Acute appendicitis is the most frequent cause of acute abdomen. However, bacteremia in patient with acute appendicitis is rare. A 34-year-old male patient presenting with fever and abdominal discomfort for two days showed leukocytosis, elevated C-reactive protein and erythrocyte sedimentation rate. Gram-negative rods were cultured in blood and empirical ceftriaxone was injected intravenously. On abdominal CT, wall enhanced and distended retrocecal appendix was recognized. Appendectomy was performed, which revealed suppurative inflammation without perforation. We report a case of acute appendicitis without perforation associated with Escherichia coli sepsis and atypical clinical manifestations in a healthy male.