Background: The main risk factor for the development of nasopharyngeal carcinoma (NPC) is Epstein-Barr virus (EBV) infection. NPC is rare among Caucasian people while it is common among people of Chinese or Middle Eastern ethnicity. Of the three histological types, the most globally diffused is the type III or undifferentiated carcinoma. We present a case of NPC which occurred in an Italian Caucasian man.

Case presentation: A 40 years old man complained of a five month history of bilateral cervical lymphadenopathies and severe weakness, treated with occasional corticosteroids and NSAIDs with mild and not sustained relief. Blood exams showed EBV-VCA IgG and EBV-DNA positivity. US and CT scan described “hyperplastic or reactive lymph nodes” at both side of neck. Consequently, the patient underwent lymph node biopsy which described lymphatic methastasis of likely rhinopharyngeal origin. Nasal fibroscopy showed the presence of nasopharyngeal swelling which was confirmed to be a NPC at the histological exam. Finally, patient started treatment with cisplatinum and radiotherapy. After five weeks, a nasal fibroscopy showed absence of neoplastic lesions and serum EBV-DNA was undetectables ix month later.

Conclusions: Even if it is rare, NPC can occur among Caucasian men. EBV-DNA test is useful for diagnosis and post-treatment follow-up.