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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ustekinumab is a human monoclonal antibody directed against interleukins &#40;IL&#41; 12 and 23&#44; which are involved in the control of infections and tumors and the pathogenesis of psoriasis&#46; Animal model studies have shown that inhibition of IL-12 and IL-23 might promote carcinogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Biologic therapies are considered to be both safe and well tolerated&#44; but there is concern about their carcinogenic potential&#46; There have been several reports of lymphoproliferative disorders developing in patients under treatment with tumor necrosis factor &#40;TNF&#41; inhibitors&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;4</span></a> We present the case of a 68-year-old man with a history of hypertension&#44; type 2 diabetes mellitus&#44; hypertriglyceridemia&#44; overweight&#44; and ischemic heart disease diagnosed with plaque psoriasis 13 years earlier&#46; Given the severity of his psoriasis&#44; the patient was administered psoralen plus UV-A therapy and methotrexate 15<span class="elsevierStyleHsp" style=""></span>mg&#47;wk for a year&#59; the treatment showed moderate effectiveness&#44; and rapid recurrence was observed following discontinuation of treatment&#46; In May 2008&#44; the patient was started on concomitant efalizumab and methotrexate &#40;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;wk&#41; therapy&#44; which was continued with satisfactory results until efalizumab was withdrawn from the market in 2009&#46; In March 2010&#44; the patient experienced a relapse and was administered ustekinumab&#44; which achieved adequate control of his psoriasis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In November 2012&#44; the patient was seen at the emergency department of our hospital with complaints of melena and upper abdominal pain&#46; A gastroscopy revealed a gastric tumor with signs of malignancy&#46; The tumor&#44; however&#44; was studied and monitored at another hospital &#8220;resultando infructuoso el intento de recuperar las muestras histologicas&#8221;&#46; The results showed a dense infiltrate composed of atypical lymphocytes without identifiable clusters of nodes&#46; In the immunohistochemical study&#44; the cells were positive for CD20 and BCL2&#44; and negative for CD10&#44; CD30&#44; cyclin D1&#44; and CD5&#46; The use of appropriate histological stains did not identify <span class="elsevierStyleItalic">Helicobacter pylori</span> or other microorganisms&#46; A diagnosis of low-grade gastric mucosa-associated lymphoid tissue &#40;MALT&#41; lymphoma was established&#44; with no metastases identified by positron electron tomography&#47;computed tomography&#46; The patient underwent 19 sessions of radiation therapy&#44; which resulted in complete remission according to a report dated April 2013&#44; which is when he came for a follow-up visit at our hospital&#46; On examination of this and other reports on the tumor&#44; it was decided to discontinue treatment with ustekinumab&#46; The patient&#39;s psoriasis&#44; however&#44; was kept under control with topical treatment&#44; which resulted in almost complete whitening of the lesions&#46; Nevertheless&#44; in August 2013&#44; the patient died suddenly of cerebral infarction&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The risk of malignancy in patients with psoriasis is a hotly debated topic&#46; Some authors have postulated that the risk might be higher than in the general population&#44; even in the absence of treatment&#44; due to the underlying chronic inflammation associated with psoriasis&#44; particularly in patients with comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There is also controversy surrounding the risk of lymphomas in patients with psoriasis&#46; It has been postulated that this potentially increased risk might be related to both the pathophysiology of psoriasis and the use of immunosuppressant therapy in this setting&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">There have been isolated reports of lymphomas developing in patients treated with a biologic&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and even of regression following withdrawal of the drug&#44; pointing to a possible causal relationship&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The development of lymphomas in patients treated with ustekinumab is rare&#46; Data from landmark trials and a recent study of the safety of ustekinumab in psoriasis over a 5-year follow-up period showed that the risk of malignancy per 9000 patient-years was similar to that seen in the general population&#44; with just 1 patient presenting a possible Hodgkin lymphoma&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In our review of the literature&#44; we found just 2 cases of MALT lymphoma that developed during infliximab therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> Both patients had <span class="elsevierStyleItalic">H pylori</span> infection&#46; Lymphoma remission was observed in the 2 cases following interruption of the biologic and administration of <span class="elsevierStyleItalic">H&#160;pylori</span> eradication therapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The authors of both reports speculated that the TNF inhibitor might have acted by promoting <span class="elsevierStyleItalic">H pylori</span> infection and&#47;or by directly inducing the lymphoproliferative process&#46; They also did not rule out that previous immunosuppressant therapy or the patients&#8217; underlying diseases may have had a carcinogenic role&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">MALT lymphoma is a B-cell non-Hodgkin lymphoma&#46; It is usually low-grade and located in the gastrointestinal tract&#46; Ninety percent of patients with gastric MALT lymphoma have concomitant <span class="elsevierStyleItalic">H pylori</span> infection&#46; <span class="elsevierStyleItalic">H&#160;pylori</span> eradication therapy achieves remission in 80&#37; of low-grade lymphomas and in just 50&#37; of