In Messina he met a mysterious person whom he calls Altotas, and from whom, he says in his Memoir, he learnt much. The following account of the meeting of Balsamo and the stranger is taken from Waite's book: "As he was promenading one day near the jetty at the extremity of the port he encountered an individual singularly habited and possessed of a most remarkable countenance. This person, aged apparently about fifty years, seemed to be an Armenian, though, according to other accounts, he was a Spaniard or Greek. He wore a species of caftan, a silk bonnet, and the extremities of his breeches were concealed in a pair of wide boots. In his left hand he held a parasol, and in his right the end of a cord, to which was attached a graceful Albanian greyhound.... Cagliostro saluted this grotesque being, who bowed slightly, but with satisfied dignity. 'You do not reside in Messina, signor?' he said in Sicilian, but with a marked foreign accent. Cagliostro replied that he was tarrying for a few days, and they began to converse on the beauty of the town and on its advantageous situation, a kind of Oriental imagery individualising the eloquence of the stranger, whose remarks were, moreover, adroitly adorned with a few appropriate compliments."

Although the stranger said he received no one at his house he allowed Cagliostro to visit him. After various mysterious doings the two went off to Egypt, and afterwards to Malta, where they performed many wonderful deeds before the Grand Master, who was much impressed. At Malta Altotas died, or, at anyrate, vanished. Cagliostro then travelled for some time, and was well received by noblemen, ambassadors, and others in high position. At Rome he fell in love with a young and beautiful lady, Lorenza Feliciani, and married her.

Cagliostro used his young wife as a decoy to attract rich and foolish men. He and his wife thrived for a time, and accumulated money and jewels; but a confederate betrayed them, and they fled to Venice, and then wandered for several years in Italy, France, and England. They seem to have made a living by the sale of lotions for the skin, and by practising skilful deceptions.

About the year 1770 Cagliostro began to pose as an alchemist. After another period of wandering he paid a second visit to London and founded a secret society, based on (supposed) Egyptian rites, mingled with those of freemasonry. The suggestion of this society is said to have come from a curious book he picked up on a second-hand stall in London. The society attracted people by the strangeness of its initiatory rites, and the promises of happiness and wellbeing made by its founder to those who joined it. Lodges were established in many countries, many disciples were obtained, great riches were amassed, and Cagliostro flourished exceedingly.

In his Histoire du Merveilleux dans les Temps modernes, Figuier, speaking of Cagliostro about this period of his career, says:

"He proclaimed himself the bearer of the mysteries of Isis and Anubis from the far East.... He obtained numerous and distinguished followers, who on one occasion assembled in great force to hear Joseph Balsamo expound to them the doctrines of Egyptian freemasonry. At this solemn convention he is said to have spoken with overpowering eloquence;... his audience departed in amazement and completely converted to the regenerated and purified masonry. None doubted that he was an initiate of the arcana of nature, as preserved in the temple of Apis at the era when Cambyses belaboured that capricious divinity. From this moment the initiations into the new masonry were numerous, albeit they were limited to the aristocracy of society. There are reasons to believe that the grandees who were deemed worthy of admission paid exceedingly extravagantly for the honour."

Cagliostro posed as a physician, and claimed the power of curing diseases simply by the laying on of hands. He went so far as to assert he had restored to life the dead child of a nobleman in Paris; the discovery that the miracle was effected by substituting a living child for the dead one caused him to flee, laden with spoil, to Warsaw, and then to Strassburg.

Cagliostro entered Strassburg in state, amid an admiring crowd, who regarded him as more than human. Rumour said he had amassed vast riches by the transmutation of base metals into gold. Some people in the crowd said he was the wandering Jew, others that he had been present at the marriage feast of Cana, some asserted he was born before the deluge, and one supposed he might be the devil. The goldsmith whom he had cheated of sixty ounces of gold many years before was in the crowd, and, recognising him, tried to stop the carriage, shouting: "Joseph Balsamo! It is Joseph! Rogue, where are my sixty ounces of gold?" "Cagliostro scarcely deigned to glance at the furious goldsmith; but in the middle of the profound silence which the incident occasioned among the crowd, a voice, apparently in the clouds, uttered with great distinctness the following words: 'Remove this lunatic, who is possessed by infernal spirits.' Some of the spectators fell on their knees, others seized the unfortunate goldsmith, and the brilliant cortege passed on" (Waite).

From Strassburg Cagliostro went to Paris, where he lived in great splendour, curing diseases, making gold and diamonds, mystifying and duping people of all ranks by the splendid ritual and gorgeous feasting of his secret society, and amassing riches. He got entangled in the affair of the Diamond Necklace, and left Paris. Trying to advance his society in Italy he was arrested by the agents of the Inquisition, and imprisoned, then tried, and condemned to death. The sentence was commuted to perpetual imprisonment. After two years in the prison of San Angelo he died at the age of fifty.