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A Southeast Asian man in his early 20s with no medical history presented with persistent abdominal pain and nausea for 3 weeks. He reported no recent sick contacts and no travel in the past 5 years since arrival to the USA. Physical examination was notable for right lower quadrant tenderness. CT of the abdomen and pelvis showed hyperaemia and fat stranding near the terminal ileum and cecum, concerning for appendicitis. He underwent laparoscopic appendectomy with pathology showing acute granulomatous appendicitis. Bacterial, fungal and acid-fast bacilli (AFB) stains were negative. Given the presence of granulomas, interferon gamma release assay and ACE levels were obtained which were unremarkable. HIV-1/2 testing …
Contributors SC prepared the manuscript and did the literature search. HS is the corresponding author, supervised the manuscript preparation and revised the final draft.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.