Immunosuppressant, major arthroplasty

64-year-old lady for left shoulder second stage revision/replacement     

Background

  • Infected Left shoulder replacement – long hospital admission with multiple washouts/removal of hardware/insertion of spacer
  • Colonised with pseudomonas

Issues

  • Severe asthma – multiple admissions to ICU postoperatively with Type 1 Respiratory failure requiring NIV
  • NYHA Class 3 dyspnoea. Daily Ventolin x3. Regular prednisolone requirement
  • Recently commenced Mepolizumab immunotherapy with excellent response in symptoms and no steroid requirement
  • Novel therapy, not frequently encountered perioperatively

Discussion

Management of Mepolizumab

  • Ideal situation would be to continue given significant improvement in respiratory symptoms however uncertain effects on wound healing, infections rate with major joint surgery
  • Absence of literature online
  • Discussed with prescribing physician – Mepolizumab is a monoclonal antibody which targets human IL-5 with high affinity and specificity. IL-5 is the major cytokine responsible for the growth, differentiation, activation, and survival of eosinophils.
  • Respiratory physician recommends continuation of therapy and has emphasized that there are no effects on neutrophils or other white cells

Plan

  • Continue Mepolizumab as advised
  • Discuss above with orthopaedic surgeons