Nocardia is a well-recognized pathogen in immunocompromised hosts, but the incidence of Nocardia infections in lung transplant recipients is not well defined. A chart review from 1990 to 2007 at Clarian Hospital Lung Transplant Center and Indiana University Medical Center revealed Nocardia infections in four of 410 lung transplant recipients despite prophylaxis. All infections were confined to lung and occurred at a median time of 315 d after transplantation. Nocardia nova was isolated in two patients, Nocardia farcinica in one, and unspecified Nocardia sp. in one. Nocardia isolates were susceptible to trimethoprim sulfa (TMP/SMX). Our data suggest that the dose of TMP/SMX, commonly used for Pneumocystis prophylaxis is not protective for Nocardia. Contrary to historic data reporting 40% mortality, none of the patients in our study died because of Nocardia. Nocardia infection is an under-recognized entity in lung transplant recipients, and the optimal duration of therapy and prophylaxis are unclear.