A 33-year-old woman comes to the physician because of a 4-month history of intermittent lower abdominal cramps associated with diarrhea, bloating, and mild nausea. During this period, she has had a 5-kg (11-lb) weight loss. She feels like she cannot fully empty her bowels. She has no history of serious illness. She has a high-fiber diet. Her father is of Ashkenazi Jewish descent. She has smoked 2 packs of cigarettes daily for 15 years. She appears well. Her temperature is 36.9°C (98.5°F), pulse is 90/min, and blood pressure is 130/90 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. The abdomen is tender to palpation without rebound or guarding. Abdominal CT scan reveals inflammatory changes affecting the ascending colon, sigmoid colon, and terminal ileum. Intestinal biopsy reveals the following: Effective treatment of this patient's condition could be achieved by targeting which of the following molecules?

Question

A 33-year-old woman comes to the physician because of a 4-month history of intermittent lower abdominal cramps associated with diarrhea, bloating, and mild nausea. During this period, she has had a 5-kg (11-lb) weight loss. She feels like she cannot fully empty her bowels. She has no history of serious illness. She has a high-fiber diet. Her father is of Ashkenazi Jewish descent. She has smoked 2 packs of cigarettes daily for 15 years. She appears well. Her temperature is 36.9°C (98.5°F), pulse is 90/min, and blood pressure is 130/90 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. The abdomen is tender to palpation without rebound or guarding.  Abdominal CT scan reveals inflammatory changes affecting the ascending colon, sigmoid colon, and terminal ileum.  Intestinal biopsy reveals the following:  Effective treatment of this patient's condition could be achieved by targeting which of the following molecules?

Quizplus · Accepted Answer

Eductional Objective: Crohn disease is an inflammatory bowel disorder that causes patchy inflammation throughout the gastrointestinal tract.  Characteristic histopathologic findings include noncaseating granulomas, transmural inflammation, and Paneth cell metaplasia.  Tumor necrosis factor-alpha (TNF-a), a cytokine produced by macrophages, plays a central role in the pathogenesis of CD; anti-TNF-a agents (eg, infliximab, adalimumab) are often used as first-line therapy.

A 33-Year-Old Woman Comes to the Physician Because of a 4-Month