Granulicatella adiacens is one of the fastidious gram positive cocci previously described as nutritionally variant streptococci due to their requirement of L-cysteine, pyridoxal, or thiol compounds for growth. These bacteria have been identified as significant causative agents of endocarditis, opthalmic infections, and meningitis. We report a case of septicemia caused by G. adiacens in an 80-year-old patient with cholangiocarcinoma. The organism was identified by phenotypic and 16S rRNA sequencing analyses. (Korean J Clin Microbiol 2008;11:63-65)