Background: Appendicitis is common medical emergency requiring surgery although currently some surgeons choose non-operative management based on the patient’s overall health status. After conservative management, surgeons usually obtain a computed tomography (CT) scan particularly when the patient’s clinical manifestations are questionable. Actinomycosis could be a rare cause of an insidious clinical presentation of appendicitis. Case Report: We report a case of appendicitis caused by actinomycosis with follow up using CT scans during non-operative management before surgery. Conclusion: Surgeons should consider actinomycosis in the differential diagnoses during non-operative management of appendicitis.