Objective To analyze the clinical characteristics of pulmonary tuberculosis patients complicated with infection of Nocardia farcinica aiming to improve the diagnosis and treatment the disease. Methods The clinical data of 22 cases of pulmonary tuberculosis complicated with Nocardia farcinica infection admitted to Guangzhou Chest Hospital from June 2020 to December 2023 were collected and the clinical manifestations， imaging， laboratory tests， treatment process， and disease outcomes were retrospectively analyzed. Results Among the 22 patients， there were 13 males and 9 females， aged 20 ~ 86 years， with a median age of 52 years. Common clinical manifestations included cough （22/22）， sputum （21/22）， and underlying diseases （13/22）. One case was positive for cerebrospinal fluid culture， and 21 cases were positive for sputum culture. The culture period was 5 ~ 26 days， with a median culture period of 18 days. The imaging manifestations were mainly plaques， plaques and cavities， and the lesions were spread in both lungs （17/22） and cavities （11/22）. After anti?tuberculosis treatment， the absorption of lung lesions in some patients was poor， and the absorption of the lesions was improved after anti?nocardia treatment. 8 cases were cured， 13 cases were improved and 1 case died. Conclusion The clinical symptoms of patients with pulmonary tuberculosis complicated with Nocardia farcinica were atypical， the culture period of Nocardia was long， and the imaging manifestations were similar to pulmonary tuberculosis， which is prone to misdiagnosis and missed diagnosis. For patients with poor response to anti?tuberculosis treatment and slow lesion absorption， the possibility of a concurrent Nocardia infection should be considered.