Problem:
A 29-year-old woman presents to her primary care physician with shortness of breath and chest pain for the past week. She says her chest pain is aggravated by deep breathing, and she becomes short of breath while walking up the stairs in her home. For the past week, she also has been feeling feverish and fatigued, with pain in her wrists, hands, and left knee. A review of systems is significant for a 4.5-kg (10 lb) weight loss over the previous month. Her past medical history consists of 2 spontaneous abortions, both of which occurred in the 1st trimester. On physical examination, a pink rash is present over her face, which has been aggravated by exposure to sunlight. There are decreased breath sounds in the right lung field. A chest X-ray shows an opacity and consolidation in the right lower lobe. Serum antinuclear antibody (ANA) and anti-double-stranded deoxyribonucleic acid (anti-dsDNA) autoantibodies are positive. What is considered to be a major T-cell-mediated effector mechanism in her autoimmune disease? A. Cytotoxic CD8 T cells B. Intrinsic pathway C. Necrosis D. Fas-FasL interaction E. Bcl-2 overexpression