Rhodococcus equi is a common respiratory pathogen of young foals on breeding farms. Although it is most commonly associated with severe pyogranulomatous pneumonia it has been known to cause a variety of extrapulmonary disorders which may be observed in the presence or even absence of traditional pneumonic signs. Differentiating R. equi from other causes of pneumonia is necessary for successful treatment as this organism does not respond to many well-established broad-spectrum antimicrobial therapies. Here we present the case of a foal infected with Rhodococcus equi showing signs of diarrhea with no clinical evidence of pneumonia. The foal's age and uncommon presentation did not initially suggest a diagnosis of R. equi, but once a definitive diagnosis was made and appropriate treatment for R. equi initiated the foal's clinical condition improved and he was discharged. As the foal’s condition was deteriorating at the time R. equi was diagnosed, it is likely that he would not have survived had we failed to recognize and diagnose Rhodococcus equi. This case reinforces the need to consider Rhodococcus equi as a differential diagnosis in any foal presenting for pneumonic signs or signs that might be attributable to an extrapulmonary manifestation of Rhodococcus equi.