Paraneoplastic Fever in a Patient With Cervical Carcinoma: A Diagnostic Challenge and Management Approach

Introduction: Persistent fever in patients with cancer presents a significant diagnostic challenge, particularly in settings where infectious diseases are highly prevalent. Neoplastic fever is an important noninfectious cause of fever that may mimic infection and result in unnecessary investigations, antimicrobial therapy, and delays in cancer treatment. Case Presentation: We report a case of a 45-year-old female patient with advanced cervical carcinoma who presented with persistent high-grade fever unresponsive to antibiotics. An extensive infectious workup was negative. Following exclusion of alternative causes, a naproxen challenge was performed, resulting in rapid resolution of fever within 24 h. Fever recurred upon withdrawal and resolved again after naproxen reintroduction, supporting the diagnosis of neoplastic fever. Conclusion: Neoplastic fever should be considered early in cancer patients with persistent unexplained fever, particularly in tuberculosis- and malaria-endemic settings. Following exclusion of infection, the naproxen challenge may provide a simple and affordable diagnostic step to distinguish neoplastic fever from infectious causes, reduce unnecessary antimicrobial use, shorten diagnostic delays, and facilitate timely cancer-directed therapy.