Abstract
Hepatocellular carcinoma ranks as the third leading cause of cancer‐related mortality globally. We present a case of a rapidly progressive hepatocellular carcinoma in an 81‐year‐old female with metabolic abnormalities. The patient initially presented with non‐specific signs and symptoms and was managed for sepsis of suspected urinary source. Unresolving laboratory markers led to repeat abdominal imaging demonstrating new hepatic lesions within six days. Biopsy confirmed moderately differentiated hepatocellular carcinoma. The patient received conservative inpatient treatment with recommendation for nutritional and performance status optimization prior to oncologic therapies, however continued to decline and passed away three months later.