Whispers of decay: necrotic mediastinal lymphadenopathy due to melioidosis in a diabetic patient

We report a case of melioidosis presenting as isolated necrotic mediastinal lymphadenopathy in a 60-year-old man from coastal Karnataka with poorly controlled diabetes (HbA1c 9.9%). Such a presentation, closely mimicking tuberculosis, is rarely described in the literature. Dual microbiological confirmation through sputum culture and endobronchial ultrasound (EBUS) guided lymph node aspiration established the diagnosis of Burkholderia pseudomallei. This case underscores the importance of considering melioidosis in the differential diagnosis of necrotic mediastinal lymphadenopathy, particularly in endemic regions and in diabetic patients. Early recognition and appropriate therapy remain crucial to prevent complications and improve outcomes in this potentially fatal but treatable infection.