We aimed to study the clinical pattern of nocardiosis in a tertiary care hospital in Saudi Arabia using a retrospective review of cases from 1987 to 2003. A total of 19 patients were identified as having culture-proven nocardial infection. The most common underlying condition was renal transplantation in 8 patients (42%). Lungs were the most common sites of involvement in 12 patients (63%). Three Nocardia species were isolated in our series: N. asteroides (58%), N. brasiliensis (21%), and N. otitidiscaviarum (21%). A high index of suspicion is essential in susceptible patients presenting with pulmonary infiltrate, cerebral abscess or deep soft-tissue abscess and usually requires an active diagnostic workup and early administration of appropriate therapy.