Lymph node tuberculosis presenting as appendicitis

•Presentation of lymph node tuberculosis is variable depending on the site of affected lymph nodes, but can be acute in onset.•Latent tuberculosis can reactivate suddenly after over a decade of dormancy.•Histological analysis is a vital part of the investigation of appendicitis.•Tuberculosis is an important differential in granulomatous appendicitis.•Lymph node tuberculosis is a manifestation of systemic disease and is treated in the same way.•Whole-genome sequencing is an important tool for guiding anti-tuberculosis therapy.•An individualized diagnostic approach to patients is paramount. Extrapulmonary tuberculosis can present in various ways and often mimics more common presentations. This case of appendicitis ended in a definitive microbiological diagnosis of M.tuberculosis, and shows the diagnostic challenges and techniques available today.