An 83-year-old man with a history of cerebral infarction, hypertension, and dementia was admitted to our hospital with a fever (40.1°C) and light-headedness. There was no history of recent travel or hot spring vacation. This elderly and physically disabled person who needed health care had been given a diagnosis of nursing and healthcare-associated pneumonia (NHCAP) according to Japanese Respiratory Society guidelines. Because aspiration pneumonia was suspected, the patient received monotherapy by sulbactam/ampicillin as the initial treatment. His condition deteriorated with right lower lobe consolidation. The diagnosis of Legionella pneumonia was achieved by positive antigenuria obtained three days after admission. Despite combination therapy by azithromycin and ciprofloxacin, his condition continued to deteriorate, and he died the following day. Legionella spp. was cultured from the autopsied lung. NHCAP is a Japanese variant of healthcare-associated pneumonia in terms of the Japanese health care insurance system, including the nursing-care insurance system, and the pattern of drug-resistant pathogens. Aspiration is thought to be the most important mechanism for the pathogenesis of NHCAP, and the frequency of Legionella spp. is extremely low as its causative organism. However, we should consider the possibility of Legionella pneumonia, even in the setting of NHCAP. We reported this case as a didactic case.