A 43-year-old Asian man with diabetes, a clerk in an office, presented with fever of one month and painful swelling below the left submandibular region of five days duration with a history of weight loss and poor appetite. An examination revealed a febrile patient with multiple lymph node swellings. His left submandibular lymph node was 2 x 1 cm and tender. His bilateral axillary nodes were palpable, the largest being 0.5 x 0.5 cm. Vital signs and systemic examination were normal. Investigations revealed neutrophilic leukocytosis with high erythrocyte sedimentation rate and uncontrolled diabetes mellitus. His chest X-ray showed widening of the right paratracheal region probably due to lymph node enlargement (Figure 1). He was empirically started on intravenous amoxicillin-clavulanic acid and subcutaneous insulin. A computed tomography (CT) scan of his thorax showed an anterior mediastinal mass measuring 4.2 x 3.7 x 3 cm in the right paratracheal region suggestive of a malignant mass with a few upper lobe densities (Figure 2). An excision biopsy of the submandibular swelling showed a non-caseating granuloma composed of lymphocytes and plasma cells suggestive of tuberculosis. A tuberculin skin test was negative. His bone marrow did not show acid fast bacilli or granuloma. Anti-tuberculosis treatment was not administered. Blood culture and bone marrow culture grew B. pseudomallei sensitive to amoxicillin-clavulanic acid, ceftazidime, piperacillin, cefaperazone-sulbactum, co-trimoxazole, doxycycline, tetracycline, meropenem and imipenem. He was treated for two weeks with ceftazidime (2 gm every six hours intravenously). During his hospital stay, he developed new right submandibular lymhadenopathy. However, the same treatment was continued. He became afebrile in eight days. He was discharged with oral co-trimoxazole (40/8 mg/kg) and doxycycline (100 mg) every 12 hours. At one month, a CT scan of his thorax revealed an increase in the right paratracheal lesion with the resolution of upper lobe densities. Treatment was continued with oral co-trimoxazole and doxycycline for six months and a repeated computed tomography (CT) scan of his chest was normal.