A 44-Year-Old Man with a Chronic Cough and Progressive Weight

A 44-year-old man with a chronic cough and progressive weight loss comes to the emergency department.  He has lost 5 kg (11 lb) over the past 3 months.  The patient recently emigrated from Southeast Asia.  Temperature is 37.4 C (99.3 F) , blood pressure is 113/70 mm Hg, pulse is 78/min, and respirations are 18/min.  Chest x-ray reveals an apical left lung infiltrate.  Sputum Gram stain and cultures are negative.  However, culture of a lung biopsy specimen grows acid-fast bacilli.  Microscopy of the lung specimen is shown below. Which of the following processes is most likely to contribute to formation of the finding indicated by the arrow?

A) Activation of CD8 T lymphocytes
B) B-lymphocyte transformation
C) Fibroblast proliferation
D) Neutrophil infiltration
E) Cytokine secretion by CD4 T lymphocytes

Correct Answer:

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