Nasopharyngeal carcinoma with unusual metastatic spread to the spine and meninges: a case report with literature review

Nasopharyngeal carcinoma (NPC) is an epithelial malignancy commonly associated with Epstein–Barr virus infection. While bone, liver, and lung metastases are well-documented, central nervous system (CNS) involvement, particularly spinal and meningeal metastases, is extremely rare. We present a 41-year-old male with nasal obstruction and diplopia, diagnosed with locally advanced NPC. After treatment with chemotherapy and intensity-modulated radiotherapy, the patient achieved excellent locoregional control. However, months later, he developed persistent back pain, and imaging revealed metastatic deposits in the spine and meninges. Histopathological analysis confirmed metastatic NPC despite resolution of the primary tumor. The patient received palliative radiotherapy and intrathecal chemotherapy, but disease progression highlighted the aggressive nature and poor prognosis of CNS metastases in NPC. This case underscores the need for advanced imaging, histological confirmation, and tailored therapies in managing rare NPC metastases, with long-term follow-up and innovative therapies critical for improving outcomes in advanced disease.