According to information obtained from police a 45-yearold man was found dead near a bus stop in the early morning. The decedent was a manual worker and a heavy smoker. He appeared to have been in good health prior to his death, with no definite medical history apart from a recent cough. His shirt was blood stained. At autopsy, the body was that of a thin middle-aged man (Fig. 1), with no significant external injuries, apart from small abrasions on both knees. Dried blood stains were present over his nostrils, mouth, and chin. The most significant findings were limited to the chest cavity where there were bilateral fibrous adhesions. Both lungs were gray in color with prominent anthracotic discoloration (Fig. 2) and emphysematous bullae. Cut sections of the lungs revealed a gray-white tubercle in the upper lobe of right lung (Fig. 3) and confluent areas of necrosis within the left lung that contained foul smelling yellow material (Fig. 4). The hilar lymph nodes were grayishwhite in color and enlarged. Hemorrhagic frothy fluid was present within the tracheobronchial tree. The remainder of the autopsy examination was unremarkable. Histological examination of the lungs revealed large areas of caseous necrosis with numerous Langhan’s giant cells typical of Mycobacterium tuberculosis infection. Lesions manifested alveolar destruction with a mixed acute and chronic inflammatory cell infiltrate. Lymph node architecture was completely effaced with replacement by confluent areas of caseous necrosis, again with epithelioid giant cell granulomas. Tubercle bacilli were demonstrated in the lungs on Ziehl–Neelsen staining (further microbiological studies were not undertaken). Toxicological studies were negative. No other underlying natural diseases were present which could have caused or contributed to death, and there was no evidence of significant trauma to indicate assault (the minor abrasions of the knees most likely occurred at the time of collapse during the terminal episode). Death was due to acute upper airway hemorrhage complicating pulmonary tuberculosis.