Pulmonary nocardiosis is an uncommon infectious disease affecting either the lungs or whole body. We
present a case of a 70-year-old female with diabetes mellitus and hypertension who developed bilateral
cavitary lung lesions following exposure to paint fumes. Initial imaging raised concerns for malignancy.
Bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial lung biopsy confirmed Nocardia
spp. infection. The patient was treated with oral trimethoprim-sulfamethoxazole (TMP-SMX) and
achieved complete resolution. We are adding to the literature this case to underscore the importance of
considering pulmonary nocardiosis in the differential diagnosis of cavitary lung lesions.
