A 14-year-old warmblood gelding was managed for waxing and waning cranial nuchal bursitis for two years. Intensive medical and surgical management was not curative, and the patient was subjected to euthanasia after becoming acutely recumbent. Ante-mortem and post-mortem next generation sequencing of bursal tissue, and post-mortem conventional PCR detected sequence within the Actinobacterial phylum. Post-mortem examination, computed tomography (CT) and magnetic resonance imaging (MRI) findings confirmed spinal cord compression, an undescribed sequela of nuchal bursitis in modern equine medicine.