We present a rare case of pulmonary nocardiosis presenting as rapidly progressive sepsis with a miliary radiologic pattern in an immunocompromised patient, with a history of idiopathic membranous nephritis under treatment with cyclosporine and methylprednisolone. Pulmonary nocardiosis presents high mortality and nonspecific clinical and radiological features. The most usual radiological patterns are alveolar opacities, consolidation, nodules, masses, reticulonodular opacities, and pleural effusion. On the other hand, a miliary pattern can occur in tuberculosis, fungal infection, viral pneumonia, malignancy, sarcoidosis, tropical pulmonary eosinophilia, hypersensivity pneumonitis, silicosis and other rare conditions. Clinical suspicion is important as microbiological isolation requires 2-7 days. Awareness around nocardiosis needs to be raised as its frequency increases in parallel with the increase of cytotoxic and steroid treatment. Pneumon 2020, 33(4):1-4.