Case of generalized pustular psoriasis with end‐stage renal disease successfully treated with granulocyte monocyte apheresis in combination with hemodialysis

Granulocyte monocyte apheresis ( GMA ) is an extracorporeal apheresis instrument that removes activated neutrophils and monocytes. Generalized pustular psoriasis ( GPP ) is characterized by neutrophil infiltration into the epidermis that causes Kogoj's spongiotic pustule. Thus, GMA is one of the useful therapies for GPP , and it was approved for the treatment in 2012 in Japan. Herein, we report a case of GPP with end‐stage renal disease ( ESRD ) successfully treated with GMA in combination with hemodialysis ( HD ). A 54‐year‐old Japanese female visited our outpatient clinic because of erythema with pustules on her trunk and extremities over the past 4 months. Histopathological examination showed an intraepidermal pustule filled with numerous neutrophils and spongiosis. These findings led to the diagnosis of GPP . She had ESRD and had been treated with HD twice a week for approximately 4 years. During maintenance HD twice a week, weekly GMA was started at Tokai University Hospital. The skin symptoms disappeared after five administrations of GMA . We suggest that GMA is an effective therapy for GPP patients with ESRD who are treated with HD .