A 72-year-old woman presented with an acute purulent hand infection which proved to be due to Nocardia asteroides. She was found to have Cushing's syndrome secondary to ectopic adrenocorticotropic hormone production. Her hand infection was successfully treated with debridement and drainage. Despite intensive medical treatment, she developed pulmonary infection while hospitalized and died from pulmonary complications. In cases such as this, treatment with sulfonamides is indicated and must be begun on the basis of Gram's stain findings since successful culture and identification of the organism may be delayed.