A 44-year-old woman was admitted into the ward on account of three months history of cough and one-week history of fever and difficulty with breathing. The cough was insidious in onset and productive of yellow sputum that is non-bloody and non-foul smelling. The fever was high grade with associated chills and rigor. There was associated history of progressive weight loss and drenching night sweats. There was no history of contact with person with chronic cough. Physical examination revealed a middle-aged woman who was in obvious respiratory distress. The pulse rate was 92 beats per minute (regular and good volume) with a blood pressure of 100/60mmHg and respiratory rate of 36 cycles per minute. Chest examination revealed dull percussion notes and absent breath sounds on the left lower lobes of the left lung. The apex beat was located in the fifth left intercostal space, mid clavicular line. An assessment of pulmonary tuberculosis was entertained to rule out metastatic lung disease. Chest x-ray that was done showed homogenous opacity with circumscribed nodular lesions of the left lower lung zones. Emergency in-patient thoracocentesis (with no imaging guidance) was performed for microbiological studies and cytology with 10mls of haemorrhagic fluid aspirated. However, some minutes after the procedure, patient complained of dizziness and went into coma. She was pronounced dead after failed resuscitation and autopsy was performed in our facility. Findings at autopsy revealed shrunken and partially fibrotic lower lobe of the left lung (about 60% of normal) with the presence of three areas of caseous necrosis located in both the upper and lower lobes (Figure 1). The enlarged heart (due to hypertensive heart disease) had replaced the space left by the shrunken lung. There was about 400mls of serosanguineous left pleural effusion. There were about four puncture wounds located at the apex of the heart, adjacent to the site of the pericardial laceration (Figure 2). Gross examination of the pericardial sac showed a 1.2 x 0.7cm laceration of the pericardial sac at the apex with about 650mls of clotted blood within the pericardial space (Figure 3). Considering the acuteness or sudden nature of the onset of symptoms and the progressive deceleration to death; the puncture was ascertained to be iatrogenic. The cause of death from autopsy findings was presented as cardiac tamponade due to iatrogenic puncture of the heart in a failed thoracocentesis. Histology of samples taken from the left lung tissue confirmed the presence of chronic caseating granulomatous inflammation due to pulmonary tuberculosis.