Intravenous Levosimendan for Acute Heart Failure with Renal Impairment Following Severe Scorpion Envenomation: Case Report and Literature Review

Acute heart failure, presenting as either cardiogenic shock or pulmonary edema, is the main cause of mortality because of scorpion envenomation (SE) in many tropical and subtropical parts of the world. Standard heart failure treatment, including inotropes and diuretics to treat cardiogenic shock and pulmonary edema, was used in most studies. However, the role of the inotrope levosimendan in the treatment of cardiogenic shock complicated by pulmonary edema and renal impairment after SE has rarely been reported, to the best of our knowledge. Here, we report this case of severe SE complicated by cardiogenic shock and pulmonary edema successfully managed with levosimendan in a 4-year-old patient. As a consequence, the use of this inotropic drug seems to be beneficial in severe cases of SE complicated by severe cardiogenic shock and not stabilized by the usually used inotropic and vasopressor agents (dobutamine and noradrenaline). Further studies are needed to confirm the usefulness of levosimendan in cardiogenic shock related to severe SE.