Gordonia species have been recognized as pathogens in immunocompromised and immunocompetent patients. We report the first case of bacteremia due to Gordonia bronchialis in a diabetic patient with a sequestrated lung. Species identification was confirmed with mycolic acid analysis by high-performance liquid chromatography and sequencing of the 16S rRNA gene.A 58-year-old woman with recently discovered diabetes mellitus, long-standing spondylolisthesis, and asthma presented with acute exacerbation of low back pain after an exercise session. Breathlessness, fever, and chills accompanied the pain. The patient had been treated for a pleural effusion and a loculated lung cyst with drainage 15 and 5 years previously, respectively. On physical examination, the patient was febrile with a reduced ability to raise and straighten her right leg and diminished deep tendon reflexes of the right lower limb. The patient's white cell count was elevated, at 15 ϫ 10 9 /liter, with a predominance of polymorphs (86%). Chest X-rays showed pneumonic-type lung consolidation, and consequently the patient was treated with ceftriaxone and clarithromycin for community-acquired pneumonia. Computer-assisted tomography of the thorax suggested a sequestrated lung.Subsequent magnetic resonance imaging of the lumbosacral spine showed a 5-mm air pocket with enhancement surrounding the lesion from L4 to S1. The antimicrobials with which the patient was treated were changed to cloxacillin for osteomyelitis and ceftazidime for possible infection with Burkholderia pseudomallei, which is endemic in the southeast Asia region. On the fifth day, blood cultures taken during admission and incubated in Bactec 9000 (Becton Dickinson, Cockeysville, Md.) were positive for growth. Haemophilus aphrophilus was isolated upon subculture on a blood agar plate and identified by using XV disks and the API NH (bioMérieux, Marcyl'Etoile, France) system. The isolate was found to be susceptible to ceftriaxone by the disk diffusion method. A transthoracic echocardiogram was normal. However, the patient's health did not improve and her neurological status deteriorated, with a loss of ankle reflex. A repeat scan of the lumbar spine demonstrated a subcortical mass at L3 to L4 with a left paravertebral abscess extending inferiorly to the gluteal region. Reincubation of the original blood agar plate for an additional 5 days revealed the presence of a second organism, which formed translucent, nonhemolytic, dry, wrinkled colonies within 24 h; these colonies became opaque, rough, and salmon colored at 72 h. Growth and pigmentation were demonstrated at 35°C with ambient air on Trypticase soy agar with sheep blood, chocolate agar, and brain heart infusion agar. The isolate was a beaded gram-positive bacillus which was weakly acid-fast. The microscopic appearance of the growth on a water agar plate showed symmetra and no aerial hyphae. Tests for lysozyme, casein, tyrosine, and xanthine hydrolysis were negative, while tests for urease and nitrate were positive after 48 h and a test fo...