CASE PRESENTATION: 05/11/2015 - 72-year-old non smoker man with asthenia, fever, weight loss, and night sweats for two months. No HIV infection, neoplasia or high-dose corticosteroid use. He takes omeprazole for gastritis and nasal fluticasone for rhinitis. Treated TB when 23 year old. Four years ago, right upper lobectomy due to bronchiectasis. 04/24/2015- culture of bronchial washing fluid obtained by fiberbronchoscopy positive for Aspergillus, starts itraconazole 400 mg/day. Axillary temperature 37.5 Celsius, Body Mass Index 17. Blood culture and serology negative for HIV and HCV. Negative acid-fast bacilli, fungi, and Gram staining sputum. 05/12/2015- Computed Tomography (CT) scan shows bronchiectasis, diffuse centrilobular opacities, consolidation, nodules with ground glass opacity. 05/15/2015- negative acid-fast bacilli, fungi and bacteria in bronchial washing fluid. Pneumocystis and Mycobacterium tuberculosis PCR: negative. No clinical improvement. 05/26/2015- CT-guided biopsy of the lung with negative results for bacteria, acid-fast bacilli, fungi and pneumocystis jirovecii; acute organizing pneumonia is identified, prednisone 40 mg/day is prescribed, and patient is discharged also taking itraconazole. 07/01/2015- readmitted and CT shows cavitation of the lung nodules. Prednisone and itraconazole suspended.07/03/2015- sample obtained by bronchoscopy shows no organism. 07/07/2015- videothoracoscopy collects lung sample with positive culture for Nocardia cyriacigeorgica by mass spectrometry. Patient starts sulfamethoxazole-trimethoprim and is discharged with tubular pleurostomia. In August, pleurostomy is closed, lung lesions improved, and treatment continued.