A Rare and Aggressive Presentation of Lung Adenocarcinoma in a Young Non-smoking Male: Concurrent Cardiomyopathy, Cardiac Tamponade, and Coagulopathy

Lung cancer is one of the leading causes of death worldwide.It mostly affects old patients with a smoking history (about 80%).Lung adenocarcinoma accounts for about 40% of all lung cancer.Lung cancer mostly presents with haemoptysis, weight loss, cough, dyspnoea, and chest pain.Very few patients have a severe presentation like cardiac tamponade, found in post-mortem patients.A 38-year-old non-smoking male presented to the emergency department with acute dyspnoea, hypotension, and signs of cardiac tamponade.Clinical examination revealed tachycardia, elevated neck veins, and bilateral crepitations.A young, non-smoking male presented with cardiac tamponade confirmed by ultrasound and electrocardiogram (ECG) showing low-voltage QRS complexes.Urgent pericardiocentesis drained 750 mL of haemorrhagic fluid, alongside bilateral pleural aspirations.Initially stabilised with inotropes, his condition worsened with hypotension, acute kidney injury (AKI), and severe biventricular dysfunction.Labs showed leucocytosis, liver dysfunction, high hs-troponin I (HSTROPI), and coagulopathy.Both effusions were haemorrhagic and exudative, but low adenosine deaminase (ADA) levels ruled out tuberculosis.Cytology revealed atypical cells, and imaging showed cardiomegaly, effusions, and a small right lower lobe lung nodule.Echocardiography revealed severely reduced heart function ejection fraction (EF): 30%.Immunohistochemistry confirmed lung adenocarcinoma thyroid transcription factor-1 (TTF)-1, Napsin A, and BerEP4 positive.Despite aggressive care-including dialysis, transfusions, ventilation, and plasma exchange-his condition deteriorated.Due to multi-organ failure, cancer treatment was not started, and he died.This rare case highlights an unusual presentation of lung adenocarcinoma with a triad of cardiac tamponade, cardiomyopathy, and coagulopathy, an uncommon combination in young, nonsmoking individuals.It emphasises the diagnostic value of pericardial fluid cytology and immunohistochemistry in atypical clinical scenarios and highlights the importance of considering malignancy even in patients without traditional risk factors.Early recognition and high clinical suspicion are critical, as delayed diagnosis in such aggressive presentations can lead to rapid deterioration and poor outcomes.