A 12-year-old female patient presented with clinical signs and symptoms of acute appendicitis over duration of one day. Histopathology analysis of the appendectomy specimen revealed the presence of caseating epithelioid granulomas formed of lymphocytes, fibroblasts, epithelioid histiocytes and Langhan's giant cells, characteristic of tuberculous granuloma. We describe this case. Case Report A 12-year-old female patient presented with clinical signs and symptoms of acute appendicitis over duration of one day. General examination revealed tenderness and rebound localised to the McBurney's point. Routine hematological and biochemical investigations were within normal limits except for raised total leucocyte count (16,000/ml). She was diagnosed as acute appendicitis and taken up for appendectomy in the emergency. Surgery was unremarkable, the appendix turgid, and showing signs of inflammation. She was discharged on the next day. On brief post operative follow-up, she developed an incisional hernia at the appendectomy site that was repaired electively later.Histopathology analysis of the appendectomy specimen revealed the presence of caseating epithelioid granulomas formed of lymphocytes, fibroblasts, epithelioid histiocytes and Langhan's giant cells, characteristic of tuberculous granuloma (Figure 1,2,3). A blood sample was also taken for PCR-TB and a positive result was within hand in 14 days later. The patient started anti-tuberculous therapy soon after the pathological report reached the surgical ward. Efforts to detect a primary focus of tuberculosis elsewhere in the body were unsuccessful. The patient is presently well on a follow up of one year.
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