Melioidosis is a serious infectious disease caused by Burkholderia pseudomallei, a bacterium endemic to tropical regions, including Taiwan. The disease can involve multiple organs; however, cardiac involvement, particularly cardiac tamponade, is rare. To date, only four cases of melioidosis presenting with cardiac tamponade have been reported in the literature. Here, we report an extremely rare case of melioidosis complicated by pericardial effusion and cardiac tamponade, which was successfully treated with pericardiocentesis and appropriate antimicrobial therapy.