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