A 59-year-old male with rheumatoid arthritis and interstitial lung disease had been treated with prednisolone, salazosulfapyridine, and tacrolimus. He had had a productive cough 12 days before admission and was referred to our hospital because of an abnormal shadow on his chest X-ray. On the admission day, he complained of severe respiratory distress, and the analysis of arterial blood gases showed marked hypoxemia. Chest computed tomography showed consolidation with cavitary lesions in the right upper lobe and randomly distributed small nodules. He had required mechanical ventilation immediately, and had received antibiotics, methylprednisolone, and sivelestat. Nevertheless, he died 18 hours later. A postmortal autopsy revealed purulent necrotizing granulomas, from which Nocardia sp. was cultured, in both lungs, both kidneys, liver, and bone, so we diagnosed disseminated nocardiosis as a result of pulmonary Nocardia infection. Although it is very rare, pulmonary nocardiosis can disseminate rapidly when a patient is immunocompromised.