A 59-year-old HIV-positive man developed necrotizing right-lobe pneumonia with abscess formation. Bronchial aspirates and bronchoalveolar lavage showed numerous inflammatory cells, mainly histiocytes and neutrophils, and intracellular and extracellular Gram- and Ziehl-Nielsen-positive cocci and coccobacilli. Rhodococcus equi was identified. The patient died one week after diagnosis and necropsy confirmed the presence of R. equi nectrotizing pneumonia.