A 20-year-old male patient presented to our outpatient department with complaints of colicky type of pain in right lower abdomen, associated with vomiting and fever since 5 days. On examination, patient was febrile and his vitals were normal. The physical examination showed marked tenderness in right iliac fossa. On initial work up, patients leukocyte count was 17,600/mm3. Since these symptoms were consistent with appendicitis, patient was taken for emergency surgery. On laparotomy, a diffuse inflammatory mass and abscess of the appendix [Figure 1] was found and appendectomy was done. Exploration of the bowel and mesentery, through the grid iron incision showed normal ileum, cecum, and mesentery. In post-operative period, he had wound infection, which was managed by regular dressing. Histopathological examination of the appendix revealed caseating epitheliod granulomas and lumen filled with neutrophilic infiltrates [Figures 2 and 3]. Patient was later evaluated for primary source of TB else where in the body. Computed tomography (CT) abdomen and pelvis showed normal bowel loops and mesentery [Figure 4]. Chest X-ray and colonoscopy [Figures 5 and 6] were normal. Three consecutive early morning sputum sample were negative for acid fast bacilli. Tuberculin skin test was negative and erythrocyte sedimentation rate (ESR) was 80 mm/h. Patient was started on standard anti-TB drugs, course similar to pulmonary TB.