A 71-year-old female, who has been treated with steroids for 3 weeks, developed a severe pneumonia with septic shock and acute respiratory distress syndrome (ARDS). Despite broad antibiosis due to the detection of pseudomonas aeruginosa (blood culture) the inflammatory markers remained high and the respiratory situation went critical. No proof of a malignoma or autoimmune process was found, despite multiple round foci in x-ray and computer tomography. Finally the delayed diagnosis of pulmonary nocardiosis was adjusted, due to the long incubation period of the pathogen Nocardia farcinica. The infectious origin may be assumed in so called "hay packs" used during the patient's residence at a health resort. After adequate change of the antibiotic regimen stabilization was achieved and the patient meanwhile recovered from the disease.