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Bone metastasis occurs frequently in patients with nasopharyngeal carcinoma (NPC). Although fluorine-18 fluorodeoxyglucose positron emission tomography with computed tomography (PET/CT) has been proven to be more sensitive at detecting bone metastases than Technetium-99m methylene diphosphonate skeletal scintigraphy in pretreatment patients with NPC in most clinical settings, there have been metastatic lesions that were positive on skeletal scintigraphy but negative on PET/CT scans. Herein, we report the case of a patient with stage IV NP