Objective To summarize the clinical characteristics and treatment outcomes of patients with acquired immunodeficiency syndrome complicated with Rhodococcus equi infection. Methods A retrospective analysis was conducted on the clinical data of 14 patients with acquired immunodeficiency syndrome complicated with Rhodococcus equi infection, who were admitted to the Public Health Clinical Center of Chengdu from September 2017 to September 2025. Results Of the 14 patients, 13 were male, with an age range of 23 to 55 years and a median age of 40 (37, 43) years. All patients reported a history of sexual exposure, among whom 1 reported male-to-male sexual contact and 1 had a history of intravenous drug use. The time from diagnosis of human immunodeficiency virus (HIV) infection to diagnosis of Rhodococcus equi infection ranged from 5 days to 7 years. Seven patients had not initiated antiretroviral therapy (ART). Among the 7 patients who had initiated ART, 3 had confirmed virological treatment failure and 2 had self-discontinuation of ART. At the time of diagnosis of Rhodococcus equi infection, the CD4⁺ T lymphocyte count was 26.0 (16.5, 47.5) cells/μL, and the CD4/CD8 ratio was 0.11 (0.06, 0.15). The main clinical manifestations included cough, sputum production, fever, chest pain, etc. Imaging findings predominantly showed pulmonary infiltration and consolidation, cavitary lesions, and pleural effusion. Rhodococcus equi-positive specimens included blood, sputum, bronchoalveolar lavage fluid, pharyngeal swabs, pleural effusion, etc., with multiple specimen types often collected from the same patient. Regarding treatment outcomes, 10 patients showed clinical improvement, 3 did not receive or abandoned treatment, and 1 patient died. Conclusions Rhodococcus equi infection is uncommon in patients with acquired immunodeficiency syndrome, but it often causes bacteremia and cavitary pneumonia. Selecting sensitive antibacterial agents for a full course of treatment based on antibacterial susceptibility test results as soon as possible after diagnosis, along with prompt initiation of ART, may improve patient prognosis.