Abstract: Objective To describe the clinical features, imaging features, pathogenic characteristics and drug resistance of pulmonary nocardiosis and to explore the reasons that nocardiosis is misdiagnosed as tuberculosis (TB). Methods The clinical and radiological materials of one pulmonary nocardiosis patient, who initially was misdiagnosed as TB and presented in the 3rd Affiliated Hospital of Sun Yat-sen University in September 2012, were reviewed; a literature review to the related papers in Chinese or English published since 1980 was conducted. Thus, 26 pulmonary nocardiosis cases with completed clinical materials, who initially were misdiagnosed as TB, were involved in the analysis together with the reported case in this paper. Results Among the 27 cases of nocardial infection, there were 21 cases with underlying diseases, including acquired immunodeficiency syndrome (AIDS) (9 cases) which was the most common, autoimmune diseases, chronic lung disease, chronic renal disease and diabetes mellitus (DM); and 25 cases were reported in the high TB burden countries. Nocardia asteroid were identified in 16 cases, nocardia brasiliensis in 4 cases and the other 7 cases were not classified. Lung was the most frequently affected organ (20 of 22 cases). Among 13 cases who had imaging abnormalities in lungs, 10 cases showed bilateral lesions. Mass shadows, patchy infiltration, consolidation or cavitations and pleural effusions were the main manifestations of chest radiology. Conclusion Immunosuppression is the most import predisposing factor for nocardia infection. Nocardia asteroid is the most common species to be isolated from clinical specimens.