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Paragangliomas arising from the urinary bladder are extremely rare. Most of them are benign, and are curable with surgical resection alone, but about 10% are malignant and may metastasise to regional nodes or distant sites. We present the case of a 45 year male patient who had a recurrent paraganglioma of the urinary bladder with vertebral metastases. The patient was managed using a combination of palliative chemotherapy with carboplatin, etoposide and zoledronate and radiotherapy to the spine. However, the patient′s general condition rapidly deteriorated while on systemic treatment. This case demonstrates the unusually aggressive course that this disease may occasionally take.