Hypertrophic osteoarthropathy (HOA) is a condition characterized by periosteal reaction of tubular long bones and characteristic bulbous deformity of the digital tips with synovial effusion. It is usually encountered in conjunction with diseases involving the lungs, mediastinum, heart, pleura and gastrointestinal tract. The occurrence of HOA as a paraneoplastic manifestation in nasopharyngeal carcinoma is rare and only a handful of cases have been reported in literature and that too in the pediatric age group. An association with pulmonary metastasis was often described in these case reports. We present a case of HOA associated with nasopharyngeal carcinoma in a 20 years old gentleman in the absence of pulmonary metastasis.