Pericardial effusion in pediatric Shiga toxin-producing E. coli hemolytic uremic syndrome: a French multicentre study

Extra-renal complications are severe in Shiga toxin-producing E. coli hemolytic uremic syndrome (STEC-HUS), with pericardial effusion being rare and inadequately characterized. This study aimed to describe the clinical and biological data, management strategies, and risk factors associated with pericardial effusion in children with STEC-HUS.

This multicentric retrospective study included all consecutive children under 18 years who developed pericardial effusion during STEC-HUS in France between 2017 and 2022. Paired comparisons were made with control children presenting STEC-HUS in the same centres, before and after the index cases.

A total of 15 cases were identified. The pericardial effusion group exhibited significantly more extra-renal manifestations compared to 30 control cases. Leukocyte counts were higher in the pericardial effusion group (22.2 G/L vs. 14.5 G/L, p = 0.002), as were hematocrit levels (30.1% vs. 24.2%, p = 0.02). Fourteen children received eculizumab, and 8 out of 15 required pericardial drainage. Two patients died from non-cardiac causes. Myopericarditis was identified in 5 cases, and 5 of the 14 patients had normal troponin levels during the initial phase.

Children with pericardial effusion during STEC-HUS exhibited more extra-renal manifestations and biological markers indicative of severe HUS at presentation. These findings suggest that patients with severe STEC-HUS and extra-renal manifestations requiring intensive care should be routinely screened for pericardial effusion.