A 39-year-old HIV-positive patient, category C3, consulted in the emergency department of our hospital due to abdominal pain. He presented bilateral cervical adenopathies due to Mycobacterium infection, for which he was under treatment. The abdominal pain had started eight hours earlier in the epigastrium and was subsequently located in the right iliac fossa. Physical examination revealed mild abdominal distension with signs of peritoneal irritation. The only alteration found in the blood test was a mild leukocytosis (11.70 x 103/mL) with neutrophilia (78%). Bilirubin, amylase, and liver enzymes were normal. Abdominal ultrasound showed hepatomegaly, splenomegaly and peripancreatic, para-aortic and celiac lymphadenopathy. The appendix and free peritoneal fluid were not visualised. The patient underwent surgery with a clinical diagnosis of acute appendicitis. On surgical examination the appendix was macroscopically normal, no adenopathy was observed and an appendectomy was performed. The immediate postoperative period was uneventful and the patient was discharged 48 hours later. Histopathological examination of the specimen showed the presence of leishmaniasis in the appendix and in two nodes of the mesoappendix. With this result, medical treatment for leishmaniasis was started.

