Immunocompetent children typically develop cutaneous or lymphocutaneous disease with pustular or ulcerative lesions that remain localized after soil contamination of a skin injury. Invasive disease occurs most commonly in immunocompromised patients, particularly people with chronic granulomatous disease, organ transplantation, human immunodeficiency virus infection, or disease requiring long-term systemic corticosteroid therapy. In these children, infection characteristically begins in the lungs, and illness can be acute, subacute, or chronic. Pulmonary disease commonly manifests as rounded nodular infiltrates that can undergo cavitation. Hematogenous spread may occur from the lungs to the brain (single or multiple abscesses), in skin (pustules, pyoderma, abscesses, mycetoma), or occasionally in other organs. Nocardia organisms can be recovered from patients with cystic fibrosis, but their role as a lung pathogen is not clear.