We describe a recent case of melioidosis presenting classically in a young Vietnam veteran. The case demonstrates extensive antibiotic resistance in this isolate and failure of ceftriaxone, despite its in vitro efficacy. Other multiple antimicrobial regimens also failed. Melioidosis remains a concern in patients who have previously lived in endemic areas. A high level of diagnostic suspicion is required, especially in patients with a febrile illness or tuberculosis-like presentations. Early detection of Pseudomonas pseudomallei and rational treatment of adequate duration are critical in successful management.