Melioidosis is called a mimicker of maladies. In its acute form it can mimic any community acquired bacterial sepsis, pneumonia or abscess, especially that produced by staphylococcus. In its chronic form, it can mimic tuberculosis or malignancy [
1]. Melioidosis can present with subcutaneous abscesses and visceral abscesses in the liver, spleen, prostate, parotid, and lymph nodal mass [
2,
3].
Melioidosis is endemic in Northern Australia, Thailand, Singapore, Malaysia, Myanmar and Vietnam [
3]. In India, it is sporadic with an increasing trend in the southern states [
4].
Burkholderia pseudomallei, the causative organism, is a gram negative, motile bacillus isolated from soil and surface water. The disease is acquired by inoculation through abraded skin, inhalation or ingestion [
5]. The majority of cases present during the rainy season [
6]. The incubation period ranges from 24 hours to many years [
3]. In an Australian study, chronic renal disease, chronic lung disease, and age > 45 years were independent risk factors for melioidosis [
7]. It produces necrotizing inflammation, abscess or granuloma with multinucleated giant cells [
8]. Clinical disease may present acutely with fever of less than two months duration or chronically with more than two months of fever with or without other symptoms such as cough, discharging sinus, and subcutaneous swellings. Localized disease presents as skin ulcers and subcutaneous abscesses or pneumonia. Disseminated disease can present with pneumonia, abscesses in the liver, spleen, kidney, prostate, skin and subcutaneous tissue, septic arthritis and osteomyelitis with or without septicemia. Lymph node swelling with necrosis can occur as part of either disseminated melioidosis or its local forms [
3,
4]. However, mediastinal lymphadenopathy as a presenting feature of melioidosis is rare. We present a case of a patient with melioidosis which involved the mediastinal lymph node and mimicked malignancy and tuberculosis.