The presentation of a Nocardia infection is quite variable. We report a case of nocardiosis presenting as endobronchial obstruction with postobstructive pneumonia and atelectasis, in a patient with a low index of suspicion for bronchogenic carcinoma. Our report emphasizes the importance of considering the diagnosis of endobronchial nocardiosis in patients with endobronchial obstruction and a low index of suspicion for carcinoma, as well as those with a high index of suspicion, but with repeatedly negative biopsies.