In patients exposed to inhaled noxious substances, nocardia should also be considered in cases of unclear pulmonary infections. Disseminated nocardiosis is often difficult to diagnose. The risk of complications is increased due to the delay in diagnosis and the long and complicated antibiotic therapy. In the case report presented here, the connection between occupationally induced pulmonary predisposition and suspected inhalation of dust must be emphasized as particularly important. Interdisciplinary diagnostics and subsequent infectious disease-supported prolonged therapy are necessary.