high-grade lymphomas&#46; This remission is maintained for many years following the eradication of infection&#46; Recurrence&#44; however&#44; is observed in 10&#37; of cases&#44; hence the need for lifetime endoscopic follow-up&#46; Radiation therapy is the next best option for patients who do not respond to eradication therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion&#44; we have presented the third case of a patient who developed gastric MALT lymphoma during biologic therapy and the first case involving a patient treated with ustekinumab&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> We cannot&#44; however&#44; rule out that the lymphoma may have been triggered by the patient&#39;s chronic inflammatory state induced by psoriasis&#44; or by previous use of immunosuppressant therapy&#46; It is&#44; of course&#44; also possible that the association was merely coincidential&#46; We stress the importance of treatment discontinuation in patients like ours who develop a lymphoma during biologic therapy&#46;</p></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; F&#44; female&#59; <span class="elsevierStyleItalic">Hp</span>&#44; <span class="elsevierStyleItalic">Helicobacter pylori&#59;</span> IS&#44; immunosuppressant&#59; M&#44; male&#59; PUVA&#44; psoralen plus UV-A therapy&#59; RA&#44; rheumatoid arthritis&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MALT Lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Management&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Response&#44; mo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Thonhofer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&#47;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MethotrexateSulfasalazine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">InfliximabMethotrexate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Paranasal sinus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Interruption of infliximab and methotrexateEradication <span class="elsevierStyleItalic">Hp</span> therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#44; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Girard et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PUVACiclosporinMethotrexateEtanerceptEfalizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Infliximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stomach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Interruption of infliximabEradication <span class="elsevierStyleItalic">Hp</span> therapyMethotrexate &#40;psoriasis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial&#44; 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Current case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PUVAMethotrexateEfalizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ustekinumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stomach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Radition therapyInterruption of ustekinumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#44; 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Case and Research letter
Gastric Mucosa-Associated Lymphoid Tissue Lymphoma in a Patient With Severe Psoriasis Receiving Ustekinumab
Linfoma gástrico de tejido linfoide asociado a mucosa en un paciente con psoriasis grave en tratamiento con ustekinumab
J. González-Ramos
Autor para correspondencia
gnzalezramosjessica@gmail.com

Corresponding author.
, M.L. Alonso-Pacheco, A. Mayor-Ibarguren, P. Herranz-Pinto
Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ustekinumab is a human monoclonal antibody directed against interleukins &#40;IL&#41; 12 and 23&#44; which are involved in the control of infections and tumors and the pathogenesis of psoriasis&#46; Animal model studies have shown that inhibition of IL-12 and IL-23 might promote carcinogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Biologic therapies are considered to be both safe and well tolerated&#44; but there is concern about their carcinogenic potential&#46; There have been several reports of lymphoproliferative disorders developing in patients under treatment with tumor necrosis factor &#40;TNF&#41; inhibitors&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#8211;4</span></a> We present the case of a 68-year-old man with a history of hypertension&#44; type 2 diabetes mellitus&#44; hypertriglyceridemia&#44; overweight&#44; and ischemic heart disease diagnosed with plaque psoriasis 13 years earlier&#46; Given the severity of his psoriasis&#44; the patient was administered psoralen plus UV-A therapy and methotrexate 15<span class="elsevierStyleHsp" style=""></span>mg&#47;wk for a year&#59; the treatment showed moderate effectiveness&#44; and rapid recurrence was observed following discontinuation of treatment&#46; In May 2008&#44; the patient was started on concomitant efalizumab and methotrexate &#40;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;wk&#41; therapy&#44; which was continued with satisfactory results until efalizumab was withdrawn from the market in 2009&#46; In March 2010&#44; the patient experienced a relapse and was administered ustekinumab&#44; which achieved adequate control of his psoriasis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In November 2012&#44; the patient was seen at the emergency department of our hospital with complaints of melena and upper abdominal pain&#46; A gastroscopy revealed a gastric tumor with signs of malignancy&#46; The tumor&#44; however&#44; was studied and monitored at another hospital &#8220;resultando infructuoso el intento de recuperar las muestras histologicas&#8221;&#46; The results showed a dense infiltrate composed of atypical lymphocytes without identifiable clusters of nodes&#46; In the immunohistochemical study&#44; the cells were positive for CD20 and BCL2&#44; and negative for CD10&#44; CD30&#44; cyclin D1&#44; and CD5&#46; The use of appropriate histological stains did not identify <span class="elsevierStyleItalic">Helicobacter pylori</span> or other microorganisms&#46; A diagnosis of low-grade gastric mucosa-associated lymphoid tissue &#40;MALT&#41; lymphoma was established&#44; with no metastases