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A male patient in the late teens presented with intermittent right iliac fossa pain associated with fever and raised inflammatory markers following a previous episode of conservatively managed appendiceal mass and was treated for recurrent acute appendicitis. The patient was managed with intravenous antibiotics and underwent an appendicectomy. The histology of the specimen reported an appendix with perforation at the tip and surrounding congestion with associated malignant tumour involving the entire length of the appendix, and further testing showed signs in keeping with a diagnosis of high-grade B-cell non-Hodgkin lymphoma. The patient was subsequently informed of the underlying diagnosis following his management for appendicitis and underwent chemotherapy.