Three months after undergoing heart transplantation, a 55-year-old man presented with N. brasiliensis cellulitis resulting from a splinter wound acquired during yard work. Surgical débridement was necessary before the infection responded to medical treatment. Although pulmonary nocardiosis is a well-documented complication of immunosuppressive therapy, this is the 1st report of a nocardial infection associated with primary skin involvement in a heart transplant patient.