Rhodococcus equiis an emerging opportunistic pathogen in immunocompromised patients. Owing to its resemblance toMycobacterium,Nocardia, andCorynebacterium,R. equiis frequently misdiagnosed as a contaminant, which can result in treatment delays.A 65-year-old man with a history of end-stage renal disease (ESRD) presented to the emergency room with pain and increased swelling in his right upper extremity. Shortly after he arrived in the emergency room, his condition deteriorated. Intravenous vancomycin was administered after collecting blood cultures. The blood cultures grewRhodococcus equi, andoral azithromycin and oral rifampin were added for a 14-day course of treatment. The patient recovered without any further complications and was subsequently discharged home.R. equiis a partially acid-fast actinomycete that spreads through contact with grazing animals and contaminated soil.R. equiinvades macrophages to survive and causes infection within a host. In this particular case, the patient worked on a farm taking care of goats. He was exposed to the bacteria after falling and sustaining multiple lacerations to the right arm.This case is unique due to the development of bacteremia withR. equi, an uncommon cause of bacteremia that led to cardiopulmonary arrest. The treatment with oral azithromycin combined with oral rifampin and intravenous vancomycin was effective for the complete resolution of the infection.