Vertebral metastasis with spinal cord compression as the first manifestation of hepatocellular carcinoma: a case report

BACKGROUND: Hepatocellular carcinoma, typically linked to chronic hepatitis B or C, usually presents with liver-related symptoms, mainly jaundice, abdominal pain, and weight loss, and rarely spreads beyond the liver. Bone metastases and their complications are uncommon and seldom the initial sign. CASE PRESENTATION: We report the case of a North African (Tunisian) man in his 70s with undiagnosed chronic hepatitis B who presented with back pain and was subsequently diagnosed with multifocal hepatocellular carcinoma. His clinical course was complicated by acute paraplegia due to spinal cord compression caused by vertebral metastases. CONCLUSION: This case highlights the variability in hepatocellular carcinoma presentations and underscores the need for heightened clinical vigilance in patients presenting with unexplained bone or neurological symptoms, even in the absence of overt hepatic signs. Skeletal metastases are rare in this tumor compared with other cancers. The diagnosis can be even more challenging when bone metastases are the predominant initial manifestation, particularly when neurological complications emerge early in the course of disease.