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