Document resource
Background Urothelial carcinoma typically announces itself through urinary symptoms- yet, in rare instances, its first whisper can defy expectation. We present a striking case of a patient whose initial encounter with this cancer manifested not in the bladder, but in the body’s rhythm: a choreiform movement disorder. This unexpected neurological debut unveils a diagnostic enigma, challenging conventional presentations and hinting at broader implications. Here, we explore this rare intersection of oncology and neurology, where chorea became the unlikely herald of hidden malignancy.Method To present a case report alongside a literature review.Case A 77-year-old man presented with a 3-year history of progressive generalized chorea. Extensive workup- including autoimmune screening, genetic testing, neuroimaging and CSF analysis yielded no etiology. An FDG-PET scan, prompted by persistent symptoms, revealed abnormal brain metabolism and a left pelvic mass. Tissue biopsy confirmed urothelial carcinoma. Following tumour resection and cancer treatment, the patient’s chorea markedly improved, suggesting a paraneoplastic mechanism. To our knowledge, no prior cases of urothelial carcinoma presenting with chorea have been reported, making this a novel clinical entity. Further study is warranted to elucidate the link between urothelial carcinoma and chorea.Conclusion The case illuminates a rare and riveting intersection of urothelial carcinoma and neurology. Beyond its diagnostic curiosity, it underscores the critical need to consider neoplastic etiologies in atypical neurological presentations. This report not only highlights a clinical rarity but also beckons further investigation into the mechanism linking cancer and movement- a dance of discovery yet to be fully choreographed.