Background: Melioidosis is a life-threatening infection endemic in the Northern Territory. Delayed diagnosis is associated with significant morbidity in adults and children. ENT presentations are uncommon and often resemble routine bacterial infections, increasing the risk of missed or late diagnosis. This presentation aims to summarise key information on melioidosis relevant to ENT clinicians and provide visual and clinical cues to facilitate early recognition of melioid tissue. Aims: To emphasise the importance of early identification of melioidosis in ENT presentations through a focused overview of epidemiology, pathogenesis, diagnosis, treatment, and prognosis. Methods: We present the case of a 62-year-old man with disseminated melioidosis presenting as a rapidly progressive right-sided deep neck abscess with extension into the superior mediastinum. Results: The initial presentation was consistent with a standard bacterial deep neck infection; however intraoperative findings and cultures confirmed Burkholderia pseudomallei. Early surgical intervention combined with targeted antimicrobial therapy resulted in clinical resolution without complication. This case provides a clear visual representation of key diagnostic features critical for early recognition and improved outcomes in endemic and rural settings. Conclusion: In the Northern Territory, ENT clinicians should maintain a high index of suspicion for melioidosis when encountering rapidly progressive or atypical head and neck infections, particularly when creamy or finely granular tissue is identified intraoperatively. Early recognition and microbiological confirmation are essential to guide appropriate treatment and improve patient outcomes.