identified by positron electron tomography&#47;computed tomography&#46; The patient underwent 19 sessions of radiation therapy&#44; which resulted in complete remission according to a report dated April 2013&#44; which is when he came for a follow-up visit at our hospital&#46; On examination of this and other reports on the tumor&#44; it was decided to discontinue treatment with ustekinumab&#46; The patient&#39;s psoriasis&#44; however&#44; was kept under control with topical treatment&#44; which resulted in almost complete whitening of the lesions&#46; Nevertheless&#44; in August 2013&#44; the patient died suddenly of cerebral infarction&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The risk of malignancy in patients with psoriasis is a hotly debated topic&#46; Some authors have postulated that the risk might be higher than in the general population&#44; even in the absence of treatment&#44; due to the underlying chronic inflammation associated with psoriasis&#44; particularly in patients with comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There is also controversy surrounding the risk of lymphomas in patients with psoriasis&#46; It has been postulated that this potentially increased risk might be related to both the pathophysiology of psoriasis and the use of immunosuppressant therapy in this setting&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">There have been isolated reports of lymphomas developing in patients treated with a biologic&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and even of regression following withdrawal of the drug&#44; pointing to a possible causal relationship&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The development of lymphomas in patients treated with ustekinumab is rare&#46; Data from landmark trials and a recent study of the safety of ustekinumab in psoriasis over a 5-year follow-up period showed that the risk of malignancy per 9000 patient-years was similar to that seen in the general population&#44; with just 1 patient presenting a possible Hodgkin lymphoma&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In our review of the literature&#44; we found just 2 cases of MALT lymphoma that developed during infliximab therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> Both patients had <span class="elsevierStyleItalic">H pylori</span> infection&#46; Lymphoma remission was observed in the 2 cases following interruption of the biologic and administration of <span class="elsevierStyleItalic">H&#160;pylori</span> eradication therapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The authors of both reports speculated that the TNF inhibitor might have acted by promoting <span class="elsevierStyleItalic">H pylori</span> infection and&#47;or by directly inducing the lymphoproliferative process&#46; They also did not rule out that previous immunosuppressant therapy or the patients&#8217; underlying diseases may have had a carcinogenic role&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">MALT lymphoma is a B-cell non-Hodgkin lymphoma&#46; It is usually low-grade and located in the gastrointestinal tract&#46; Ninety percent of patients with gastric MALT lymphoma have concomitant <span class="elsevierStyleItalic">H pylori</span> infection&#46; <span class="elsevierStyleItalic">H&#160;pylori</span> eradication therapy achieves remission in 80&#37; of low-grade lymphomas and in just 50&#37; of high-grade lymphomas&#46; This remission is maintained for many years following the eradication of infection&#46; Recurrence&#44; however&#44; is observed in 10&#37; of cases&#44; hence the need for lifetime endoscopic follow-up&#46; Radiation therapy is the next best option for patients who do not respond to eradication therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion&#44; we have presented the third case of a patient who developed gastric MALT lymphoma during biologic therapy and the first case involving a patient treated with ustekinumab&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a> We cannot&#44; however&#44; rule out that the lymphoma may have been triggered by the patient&#39;s chronic inflammatory state induced by psoriasis&#44; or by previous use of immunosuppressant therapy&#46; It is&#44; of course&#44; also possible that the association was merely coincidential&#46; We stress the importance of treatment discontinuation in patients like ours who develop a lymphoma during biologic therapy&#46;</p></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; F&#44; female&#59; <span class="elsevierStyleItalic">Hp</span>&#44; <span class="elsevierStyleItalic">Helicobacter pylori&#59;</span> IS&#44; immunosuppressant&#59; M&#44; male&#59; PUVA&#44; psoralen plus UV-A therapy&#59; RA&#44; rheumatoid arthritis&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&#47;Age&#44; y&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Interruption of infliximab and methotrexateEradication <span class="elsevierStyleItalic">Hp</span> therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#44; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Girard et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PUVACiclosporinMethotrexateEtanerceptEfalizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Infliximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stomach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Interruption of infliximabEradication <span class="elsevierStyleItalic">Hp</span> therapyMethotrexate &#40;psoriasis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partial&#44; 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Current case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#47;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PUVAMethotrexateEfalizumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ustekinumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stomach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Radition therapyInterruption of ustekinumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complete&#44; 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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