Most small hepatocellular carcinomas are asymptomatic. While small hepatocellular carcinomas do have symptoms, these symptoms are usually related to the underlying liver disease, not to the tumor itself. We encountered a 63-year-old male patient with a small hepatocellular carcinoma, 2.5 cm in diameter, presenting with fever, abdominal pain and sensation of abdominal fullness. These were unusual clinical manifestations related to the small hepatocellular carcinoma itself and challenged the diagnosis.