Systemic nocardiosis is rarely reported in patients with systemic vasculitis, and is mostly described in patients experiencing long-term immunosuppression following organ transplantation. In this report, we describe a 71-year-old man who developed disseminated Nocardia infection during treatment of his underlying microscopic polyangiitis. He had no other associated risk factors. This case highlights the importance of considering rare pathogens in immunosuppressed patients who present with nonspecific symptoms, as well as the impact of such pathogens on clinical management.