnumValueService.java b/sormas-backend/src/main/java/de/symeda/sormas/backend/customizableenum/CustomizableEnumValueService.java
index f5e5bff9aad..4f0b6574ea5 100644
--- a/sormas-backend/src/main/java/de/symeda/sormas/backend/customizableenum/CustomizableEnumValueService.java
+++ b/sormas-backend/src/main/java/de/symeda/sormas/backend/customizableenum/CustomizableEnumValueService.java
@@ -15,6 +15,10 @@
 
 package de.symeda.sormas.backend.customizableenum;
 
+import java.util.List;
+import java.util.stream.Collectors;
+
+import javax.ejb.EJB;
 import javax.ejb.LocalBean;
 import javax.ejb.Stateless;
 import javax.persistence.criteria.CriteriaBuilder;
@@ -23,8 +27,13 @@
 import javax.persistence.criteria.Predicate;
 import javax.persistence.criteria.Root;
 
+import de.symeda.sormas.api.Disease;
+import de.symeda.sormas.api.caze.CaseCriteria;
 import de.symeda.sormas.api.customizableenum.CustomizableEnumCriteria;
+import de.symeda.sormas.api.disease.DiseaseVariant;
 import de.symeda.sormas.api.utils.DataHelper;
+import de.symeda.sormas.backend.caze.Case;
+import de.symeda.sormas.backend.caze.CaseService;
 import de.symeda.sormas.backend.common.AdoServiceWithUserFilterAndJurisdiction;
 import de.symeda.sormas.backend.common.CriteriaBuilderHelper;
 
@@ -32,6 +41,9 @@
 @LocalBean
 public class CustomizableEnumValueService extends AdoServiceWithUserFilterAndJurisdiction<CustomizableEnumValue> {
 
+	@EJB
+	private CaseService caseService;
+
 	public CustomizableEnumValueService() {
 		super(CustomizableEnumValue.class);
 	}
@@ -70,4 +82,20 @@ public Predicate buildCriteriaFilter(CustomizableEnumCriteria criteria, Criteria
 		return filter;
 	}
 
+	/**
+	 * Get all cases for a specific disease and disease variant that are using a customizable enum value. This is used to determine whether
+	 * a customizable enum value can be deleted or not.
+	 * 
+	 * @param disease
+	 * @param diseaseVariant
+	 * @return
+	 */
+	public List<String> areCasesUsingCustomizableEnumValue(Disease disease, DiseaseVariant diseaseVariant) {
+		CaseCriteria caseCriteria = new CaseCriteria();
+		caseCriteria.setDisease(disease);
+		caseCriteria.setDiseaseVariant(diseaseVariant);
+		List<Case> result = caseService.findBy(caseCriteria, true);
+		return result.stream().map(Case::getUuid).collect(Collectors.toList());
+	}
+
 }