We report here a forty nine years old male who is a known case of hypertension, diabetes and end-stage renal disease secondary to membranous glomerulonephritis, and who remained in regular hemodialysis for two years before getting a cadaveric transplant. He had an induction with anti thymocyte globulin and was maintained on triple immunosuppressive regimen and his best creatinine post transplant was 1.4 m/dL. After 2 months, he came with productive cough, high grade fever and mild leukocytosis (WBC count of 11.3 x 103). On examination he was stable, conscious and oriented. 
 On chest examination, bronchial breathing was heard and the chest radiograph showed solid consolidations in the right upper lung lobe (Figure 1). Subsequently performed, a high resolution CT chest depicted a mass-like consolidation in right upper lobe (Figure 2) measuring 7cm x 10 cm with air bronchogram. Bronchoscopy was performed and biopsies were taken, which revealed filamentous gram-stain positive bacteria. The sample was negative for Ziehl-Neelsen staining for acid fast bacillus. Polymerase chain reaction (PCR) for tuberculosis (TB) and subsequent culture for TB was negative. On routine TTE, the patient had a mobile mass (0.3 cm x 0.85 cm) attached to the posterior leaflet of mitral valve (Figure 3). This was an incidental finding as pre-transplant TTE was normal. A PCR for Nocardia came out to be positive. 
 Based on the above mentioned studies, the patient was started on IV TMP-SMX (Trimethoprim- sulfamethoxazole) and Imipenem and this combination was continued for four weeks. Our patient received initial induction therapy with IV TMP-SMX (Trimethoprim- sulfamethoxazole) and Imipenem and this combination was continued for four weeks. The patient showed swift recovery, with frequent radiological imagings showing gradual improvement of lung consolidation. Intracardic mass disappeared after two weeks of treatment. Following the response to antibiotic therapy, the patient was kept on maintenance dose of oral TMP-SMX 960 mg once a day for six months.