SEVERE PAIN AND NEUROLOGICAL SYMPTOMS AS AN INITIAL MANIFESTATION OF PARANEOPLASTIC SYNDROME: A CASE REPORT

A. Górecka¹, D. Myrcik², U. Michalik-Marcinkowska³, G. Varrassi⁴, K. Walkiewicz², M. Muc-Wierzgoń², M.S. Świtała⁵ | ¹Department of Health Risk Management, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, Bytom, Poland; ²Department of Propaedeutics of Internal Diseases and Emergency Medicine, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, Bytom, Poland; ³Department of Family Medicine and Public Health, Faculty of Medicine, University of Opole, Poland; ⁴Fondazione Paolo Procacci, Rome, Italy; ⁵Department of Health Economics and Health Management, Medical University of Silesia in Katowice, Bytom, Poland

Background and Aims. Paraneoplastic neurological syndromes (PNS) are rare, affecting less than 1% of patients with malignancy, yet they may precede cancer diagnosis and represent a significant diagnostic challenge. Pain is highly prevalent in oncology, affecting approximately 55% of patients during anticancer treatment and up to 66% in advanced disease. In paraneoplastic neuropathies, pain has been reported as the first manifestation in 41.3% of cases and as the sole initial manifestation in 13.0%.
Methods. A 63-year-old female patient presented with recurrent episodes of severe pain accompanied by neurological symptoms, including muscle stiffness and seizure-like episodes. The attacks occurred with very high frequency, at times every 20 minutes, leading to marked functional impairment and deterioration in quality of life. Initial clinical evaluation was inconclusive due to the non-specific presentation, resulting in repeated consultations and diagnostic uncertainty. With disease progression, advanced malignancy of unknown primary origin was diagnosed. The constellation of neurological symptoms and severe, treatment-resistant pain was subsequently recognized as a manifestation of a paraneoplastic syndrome. Despite standard analgesic treatment, pain remained refractory, representing a major therapeutic challenge.
Results. This case highlights the diagnostic complexity of paraneoplastic syndromes when pain dominates the clinical picture. Severe, recurrent, and treatment-resistant pain associated with atypical neurological features should prompt consideration of a paraneoplastic etiology. Since PNS may precede oncological diagnosis, delayed recognition may prolong patient suffering and postpone appropriate management.
Conclusions. Paraneoplastic syndromes may present with severe refractory pain and neurological symptoms before malignancy is diagnosed. Increased clinical awareness of such presentations is essential to reduce diagnostic delay and improve patient management.