We report a case of multiple pulmonary nodules in an 80-year-old man with adult Still's disease who was receiving corticosteroid treatment. Microbiological examination of sputum was positive for Nocardia, and pulmonary nocardiosis was diagnosed. He was treated with oral sulfamethoxazole-trimethoprim alone; however, his cavitary pulmonary nodules were worsened. Brain magnetic resonance imaging showed small high-intensity nodules, and disseminated nocardiosis was diagnosed based on sputum, skin cultures growing Nocardia sp. After he was treated with amikacin and imipenem/cilastatin, pulmonary and brain nodules were improved. The isolate was later identified as Nocardia otitidiscaviarum by 16S rRNA analysis. Pulmonary nocardiosis resulting from N. otitidiscaviarum appears to be rare, and isolated N. otitidiscaviarum showed resistance to antimicrobial agents, including sulfamethoxazole-trimethoprim and imipenem. Disseminated nocardiosis, including central nervous system infection, is a poor prognosis, and multiple antimicrobial therapy should be important until isolates identify antimicrobial susceptibility.