Bacillus cereus is well known as a causative agent of food poisoning but it also causes bacteremia and endophthalmitis in nosocomial infections. However, as an environmental bacterium that lives in soil, it is often treated as simple contamination by hospitals. In recent years, highly pathogenic B. cereus strains that are similar to Bacillus anthracis have been detected in hospitals. The B. cereus sphingomyelinase contributes to its pathogenicity, as do sphingomyelinases produced by Staphylococcus aureus, Pseudomonas aeruginosa, Helicobacter pylori, and B. anthracis. Highly pathogenic B. cereus produces a large amount of sphingomyelinase. In this review, we describe the regulation of sphingomyelinase expression through the PlcR–PapR system, the pathogenicity of bacterial sphingomyelinases, and their potential as therapeutic drug targets.